Heart Failure and Associated Medical Conditions

This assignment delves into the complexities of heart failure, a significant public health concern worldwide. It provides an overview of heart disease in Australia, the benefits of beta-blockers, and targeted temperature management. Additionally, it touches on the relationship between heart failure and other medical conditions like diabetes mellitus and anxiety.

Running head: ACUTE CARE NURSING
Acute care nursing
Name of the student:
Name of the University:
Author’s note

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Q 1. Causes, incidence and risk factors of identified condition and its impact on the patient
and family
Mrs. Sharon McKenzie is a 77 year female patient, who came to the emergency
department with symptom of shortness of breath, swollen ankles, mild nausea and dizziness.
Based on his vital sign observation and presenting symptoms, congestive cardiac failure (CCF) is
the identified condition in Mrs. Sharon. CCF is a progressive and chronic clinical condition that
affects the hearts ability to pump blood at normal rate. This results in symptoms of tachycardia,
fatigue, weakness, wheezing and rapid pulse (Teerlink et al., 2013). Many abnormalities like
pressure and volume overload affects the myocardial contractility and the ability to maintain
arterial pressure of vital organs. In case of heart failure, the adaptive mechanism involved in
maintaining the contractility of heart becomes maladaptive. This results in poor cardiac output
and activation of three major compensatory mechanisms such as adrenergic system, rennin-
angiotensin-aldosterone system and ventricular hypertrophy. The adrenergic mechanism
enhances sympathetic activity and increases level of cathecholamines contributing peripheral
vasoconstriction. Hence, the compensatory mechanism increases the venous return and lead to
alterations in heart rate, preload, afterload and contractility (Kemp & Conte, 2012)..
CCF is a global pandemic affecting about 26 million people worldwide and its incidence
is increasing data by day due to poor lifestyle and behavioral risk factors. It is a significant public
health problem as CCF is associated with significant mortality, morbidity and health care
expenditure (Roger, 2013). The review of heart disease statistics of Australia reveals that it is a
significant health issue in Australia too as heart disease affects around 1.2 million Australians
and it is the single leading cause of death in the country (The Heart Foundation, 2018). Hence,

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major preventive care activities needs to focus on addressing the behavioral risk factor of the
disease.
There are many common cause of CCF such as coronary heart disease, hypertension and
alcohol consumption. Apart from this, poorly controlled diabetes, smoking, high cholesterol and
family history of heart diseases are common risk factors that lead to CCF. Evidence has shown
that diabetes amplifies the risk of CCF and many other comorbid conditions like obesity,
hypertension and coronary heart disease contributes to high rate of CCF. Insulin resistance and
hyperglycemia is directly linked to cardiac dysfunction due to its effect on cardiac metabolism
and the rennin-angiotensin system (Nasir & Aguilar, 2012). The diagnosis of CCF is associated
with great physical and psychological impact on patient and their family member. They struggle
to cope with the comorbidities of the condition and many psychosocial issues like depression and
lack of social support further increases hospital admission rates in patient. In case of family
members, emotional distress and care giving burden increases. Negative situations arising from
care worsens their quality life, increases level of stress and increase care giving burden for
family members (Lacerda et al. 2017). Hence, certain interventions should be implemented for
family members to help them cope with psychological burden of the disease.
Q2. List five common signs of the selected diseases and for each provide the link to the
underlying pathophysiology
In case of Mrs. Sharon McKenzie, she was identified to be suffering from CCF due to
presence of symptoms like shortness of breath, mild nausea, dizziness and swollen ankles and
high respiratory rate. All the four symptoms along with palpitations are are common signs of
CCF and they are linked to the pathophysiology of the disease. Edema is seen in patients with

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CCF due to the activation of humoral and neurohumoral mechanism that promotes reabsorption
of sodium and water by the kidneys. Apart from this, CCF leads to abnormal Starling forces thus
increasing venous capillary pressure and fluid extravasation. Such mechanism increases the
likelihood of edema in patients with CCF (Arrigo et al. 2016).
Shortness of breath is the most common symptom seen in CCF patient due to pulmonary
edema. Pulmonary edema may be caused by narrow of the arteries, kidney failure of effect of
medications. During CCF, the heart’s ability to pump blood at a normal rate is affected and this
leads to accumulation of blood in the veins that take blood through the lungs. The increase in
pressure in the blood vessels pushes fluid into the alveoli and disrupts normal oxygen exchange
through the lungs. All these factors together causes shortness of breath in patient (Dubé,
Agostoni & Laveneziana, 2016).
Many patients with CCF experience symptoms of dizziness. Irregular heart beat also
results in decreases blood pressure which leads to dizziness in patient. Dizziness is caused by the
effect of medications too. In addition, the symptom of nausea is seen due to the build-up of fluid
around liver and guts. The complex interaction between central nervous system, autonomic
nervous system and endocrine nervous system results in nausea. Histamines and dopamines act
as stimuli that give rise to nausea (Singh, Yoon & Kuo 2016).
The fifth symptom of CCF is palpitation and it is associated with very rapid or irregular
heart beat in patient. This symptom in seen during CCF due to the effect of the disease on hears
muscle contractility. Patients like McKenzie may feel that their heart is racing or pounding at a
rapid rate. This may be caused by the onset of compensatory mechanism. Cardiac arrhythmias
also results in high heart rate and it the condition affects the normal heart rhythm. The

