Acute Care for Congestive Cardiac Failure

This document provides information on acute care for congestive cardiac failure. It discusses the disease, causes, incidence, and risk factors, as well as the impact on patients and their families. It also explores common signs and symptoms and the underlying pathophysiology. Additionally, it covers the pharmacodynamics and pharmacokinetics of calcium channel blockers and provides a nursing care plan for the first 8 hours post ward admission.

Running head: ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
Name of the Student:
Name of the University:
Author note:

1ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
Q1) Outline the disease, causes, incidence and risk factors. Discuss the impact of the selected
disease on the patient and their family
Congestive cardiac failure (CCF) is also referred as heart failure, signifying the
condition when the heart muscle is unable to pump adequate amount of blood required by the
body. The condition takes place due to change in the structure of ventricles, which is
considered as the main blood-pumping chamber (Healthdirect.gov.au, 2019). The heart
muscle become either very stiff or very weak to supply adequate amount of blood throughout
the body. Congestive cardiac failure develops in a person gradually leading to enduring
cardiac failure and it sometimes develop very quickly leading to acute cardiac failure
(Martindale et al., 2016).
There is no single cause of heart failure instead various health factors leads to the
development of this disease. The causes of heart failure can be summarized into two broad
categories namely most communal causes of congestive cardiac failure and less communal
causes of congestive cardiac failure (Betterhealth.vic.gov.au, 2019).
The most communal causes leading to heart failure are as follows:
 Hypertension
 Prolong alcohol consumption
 Coronary artery sickness
 Heart valves disorder
 Other idiopathic causes
The less communal causes leading to heart failure are as follows (Betterhealth.vic.gov.au,
2019):
 Thyroid disorder
 Abnormalities in heart rhythm

2ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
 Viral infection leading to stiffness in heart muscle.
It was projected that approximately 300,000 Australians were suffering from congestive
cardiac failure (CCF) with 4% of the Australian population were in between the age of 45 and
above. More than 30,000 people were diagnosed every year with heart failure (aihw.gov.au,
2019). In the previous years, it was noticed that the percentage of hospitalization due to heart
failure have reduced in Australia considering both women and men. 2% of Australian
population are suffering from heart failure and the condition is more predominant in elder
population effecting up to 10% the elder population of Australia (Safetyandquality.gov.au,
2019).
There are various risk factors, which are responsible for the onset of congestive heart
failure (CCF) such as high cholesterol, smoking, diabetes, increased blood pressure, family
background history of heart disease, disorder in heart valves, consumption of alcohol and
drugs, infection in heart valves and disorder of connective tissue like amyloidosis and
sarcoidosis (nps.org.au, 2019).
The present health condition of the patient was effecting her quality of life as she was
going through physiological pain including weakness, shortness of breath, nausea, dizziness
and swollen ankle. The patients’ ability to fulfil the physical requirement of the body was
reduced due to which she could not socialize. Lack of socialization left her alone and she was
felling completely isolated (Hooker et al., 2015). Her condition was effecting her family and
husband, as they were incapable to make her happy. The family members were sad; as they
do not do, anything to release her from this condition so that she could again led her life
normally. Hence, the family members were effected both socially and personally.

3ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
Q2) Discuss three (3) common signs and symptoms of the selected disease and explain the
underlying pathophysiology of each.
The patient was an elderly female who was suffering from various symptoms of
congestive cardiac failure, which includes swollen ankles, nausea, weakness, dizziness and
shortness of breath. The patient had a background history of myocardial infraction (MI). She
was facing difficulty in breathing from past 7 days with her condition deteriorating day by
day. Her fingers were always cold with 2 seconds of capillary refill. Hence, the major
symptoms of congestive cardiac failure surrounding the pathophysiology of the disease in
patients are explained as below (Nicholson, 2014):
Sign and Symptom Pathophysiology
1) Shortness of breath or dyspnea  Shortness of breath or dyspnea is the
major symptom showcased by the
patient in the case study. Dyspnea
results due to mismatch in central
nervous system (CNS) between
efferent and afferent signalling
(Berliner et al., 2016).
 The mismatch in signalling occurs
due to the accumulation of blood in
pulmonary vein, as the heart is
incapable in pumping adequate
amount of blood.
 This leads to outflow of fluid in the
Lungs. Hence, increasing the
pressure in pulmonary vein (Harjola
et al., 2017).
 The effect on senses of
chemoreceptor stimulation,
neuroventilatory dissociation and

4ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
mechanical stimuli of chest and lung
receptor leads to shortness of breath
or dyspnea (Mentz & O’connor,
2016).
 No exchange of gases takes place,
which results in difficult breathing
in-patient (Nicholson, 2014).
2) Swollen ankles or Edema  As the heart is unable to process
adequate amount of blood in the
body leading to weak heart and poor
circulation of blood (Scott &
Winters, 2015).
 The blood accumulates in the heart,
which leads to further accumulation
of fluid in the tissue.
 The kidney lack in processing the
water and sodium content in the
body thereby leading to fluid
retention in the body (Arrigo et al.,
2016).
 As a result, the blood is accumulated
in the ankles, feet and legs of the
patient leading to Edema (Nijst et
al., 2015).
3) Dizziness  The amount of blood required by the
body to cope up with regular
physical activity is reduced in
cardiac failure
 As the brain cannot receive enough
blood it leads to lack of
consciousness in the patient (Miller,
2016)

5ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
 This results in decreased blood
pressure leading to hypotension in-
patient due to which the patient feel
dizzy while doing any minor
activity.
Q3) Discuss the pharmacodynamics & pharmacokinetics of one (1) common class of drug
relevant to the chosen patient.
Calcium channel blocker is the class of drug considered relevant for the patient. The
pharmacodynamics and pharmacokinetics of the drug is explained as follows:
 Pharmacokinetics of the drug:
The medicines like nifedipine, diltiazem and verapamil are considered in calcium channel
blockers with almost related pharmacokinetics property. Calcium channel blockers are fully
absorbed in the patent body through oral administration of the drug (Kubota et al., 2015). The
bioavailability of calcium channel blocker is less in the body because of hepatic absorption.
Within 2 hours of the consumption, the onset of drug activity takes place. The drugs are
metabolized in liver while excretion of the drug takes place through urine (Tocci et al., 2015).
This class of drug has a short half live of 3-8 hours. Calcium channel blocker possess first
pass metabolism where nifedipine and verapamil are excreted through kidney and diltiazem is
excreted through liver. Hence, the pharmacokinetics activity of the drug will result in
decreased cardiac work due to peripheral vasodilation.
 Pharmacodynamics of the drug:

6ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
Pharmacodynamics of the drug explains the mechanism of drug action, which takes place
in the patient body stating the process of how the patients’ body react to the drug. Calcium
channel blockers act by inhibiting the calcium ion movement through the membranes of
myocardial muscle cells and arterial cells (Larochelle, Tobe & Lacourciere, 2014). Diltiazem
and Verapamil blocks the movement of calcium ions in both vessels and the heart. This
results in alteration of action potential thereby stalling the contraction of muscle cell. The
pharmacodynamics effect of the drug will decrease the myocardial contractility with
decreased electrical crusade of heart muscle (Striessnig, ortner & pinggera, 2015). Hence, the
drug will result in lower blood pressure due to better dilation and relaxation activity of the
blood vessel hence, reducing the overall tone of smooth muscles making it easy for the heart
to pump blood without any external stress.
Q4) In order of priority, develop a nursing care plan for your chosen patient who has just
arrived on the ward from ED. Nursing care plan goals, interventions and rationales must
relate to the first 8 hours post ward admission.
Nursing care plan is composed of the nursing goals, intervention and rationale, which
is constructed for the patient to recover fast with effective care and diagnosis. In this case
study, the patient was majorly suffering from shortness of breath and tissue perfusion. Hence,
nursing care plan for the patient include different programs and approaches to reduce the
difficulty of patient in breathing and improving the patients’ tissue perfusion.
1. Due to inefficient breathing pattern, the patient was facing difficulty in breathing. The
head of patients’ bed must be positioned at 30-degree angle, hence allowing the
patient with improved breathing pattern (Doherty, Fitzsimons & Mcllfatrick, 2016).
Complete bed rest is recommended for the patient to recover fast.

7ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
2. The symptoms like restlessness, improper communication was observed, and different
pain management method was provided to the patient. The level of pain anxiety is
measured in pain management and analgesics are provided to the patient to reduce
their pain (Albert et al., 2015). The steps to be considered by the nurse in pain
management includes continuous communication, building patient affinity and
monitoring the patients’ anxiety level. These pain management approaches will uplift
the patients’ health by establishing proper health support involving both physical and
mental support thereby distracting the patient from her critical condition.
3. As the respiratory rate of the patient with ineffective breathing pattern revealed that,
the total oxygen saturation in the patient was less leading to dyspnoea. Oxygen
therapy was used for helping the patient to breathe properly and overcoming the
symptoms of hypoxia (Nazir, Dennis & Unroe, 2014). Oxygen therapy was used to
increase the total blood oxygen content. The patients’ respiratory rate was observed
which included assessment of patients’ body temperature, urine and cardiac output,
monitoring of blood pressure (both systolic and diastolic blood pressure) and
assessing the psychological condition of the patient (Brown, 2018). The pulse rate and
heart rhythm of the patient is monitored with electrocardiogram (ECG) signifying
high pulse rate due to low cardiac output. Angiotensin is used for reducing the pulse
rate level of the patient. Hence, the effective care plan will help the patient to recover
or improve early.
4. As the patients had lost her social life due to her heart problem, an effective
communication will help the patient to release the mental stress. In the nursing care
plan, patient improvement takes place due to effective communication between the
patient and her family members. Multi-disciplinary team (MDT) also takes part in this
nursing intervention in order to collect the necessary information regarding the patient

8ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
health condition and the result of the nursing intervention to check for any additional
care required by the patient to recover as soon as possible (Comin et al., 2016).
Hence, effective communication is considered as the most significant nursing
intervention for patient recovery by enhancing the patient and nurse relationship.

9ACUTE CARE FOR CONGESTIVE CARDIAC FAILURE
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