Question

Mrs. S is a 49-year-old woman with end-stage cardiomyopathy. She and her husband have been restaurant owners for many years. She is anorexic and finds it difficult to eat solid foods, which is emotionally distressing for her and her family. She has lost 10 lb in the past month. Mrs. S was placed on the heart transplant list 6 months ago. She has agreed to hospitalization to optimize her medical management and nutrition status.

Clinical Assessment

Mrs. S is admitted to the critical care unit. A central line has been inserted for dobutamine therapy. A nutrition assessment has been completed by the dietitian that includes recommendations for frequent, small, calorie-dense, low-sodium feedings.

Diagnostic Procedures

Mrs. S is 5 feet 2 inches tall and weighs 90 lb. Her vital signs are as follows: blood pressure of 100/60 mm Hg, heart rate of 80 beats/min (sinus rhythm), respiratory rate of 20 breaths/min, and temperature of 98.2°F. Serum laboratory findings are as follows: hemoglobin level of 8.3 g/dL, prealbumin level of 14 mg/dL, sodium level of 125 mmol/L, potassium level of 3.3 mmol/L, chloride level of 94 mmol/L, carbon dioxide concentration of 26 mEq/L, calcium level of 8 mg/dL, magnesium level of 1.5 mg/dL, and B-type natriuretic peptide concentration of 500 pg/mL.

Medical Diagnosis

Mrs. S is diagnosed with cachexia resulting from end-stage cardiomyopathy.

Questions

1. What major outcomes do you expect to achieve for this patient?

2. What problems or risks must be managed to achieve these outcomes?

3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?

5. What possible learning needs do you anticipate for this patient?

6. What cultural and age-related factors may have a bearing on the patient’s plan of care?

Answer 1

Cachexia is characterised by weight loss and muscle wasting by a reduction in muscle mass without body weight loss.

1.expected outcome of the patient with cardiac cachexia to reverse the impact of muscle wasting by providing more emphasis to the nutritional aspects that contribute to the wasting progress and support with micro and macro nutrient supplements.

2.risk and problems associated with the outcome to achieve is that it often difficult to diagnose as edema increases body weight and interfere with the evaluation of other anthropometric measurements. It is also difficult to interpret results from nutritional biomarkers. Moreover it is difficult to determine the cardiac consequences of cachexia as the heart is affected primarily.

3. Interventions--a better understanding of the mechanism involved in the pathophysiology helps to approach the condition pharmacology and non pharmacologically.

-Nutritional support along with physical exercise can be found effective

-providing micro and nutrients and vitamin supply

-offer appetite stimulators,anti inflammatory drugs, hormones and anabolic stimulants.

4 and 5. -Promote self management skills .

-improve medication and dietry compliance.

-encourage daily weighing and exercise.

-assure close follow up