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pathophysiology behind such condition is the onset of three mechanisms like enhanced
automaticity, triggered activity or re-entry. The enhancement of automaticity results in multiple
arrhythymia and symptom of palpitation in CCF patient (Raviele et al., 2011). It can be
concluded that several mechanism like contraction of the heart rate and cardiac arrhythmias
results in symptoms of palpitation in patient.
Q3. Describe two (2) common classes of drugs used for patients with the identified
condition including physiological effect of each class on the body
The two common classes of drugs that are used for patients with CCF include the ACE
(Angiotensin-converting enzyme) inhibitors and the beta-blockers. Drugs like beta blockers are
given to patient when there is a need to slow down heart rate and for this reason it is suitable for
use in CCF patient as the condition mainly leads to rapid heart rate. Some examples of beta
blockers include Metoprolol and Acebutolol and their physiological effect on the body is seen
due to its role in blocking the effect of epinephrine hormone. Beta blockers are able to block the
effect of the function of norepinephrine and epinephrine by binding to the beta-adrenorecptors
where norepinephrine binds. Such action of the drugs results in inhibition of sympathetic effect.
They are also known as partial agonist as during the process of binding, they activate the
receptors too. Sympathetic influence are the reason for heart rate, contractility and electrical
condition and betablockers reduce such sympathetic influence thus leading to a decreases in
heart rate, contractility, conduction and relaxation rate. Due to such physiological effect of beta-
blockers, this drug is most commonly given to CCF patient (Kotecha et al., 2017).
ACE inhibitors are most common drug used for the management of heart failure. The
main rational for its use is that it works to relax the blood vessels and reduces blood pressure.

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This eventually leads to improved work flow and improvement in the heart’s ability to pump
blood to different parts of the body. The physiological mechanism of ACE inhibitor is seen due
to their role in preventing the enzyme to produce angiotensin II. The effect of angiotensin is to
the narrow the blood vessels thus contributing to high blood pressure. Such conditions make it
harder for heart muscles to pump blood. However, the ACE inhibitors diminish the activity of
rennin-angiotensin-aldosterone system that controls blood pressure fluctuation in the body.
Angiotensin II is an activated form of protein that stimulates release of aldosterone, however the
conversion of angiotensin I to angiotensin II is blocked by ACE inhibitors. This results in
increased secretion of sodium and increase in cardiac output (Larson, Symons & Jalili, 2012).
For this reason, the drug is found to be useful for treatment of patients with CCF.
Q4. Identify and explain, in order of priority the nursing care strategies you, as the
registered nurse, should use within the first 24 hours post admission for this patient
The review of Mrs. McKenzie’s vital sign observations revealed that she had blood
pressure of 170/110 mm Hg, heart rate of 54 bpm, SpO2 at 92% and respiratory rate of 30 bpm
per minutes. All the vital signs are above the normal range and hence the first nursing care
priority is to address the abnormal vital sign of patient. The normal blood pressure is 120/80
however Mrs. McKenzie blood pressure observation shows that she is hypertensive.
Implementing appropriate nursing intervention to increase blood pressure is necessary because
hypertension increases risk of complication in patient. Hence, it will be necessary for nurse to
consult physician to provided appropriate antihypertensive drugs that reduces blood pressure of
Mrs. Sharon. Drugs like beta-blockers, ACE inhibitors and nitrates are most effective in
decreasing blood pressure and management of adverse symptoms in patient with CCF.

