Acute Care Nursing: CHF Risk Factors, Symptoms, Interventions

This document provides information on congestive heart failure (CHF) in acute care nursing. It discusses the risk factors, symptoms, and nursing interventions for CHF. The pathophysiology of CHF and the role of ACE inhibitors in treatment are also explained. Additionally, the document outlines the goals and interventions for CHF patients within the first 8 hours of admission.

Acute Care Nursing
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Q.1.
Congestive heart failure (CHF) is a cardiovascular condition which is associated with
inability of heart to pump adequate amount of blood. Heart pump inadequate amount of blood
mainly due to narrowing of arteries and hypertension. Risk factors of CHF include old age,
high cholesterol level, diabetes, hypertension and smoking. Age of Mckenzie is 77 years;
hence, her age could be the risk factor for CHF in her. 2 and 5 % people of age between 41 -
60 and 61 – 70 respectively are at higher risk of CHF. Alcohol intake, family history,
inadequate physical activity and obesity are also responsible for CHF. Hypertension is one of
the significant risk factors for CHF. Likewise, Mckenzie is also detected with hypertension.
In comparison to the normal females, hypertensive females are 4 times are at higher risk of
CHF. Moreover, females (60 %) are at higher risk of CHF in comparison to males (40 %)
(Mahmood and Wang, 2013). High levels of low-density lipoproteins and low levels of high-
density lipoproteins are risk factors of CHF. Intake of high amount of saturated fat is mainly
responsible for CHF. β-type natriuretic peptides at the higher side are also responsible for
CHF (Mirkin, Enomoto, Caputo, and Hollenbeak, 2017). 36 and 20 % people associated with
active smoking and obesity respectively are susceptible to CHF (Australian Institute of
Health and Welfare (2014).
Cardiovascular disease conditions like coronary artery disease (CAD), myocardial infraction
(MI), arrhythmias, cardiomyopathy, defective heart valves and myocarditis are responsible
for the occurrence of CHF. MI in case of Mckenzie, might increase chances of CHF.
Consumption of medicines like antidiabetic medicines (rosiglitazone and pioglitazone),
nonsteroidal anti-inflammatory drugs (NSAIDs) (rofecoxib and celecoxib), anaesthetic and
anticancer might produce CHF (Castillo, Edriss, Selvan, and Nugent, 2017). It has been
reported that people with CHF might not survive more than 5 years after its diagnosis. In
comparison to the normal people, death rate might be 10 % more in people with CHF
(Australian Institute of Health and Welfare, 2014).
Mckenzie is associated with cardiovascular and respiratory dysfunction. Hence, she
might not be able to carry out her daily activities. It is necessary for her to take support from
family members. In addition to support her in activities, family members should observe her
daily activities. It might extend emotional and psychological strength to her. Family members
might experience financial burden and psychological stress due to her diseased condition.
Speedy recovery of Mckenzie could be effectively achieved through monitoring her
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medications, diet and risk factors by family members and care staff. Positive communication
is one of the important factors for the recovery of older people; hence, family members and
staff members need to develop positive communication with her (Raman, 2016).
Q2. :
Symptom Pathophysiology
Dyspnoea CHF is associated with decreased cardiac output. As a result, there would
be less blood supply to different parts of the body including skeletal
muscle. Less supply of blood to skeletal muscle results in the improper
functioning of the skeletal muscles. It has been established that improper
functioning of the skeletal muscles leads to increased left ventricular
pressure to improve cardiac output. Consequently, sequence of events
occur like pulmonary diffusion and interstitial oedema and breathlessness.
Increased diastolic pressure lead to more expenditure and requirement of
energy. It lead to myocardial ischemia and augmented myocardial oxygen
requirement (Pang, Collins, Gheorghiade, and Butler, 2018). Hence,
Mckenzie is suffering through shortness of breath due to increased oxygen
requirement.
