Pathophysiology DQ 13 student reply Lourdes marrero

 The following is another student post to wish i have to react. Please add some other information. relate to the question but different from the student post. remember APA and similarity. 

 
Sixty-two–year-old James White is accompanied to the clinic today by his wife and son. James has had increasing problems with his memory for the past several months and has rapid mood swings for no apparent reason. His wife says that “he’ll go outside in the garden without his clothes on, and his speech is difficult to understand.” His son reports that at times James flaps his arms a lot and notices that he is unable to cut his food or tie his shoes. James was diagnosed with heart failure approximately 6 months ago.

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a. How would you explain to the White family what is occurring with James?
I would explain that heart failure is when the heart is not pumping adequate amount of blood carrying oxygen and nutrients to the cells in the body. Heart failure is a progressive disease with risk factor for cognitive impairment as seen with James case (Witt, Rotter, Stearns, Gottesman, Kucharska-Newton, & Chang, 2018). Problems with oxygenation, cardiac reserves and skeletal muscle contribute to symptoms and functional impairment in heart failure patients. I would further explain that fatigue, shortness of breath, activity intolerance, and weakness are cardinal symptoms of heart failure. It would be important to point out that disability is commonly seen in patients affected by heart failure with an inability to perform basic activities of daily living, such as those of self-care that include eating, bathing and dressing.  I would advise them that further decline, disability and eventually frailty is possible. Most people affected with mild cognitive impairment progress to dementia. I would explain that there are many reasons for developing cognitive impairment in heart failure patients including decreased cerebral perfusion due to vascular abnormalities (Harkness, Heckman, & McKelvie, 2012).

b. What treatment modalities would be appropriate for James at this time?

James would benefit from neuropsychological testing and a detailed examination of his disease state contributing to his cognitive decline (Witt, Rotter, Stearns, Gottesman, Kucharska-Newton, & Chang, 2018). James needs improved heart failure treatment to increase cardiac output and a review of his medication. Pharmacological agents such as ACE inhibitors have shown benefits on function and possibly cognition and mood in heart failure patients. There is a need to identify and reduce risk factors that are contributing to James cognitive impairment leading to poor quality of life.  It is recommended for James to be attend an outpatient heart failure disease management program designed for complex heart failure patients. Regular exercise for strength and resistance training is encourage for heart failure patients. Family support is also recommended (Harkness, Heckman, & McKelvie, 2012).
References
Harkness, K., Heckman, G. A., & McKelvie, R. S. (2012). The older patient with heart failure:
High risk for frailty and cognitive impairment. Expert Review of Cardiovascular Therapy, 10(6), 779-95. doi:http://dx.doi.org/10.1586/erc.12.49
Witt, L. S., Rotter, J., Stearns, S. C., Gottesman, R. F., Kucharska-Newton, A., A, R. S., . . .
Chang, P. P. (2018). Heart failure and cognitive impairment in the atherosclerosis risk in communities (ARIC) study. Journal of General Internal Medicine, 33(10), 1721-1728. doi:http://dx.doi.org/10.1007/s11606-018-4556-x

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