Congestive Heart Failure: Risk Factors, Pathophysiology, Nursing Interventions and Drug Class

Acute Care Nursing
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Q.1.
Congestive heart failure (CHF) is a diseased condition which is associated with reduced
pumping of blood due to narrowed arteries and high blood pressure. Risk factors responsible
for the congestive heart failure (CHF) include age, augmented cholestrol, diabetes mellitus,
hypertension and active smoking. In the present case study, older age of Sharon Mckenzie
(77 yrs) might be responsible for CHF. Literature mentioned that, risk of CHF increases with
the age. 2 % people of age 40 to 60 years and 5 % people of age 60 to 70 years are usually at
risk of CHF. Moreover, other factors responsible for CHF include lack of physical activity,
family history, obesity and alcohol consumption (Dhingra et al., 2014). Hypertension is also
responsible for the occurrence of CHF. Moreover, her current assessment indicated
hypertension in her. Females with hypertension are approximately four times more
susceptible to CHF in comparison to the non-hypertensive females. 40 and 60 % male and
female respectively are prone to CHF (Mahmood and Wang, 2013). Low-density lipoproteins
(LDL) and high-density lipoproteins (HDL) with high and low levels respectively play
significant role in CHF. Smoking (36 % people) and obesity (20 % people) are prone to CHF.
Intake of saturated fats lead to development of CHF. Increased levels of β-type natriuretic
peptides are responsible for the occurrence of CHF (Australian Institute of Health and
Welfare, 2014; Díaz-Toro,Verdejo, and Castro, 2015; Mirkin, Enomoto, Caputo, and
Hollenbeak, 2017).
Cardiovascular conditions like coronary artery disease (CAD), myocarditis,
congenital heart defects, heart attack, cardiomyopathy, heart arrhythmias, and faulty heart
valves might lead to development of CHF. Mckenzie is associated with the MI, which further
augment chances of CHF in her. Medications like medications for diabetes (rosiglitazone and
pioglitazone), certain anaesthetics, nonsteroidal anti-inflammatory drugs (NSAIDs) and
anticancer are also produce CHF (Gotto, Lenfant, Paoletti, Alberico and Catapano, 2012;
Castillo, Edriss, Selvan, and Nugent, 2017). Literature mentioned that people with CHF die
within 5 years duration of its diagnosis. People with CHF would have about 10 % more death
as compared to the normal people (Australian Institute of Health and Welfare, 2014).
Her overall health condition indicate that she would not be able to perform her
activities of daily living. Hence, she should seek assistance from others or family members.
Family members should monitor her activities of daily living. It might produce psychological
impact on her. Since, family members need to take care of her which might lead to stressful
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condition to other family members and produce economic burden on the family members.
Family members and care providers should monitor her diet, medications and risk factors.
Moreover, they should establish positive communication and positive approach with her
(Cooper, DeVore,and Michael Felker, 2015; Raman, 2016).
Q2. :
Symptom Pathophysiology
Dyspnoea Reduced cardiac output results in the decreased blood supply various
organs and tissues along with skeletal muscle. It produces augmented left
ventricular pressure to restore necessary cardiac output. Subsequently, it
leads to lessened pulmonary diffusion and subsequently interstitial oedema.
Breathlessness occur due to interstitial oedema. Increased expenditure of
myocardial energy occurs due to augmented diastolic pressure which
require increased amount of energy. Ventricular remodelling, increased
myocardial oxygen demand and myocardial ischemia occur due to raised
requirement of energy (Güde, Brenner, Störk, Hoes, and Rutten, 2014;
Hosenpud and Greenberg, 2013). From the case study, it is evident that
McKenzie is suffering through shortness of breath problem.
Swollen
ankle
In swollen ankle, there would be more swelling in the leg or ankle.
Swelling predominantly befalls as result of accumulation fluid in the
particular organ which results due to reduced cardiac output. Vasodilation
and decreased ventricular filling pressure occur mainly due to augmented
indigenous peptides like natriuretic peptide and β-type natriuretic peptide.
It leads to decreased cardiac preload and afterload which lead to reduced
back flow of blood to the heart through veins. This reduced back flow of
blood occurs due to narrowing of the valve. It results in the insufficient
pumping of the blood by the heart (Moe, 2016; Eisen, 2014). Swollen ankle
in McKenzie occurs due to cardiovascular impairment and abnormality.
Dizziness CHF lead to reduced blood flow to different organs including brain which
lead to dizziness in the patient. Heart rate and rhythm abnormality
predominantly accountable for reduced blood supply to the brain. Six
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