Swollen
ankle
Swollen ankle occurs due to swelling in the ankle or leg. Accumulation of
fluid is mainly responsible for the swelling in any organ. Swelling is the
consequence of increased cardiac output. Increased levels of natriuretic
peptide and β-type natriuretic peptide are mainly responsible for the
vasodilation and decreased ventricular filling pressure. Vasodilation and
decreased ventricular pressure results in the decreased both cardiac preload
and afterload. Consequently, it results in the decreased blood back flow to
the heart through the veins. Valve narrowing is mainly responsible for the
reduced blood back flow which results in the inadequate blood pumping by
the heart (Moe, 2016). This cardiovascular dysfunction like reduced cardiac
output is mainly responsible for the swollen ankle in McKenzie.
Dizziness CHF mainly occur due to recued amount of blood to various organs as well
brain. Reduced supply of blood to the brain results in the dizziness in the
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person. Abnormality in the heart rate and rhythm are primarily blamed for
the dizziness in the patient. Functioning of the vestibulo-ocular reflex
(VOR) depends on the six primary neurotransmitters of three-neuron arc.
These neurotransmitters include glutamate, acetylcholine, gamma-
Aminobutyric acid (GABA), dopamine, norepinephrine and histamine.
Acetylcholine exhibits its action as an excitatory neurotransmitter for both
peripheral and central synapses. GABA exhibits its action as an inhibitory
neurotransmitter in the VOR, lateral vestibular nucleus and medial
vestibular nucleus. Dopamine exhibits its action through accelerating
vestibular compensation. Norepinephrine exhibits its action through
controlling vestibular stimulation.
However, role of histamine in the dizziness is unclear. Thus, cardiovascular
dysfunction in the form of reduced cardiac output led to dizziness in
McKenzie (Kemp and Conte, 2012).
Q.3.
Angiotensin-converting-enzyme inhibitor (ACE inhibitor) is a choice of drug in patients like
McKenzie.
ACE inhibitor is primary selection of drug for CHF patients. ACE inhibitors produce
its action through inhibiting angiotensin-converting enzyme. Angiotensin-converting enzyme
in a vital constituent of the physiological system renin–angiotensin- aldosterone (RAAS)
system. Abnormal working of the RAAS is one of the main cause responsible for
hypertension. ACE inhibitors produce its antihypertensive effect by inhibiting conversion of
Angiotensin I (ATI) to Angiotensin II (ATII). ACE inhibitors produce different physiological
effects like reduced resistance in blood vessels, reduced arteriolar resistance, increased
excretion of sodium in the urine, decreased resistance in blood vessels and reduced cardiac
output and volume (Opie and Gersh, 2011). ACE inhibitors produce its antihypertensive
effect through relaxation of the blood vessels and reduced amount of blood volume. It results
in the reduced blood pressure and reduced oxygen demand and consumption by the heart
(Sayer and Bhat, 2014). Hence, ACE inhibitors are considered as the first line of treatment
for cardiovascular patients like Mckenzie. In case of Mckenzie, ACE inhibitor like enalapril
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is being used. Enalapril is useful in various cardiovascular abnormalities like asymptomatic
left ventricular dysfunction, hypertension and symptomatic heart failure. All these
cardiovascular conditions are associated with CHF. Enalapril is also proved useful in renal
diseases like chronic kidney failure and psychogenic polydipsia. Management and treatment
of all these cardiovascular and related conditions are required in patients like Mckenzie
because all these are the risk factors for CHF. Examples of ACE inhibitors include
benazepril, enalapril, ramipril, captopril, perindopril, zofenopril, trandolapril and lisinopril
(Sayer and Bhat, 2014).
Following are the pharmacokinetic parameters of enalapril: onset of action is 1-hour,
peak effect between 4 – 6 hours, total duration of action 12 – 24 hours and oral bioavailability
60 %. Enalapril is a prodrug and it exhibit its ACE inhibitory potential through its metabolite
Enalaprilat (Opie and Gersh, 2011).
Q.4. Nursing Intervention for Mckenzie within first 8 hours of her admission.
Goals Intervention Rationale
To maintain normal
cardiovascular parameters
like hear rate, hear sound,
peripheral pulse and heart
beat rhythm.
Monitor and record
cardiovascular parameters
like heart rate and heart beat
rhythm. Observe heart
sound. Record and note
peripheral pulses.
Heart rate need to be
maintained between 60 –
100 bpm in McKenzie.
