Intervention Strategy for Grief Long Qt Syndrome Term Paper

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Intervention Strategy for Grief

Long QT syndrome is a congenital that can result in sudden arrhythmia death syndrome (SADS), where sudden death occurs as a result of cardiac arrest. Although rare, deaths from SADS, including those attributed to long QT syndrome, are not accompanied with any anatomic abnormality, which can make prediction and prevention very difficult (Meyer, Mehdirad, Salem, Kulikowska, Kulikowski, & Jamry, 2003). Long QT syndrome is characterized by arrhythmias that are associated with prolongation of the electrocardiographic QT interval, and it is also associated with hereditary genetic defects that affect the cardiac ion channels.

Since it is mostly asymptomatic, the presence of long QT syndrome often goes undetected until it is too late, and death has occurred. When there is an awareness of the presence of the disorder, some preventative measures can be taken, but there is still a greatly increased risk of early death associated with the syndrome. Family members, such as parents, of children diagnosed with long QT syndrome must be appropriately educated regarding the disorder and the risks associated with it. Furthermore, since there is a high risk of death associated with the syndrome, it is important that strategies be in place to aid parents in psychologically processing loss and grief.

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To illustrate the educational techniques that are effective for family members of those diagnosed with long QT syndrome, a case study involving a 32-year-old mother of children diagnosed with the syndrome will be investigated. Suggestions for interventions regarding education on long QT syndrome, as well as strategies for dealing with loss and grief will be discussed.

Case Study

Term Paper on Intervention Strategy for Grief Long Qt Syndrome Assignment

The case study presented by Firth and Hurst (2005) details a 32-year-old woman who is the mother of two children who have been diagnosed with long QT syndrome. The children have experienced a few hospitalizations already, and it has been determined by physicians that pacemakers will be implanted in attempts to increase the children's chances for survival. The children are school-aged, so it of the utmost importance that teachers and administrators at the school be made aware of the syndrome, and receive some education regarding its etiology, symptoms, and what to do in case of an emergency. It is also important that the mother be available at all times in case of an emergency. Therefore, it is necessary that the workplace of the mother also has an awareness of the disorder so that they are sensitive and accommodative to the needs of the mother.

It is of the utmost importance that all people involved in the well-being of the children fully understand what long QT syndrome entails and what steps can be taken to ensure health of the children and minimize the risk of sudden death.

It is also important that interventions dealing with grief be made available for the mother if she suffers a loss of the children. The following is a discussion regarding educational interventions covering explanations of long QT syndrome, as well as interventions concerning loss and grief.

Long QT Syndrome

Long QT syndrome is associated with a risk of SADS. The most common type of SADS that it is associated with is Romano-Ward syndrome, which is autosomally dominant, and results in syncope, seizures and sudden death. There is a high risk of death associated with diagnosis of this disorder, since sudden death occurs in 30 to 40% of patients (Meyer et al., 2003). In this syndrome, genetic errors occur in which affected genes produce proteins in cardiac cell membrane sodium and ion channel function.

Long QT syndrome is symptomatic in approximately 60% of patients. These symptoms include sinus pauses, poor heart rate response to exercise, and syncope. The syndrome causes alterations in various ion channels, which leads to abnormalities in the refractory period and repolarization of cardiac pacemaker cells. This results in ventricular tachyarrhythmias.

It is possible for asymptomatic patients with long QT syndrome to be diagnosed through recognition of the gene responsible for the disorder, but not all those who carry this gene and are susceptible to cardiac troubles demonstrate abnormal ECG findings (Meyer et al., 2003). Therefore, it is understandable how someone could be unaware that they have the syndrome and experience SADS.

Physical stress and emotional stress are the most common precursors to life threatening events that occur with long QT syndrome.

Deaths can also occur during sleep, since slowing of the heart rate during sleep results in a prolonged QT interval in some people affected with long QT syndrome (Meyer et al., 2003). There are certain clues that aid in the diagnosis of long QT syndrome. Specifically, this syndrome is highly likely in any person who experiences recurrent syncopal events during physical activity or emotional distress, or anyone with a family history of deaths that are unexplained and sudden in otherwise healthy individuals (Meyer et al., 2003). Also, resting ECG can be used to diagnose the syndrome in some people, but obvious evidence of prolonged QT interval is sometimes minimal or absent in some people who carry the genetic mutation that causes the disorder. If the syndrome is suspected but resting ECG findings appear normal, it is recommended that ECG be used during exercise. This may demonstrate an abnormal reading that could not be seen at rest (Meyer et al., 2003).

Risk assessment associated with long QT syndrome is based upon the genetic locus, length of the QT interval, and gender. It may be risky for some patients with the syndrome to take part in competitive sports, since symptoms are often precipitated by physical activity and emotion. It would probably be beneficial if the mother of the children with long QT syndrome was advised to keep her children out of competitive sports due to the elevation of risk of cardiac events.

Treatment of long QT syndrome is implemented with the aim of resolving symptoms. Medications, such as beta blockers and potassium supplements, are used and they often result in a normalization of ECG readings. Strangely, although they seem to have little effect on QT duration, beta blockers are the most common drug used for the treatment of long QT syndrome. Of note, it is extremely important that patients comply completely when on a treatment regimen with beta blockers, because stopping usage of this drug can result in a rebound receptor catecholamine hypersensitivity, which causes life-threatening arrythmias (Risser & Murphy, 2003). Pacemakers are also often used, as in the case study under discussion.

There are also certain genetic-cased therapies that can be used. These therapies include sodium channel blocking agents, which can shorten the QT in some patients. Also, exogenous potassium supplementation or potassium channel openers can be used in patients presenting with potassium channel defects. However, research has shown that potassium therapy may not be effective for the long-term (Towbin, Wang, & Li, 2001). Furthermore, no drug interventions for long QT syndrome have been shown effective in improving survival (Towbin et al., 2001).

There are three main points that all people involved with the children in the case study must be aware of regarding long QT syndrome. These three points include: 1) an awareness of unexplained loss of consciousness in the children under times of physical activity or emotional stress; 2) if the children present with these symptoms, make sure they receive medical attention as soon as possible; 3) it is important that any relatives of the children also be tested for long QT syndrome, since there is a strong hereditary component to the disorder (Elliott, 2000).

Educational strategies aimed at the mother of the children with long QT syndrome must present important, relevant information in a manner that is accessible and easy to understand. Written reference material should be provided that she can consult whenever needed in order to make decisions regarding the medical care of her children. This educational material should contain all signs and symptoms of cardiac events that require immediate attention.

Interventions concerning loss and grief

There is a great risk of sudden death for the children in the case study that have been diagnosed with long QT syndrome. Therefore it is important that resources be made available to help the mother if her children die suddenly as a result of the disorder. There are several options available to assist individuals in the process of bereavement. The focus in the present discussion will be on strategies for grief management that involve guided imagery and visualization techniques.

There has been an increasingly large body of literature indicating the effectiveness of guided imagery as an intervention for numerous physical, mental, and emotional ailments, including grief. Guided imagery allows clients to connect with their internal cognitive, affective and somatic resources, which may not be accessible through other conscious means (Utay & Miller, 2006). The goal of guided imagery therapy is to facilitate awareness of certain imagery present within the client, and to guide clients in the usage of this imagery in order to heal (Utay & Miller, 2006). Guided imagery can be used as an effective intervention with several intentions. The goal involved in guided imagery for… [END OF PREVIEW] . . . READ MORE

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