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Hypertension increases cardiac work and taking action against hypertension is the most effective
strategy to provide relief to patient.
Mrs. Sharon’s heart rate and respiratory rate was also abnormally high. Leaving this
symptom untreated may lead to respiratory stress in patient. Hence, the nursing care plan for
addressing these symptoms includes providing oxygenation to patient and providing appropriate
body position alignment to patient. Oxygen therapy is also necessary to bring the SpO 2 value of
Sharon to normal limits of 95-100%. The advantage of oxygen therapy for patients with CCF is
that it reduces cardiac output and heart rate thus providing relied to patient (Larson, Symons &
Jalili, 2012). However, the rate of oxygen administered to patient must be carefully monitored as
excessive supplemental oxygen may also deteriorate cardiac function of patient. To provide
relief to patient, another care plan is to elevate head of bed of patient. The ABG value of patient
will be monitored too to prevent adverse symptom in patient. This care plan can enhance comfort
level of Sharaon (Pool et al. 2015).
The second nursing care priority for management of Sharon’s condition is to take action
for edema (swollen feet). The Symptom of edema is a sign that patient has high cardiac output.
Hence, to provide appropriate care to patient, the nursing care plan is to evaluate fluid status of
patient and identify fluid restrictions that are necessary for patient. Fluid restriction will help to
maintain fluid volume for patient. Fluid intake and output measurements needs to be monitored
at regular intervals too. In addition, diuretics may also be provided to Sharon to maintain fluid
volume imbalances (Ter Maaten et al, 2015).
The third care priority for the recovery of Sharon is to address symptom of hypothermia
in patient. Review of Sharon’s condition revealed that her finger was cool to touch and she

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always used to wear bed socks for her cool feet. To maintain the body temperature of patient, it
will be necessary to monitor fluid loss in patient and control the temperature of the room.
Evidence has shown that targeted temperature management protocols are effective in addressing
temperature changes in patient (Lundbye et al., 2017).
Mrs. Sharon’s potassium level was 2.5 mmol/L. The normal level is 3.5-5.0 thus
indicating that patient has hyperkalemia. This condition arise due to side effects of medications
like diuretics and the care plan to address electrolyte imbalance is necessary to prevent further
discomfort to patient (Urso, Brucculeri & Caimi, 2015).

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References:
Arrigo, M., Parissis, J. T., Akiyama, E., & Mebazaa, A. (2016). Understanding acute heart
failure: pathophysiology and diagnosis. European Heart Journal
Supplements, 18(suppl_G), G11-G18.
Dubé, B. P., Agostoni, P., & Laveneziana, P. (2016). Exertional dyspnoea in chronic heart
failure: the role of the lung and respiratory mechanical factors. European Respiratory
Review, 25(141), 317-332.
Kemp, C. D., & Conte, J. V. (2012). The pathophysiology of heart failure. Cardiovascular
Pathology, 21(5), 365-371.
Kotecha, D., Flather, M. D., Altman, D. G., Holmes, J., Rosano, G., Wikstrand, J., ... & Van
Veldhuisen, D. J. (2017). Heart rate and rhythm and the benefit of beta-blockers in
patients with heart failure. Journal of the American College of Cardiology, 69(24), 2885-
2896.
Lacerda, M. S., Cirelli, M. A., Barros, A. L. B. L. D., & Lopes, J. D. L. (2017). Anxiety, stress
and depression in family members of patients with heart failure. Revista da Escola de
Enfermagem da USP, 51.
Larson, A. J., Symons, J. D., & Jalili, T. (2012). Therapeutic potential of quercetin to decrease
blood pressure: review of efficacy and mechanisms. Advances in nutrition, 3(1), 39-46.
Lundbye, J., Hand, H., Adams, M., & Boyd, L. (2017). Targeted Temperature Management in
Nursing Care. Therapeutic hypothermia and temperature management, 7(3), 122-124.

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Nasir, S., & Aguilar, D. (2012). Congestive heart failure and diabetes mellitus: balancing
glycemic control with heart failure improvement. American Journal of
Cardiology, 110(9), 50B-57B.
Pool, J., Dercher, M., Hanson, B., Heiman, L., Li, Y., Schraeder, K., ... & Ebberts, M. (2015).
The effect of head of bed elevation on patient comfort after angiography. Journal of
Cardiovascular Nursing, 30(6), 491-496.
Raviele, A., Giada, F., Bergfeldt, L., Blanc, J. J., Blomstrom-Lundqvist, C., Mont, L., ... &
Document reviewers. (2011). Management of patients with palpitations: a position paper
from the European Heart Rhythm Association. Europace, 13(7), 920-934.
Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.
Singh, P., Yoon, S. S., & Kuo, B. (2016). Nausea: a review of pathophysiology and
therapeutics. Therapeutic advances in gastroenterology, 9(1), 98-112.
Teerlink, J. R., Cotter, G., Davison, B. A., Felker, G. M., Filippatos, G., Greenberg, B. H., ... &
Dorobantu, M. I. (2013). Serelaxin, recombinant human relaxin-2, for treatment of acute
heart failure (RELAX-AHF): a randomised, placebo-controlled trial. The
Lancet, 381(9860), 29-39.
Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A.
(2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and
therapy. Nature Reviews Cardiology, 12(3), 184.
The Heart Foundation. (2018). Heart disease in Australia. Retrieved 27 March 2018, from
https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-australia

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Urso, C., Brucculeri, S., & Caimi, G. (2015). Acid–base and electrolyte abnormalities in heart
failure: pathophysiology and implications. Heart failure reviews, 20(4), 493-503.