McKenzie is associated with
bradycardia. Due to her
CHF; there could be
dysrhythmias like premature
atrial contractions,
paroxysmal atrial
tachycardia, premature
ventricular contractions,
multifocal atrial tachycardia,
and atrial fibrillation (Suter,
Gorski, Hennessey, and
Suter, 2012).
Since, McKenzie is a CHF
patient; there would be
reduced pumping action in
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To maintain normal blood
pressure.
To maintain normal urine
output and urine
concentration.
To provide medication to
McKenzie on regular basis.
Measure and record blood
pressure.
Measure and note urine
output and observe urine
concentration.
Monitor medicine
consumption by McKenzie
and ensure regular
consumption of furosemide
her. It leads to weak S1 and
S2 sounds. Valvular
incompetence produces
murmurs in the heart sound
(Suter, Gorski, Hennessey,
and Suter, 2012). Patients
with CHF produce pulse like
popliteal, post tibial pulse,
radial and dorsalis pedis.
Blood pressure need to be
maintained in McKenzie
between 120/80. Systemic
vascular resistance might
produce hypertension in
patients with CHF (Suter,
Gorski, Hennessey, and
Suter, 2012).
Normal urine output need be
maintained in McKenzie to
2000 millilitres per day.
CHF patients are usually
associated with lessened
cardiac output which is
mainly responsible for
reduced urine output.
Concentration of urine
usually alters as a result of
sodium and water retention
(Suter, Gorski, Hennessey,
and Suter, 2012).
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and enalapril by her. Furosemide is a class of
loop diuretic. It exhibits its
action through maintaining
normal cardiac output and
reducing preload (Paul and
Hice, 2014). Enalapril is an
antihypertensive drug which
exhibit its action through
inhibiting ACE. ACE
inhibitors exhibit its action
through augmenting cardiac
output and ventricular filling
pressure (Paul and Hice,
2014).
To maintain normal
respiratory parameters in
McKenzie.
To maintain normal ABG
levels in McKenzie.
Measure and record
respiratory rate after every
four hours.
Measure and record ABG
levels. With the physicians
consultation, provide
oxygen 4L by nasal prone.
In adults normal respiratory
rate is 10 – 20 bpm.
Respiratory rate outside this
normal range reflects
dysfunction of respiratory
system which include
irregular breathing pattern
(Suter, Gorski, Hennessey,
and Suter, 2012). Abnormal
breathing pattern indicate
dysfunction of respiratory
system (Paul and Hice,
2014).
ABG measurement include
different parameters like
HCO3, pH, PaCO2 and PaO2.
Hence, ABG levels
measurement is useful in
determining acidosis and
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To ensure consumption of
medications by McKenzie.
To maintain normal
breathing pattern in
McKenzie.
Ensure McKenzie is
consuming bronchodilator
medicines.
To observe breathing
pattern.
Demonstrate deep breathing
technique to McKenzie and
ensure she is following it on
regular basis. Following are
the deep breathing
techniques : passive
exhalation, slow inhalation
and end respiration holds
hypoxia in the patient. ABG
levels measurement is
helpful in assessing oxygen
saturation level and
ventilation pattern. Altered
ventilation pattern mainly
occur due to shortness of
breath. Normal oxygen
saturation is 95 – 100 %
(Suter, Gorski, Hennessey,
and Suter, 2012).
Bronchodilator medicines
produce bronchodilation and
airway passage opening
(Paul and Hice, 2014).
Abnormal breathing pattern
indicate dysfunction of
respiratory system (Paul and
Hice, 2014). Deep breathing
facilitates deep respiration
which improves oxygen
saturation level. Extended
expiration is useful in
preventing air trap (Suter,
Gorski, Hennessey, and
Suter, 2012).
References:
Australian Institute of Health and Welfare (2014). Cardiovascular disease, diabetes and
chronic kidney disease— Australian facts: Prevalence and incidence. In:
Cardiovascular, diabetes and chronic kidney disease series no. 2. Cat. no. CDK 2.
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disease/cardiovascular-diabetes-chronic-kidney-prevalence/contents/table-of-contents
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