Decompensated Heart Failure: Causes, Symptoms, and Treatment

Running head: DECOMPENSATED HEART FAILURE
DECOMPENSATED HEART FAILURE
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DECOMPENSATED HEART FAILURE
Brian James is a 73-year-old male who was brought in by ambulance to the Emergency
Department. He was presented with shortness of breath, swollen ankles, crackles bilaterally in his
posterior lung bases. He suffered from recent increase in weight and his rhythm was noted as sinus
tachycardia (heart rate 105). His relevant history included a new diagnosis of heart failure 4 months ago
with an EF of 39%, ischaemic heart disease, hypertension, obesity. He is a current smoker. Brian has
presented with acutely decompensated heart failure and triggering factor for his clinical presentation is
non-adherence to treatment. Several interventions are employed during the admission of an acutely
overloaded patient with immediate goals being to improve the symptoms of decompensated heart failure,
restore oxygenation to improve overall organ perfusion and to limit any cardiac or renal impairment (Jha
et al., 2018). The treatment focuses on reversing pulmonary and peripheral congestion, considering
potential precipitating causes and optimizing the therapeutic approach. The two major interventions that
will be discussed during this essay in the context of Brian’s acutely decompensated heart failure include
diuresis with medical therapy as an in-patient and discharge planning and patient education facilitated by
the registered nurse.
Acute decompensate heart failure (ADHF) is considered to be one of the most common causes for
hospital admissions. Studies have found that patients affected with this disorder have longer hospital stays
and even remain highly vulnerable towards in-hospital as well as post-discharge mortality and morbidity
(Qavi et al., 2015). Fluid overload or congestion is found to be the classical clinical feature of the patients
who present with ADHF to the admission wards. In some of the patients, pulmonary congestion is seen to
take place at a very rapid rate. Researchers have opined that such clinical conditions are found to be
intricately associated with patients who face sudden increase in the left ventricular filling pressures
(Brambett et al., 2017)). Some of the most important causal factors that had been recognized to be
contributing to such situation are acute myocardial ischemia and uncontrolled hypertension. The
preliminary assessments that were conducted of the patient named Brian showed that he had hypertension
and had history of myocardial infarction. Studies have found that in such circumstances, the edema is

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DECOMPENSATED HEART FAILURE
usually localized predominantly within the pulmonary spaces, causing pulmonary edema, although the
amount of fluid in the cardiovascular system remaining unchanged.
A number of initial objective signs and symptoms had helped nursing professionals in case of
Brian to develop an idea about the immediate issue that needs to be addressed. The patient named Brian
had represented with abnormal heart sounds and crackles in the lungs were also heard. The nursing
professionals had also found an increased heart rate for about 105 showing that he was suffering from
tachycardia as well. The normal heart rate of patients needs to be between 60 and 100 that are considered
the normal range of heart rate (Fang, 2016). Hence, increased heart rate is another symptom that
suggested of the chances of ADHF with chances of fluid accumulation. Moreover, he also showed rapid
breathing or tachypnea as well. Studies have found that crackles in lungs, increased heart rate as well as
rapid breathing can determine pulmonary edema. The study has also stated some other recognizing factors
for nurses to identify the condition of pulmonary edema are leg or abdominal swelling, pale and blue skin
as well as abnormalities of the neck veins and even abnormalities of neck veins that show too much of
fluids in the body. Brian was found to have swollen ankles that could be due to edema in the legs. Studies
have stated that rapid weight gain might be due to increased retention of fluids in the body that had
resulted in increasing the weight of the body (Mori et al., 2017). This symptom can also contribute in
strengthening the fact that he was suffering from edema and therefore there was an urgent need to make
the body free from retained fluid through proper medicinal therapies.
Several tests were conducted that helped the nurse to identify the condition of the heart and the
lungs presently thereby helping the nurse to develop a plan of care for Brian. The first test that needs to be
done in such cases is X-rays. Researchers advise chest X-ray as the first diagnostic assessment to confirm
the diagnosis of pulmonary edema as well as to exclude other possible causes of shortness of breath
(Aronson, 2017). Brian was suffering from shortness of breath as well and therefore conducting this test
was important. Pulse oximetry helps in determining the amount of oxygen that is required in the blood.
As the organs are getting deprived of oxygen due to lack of flow of oxygenated blood to the different

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parts of the body, organs start to malfunction and this may result in threatening situation to the body
(Hoorn et al., 2017). Hence, pulse oximetry for Brain was needed to be done that showed very few
amount of oxygen in the blood. Blood tests also need to be done not only for about measuring the amount
of oxygen and carbon dioxide in the blood to find about the arterial blood gas concentrations (Hanberg et
al., 2016). Another important reason for which nurses need to conduct blood test is to find out whether a
substance called B-type natriuretic peptide (BNP) is present or not in the blood. Studies have found that
increased levels of BNP are indicative of the fact that heart is not functioning well and is also indicative
of the presence of edema due to poor heart condition. Reduction of the level of BNP shows that the heart
is recovering gradually (Urso et al., 2015). This was conducted for Brian to finalize the assumptions made
about his symptoms of ADHF.Nurses for Brian also conducted Electrocardiogram or ECG. This test
helps to exhibit the patterns of the heart rate as well as the rhythm and also helps to know whether any
areas of the heart showed diminished blood flow or not (Schefold et al., 2016)). This test helped in
revealing that Brian had higher heart rate and also his blood flow from the heart is diminished.
Echocardiogram is a test that with the help of sound waves can help in showing different types of heart
problems like heart valve issues, abnormal motions of the ventricular walls, fluid around the heart and
even other types of congenital defects. It also shows areas of diminished blood flow from the heart when
heart pumps blood less effectively during its beats (Krishnan et al., 2016). This test showed that Brian’s
heart had elevated left ventricular pressure filling that had resulted forced accumulation of fluid in the
lungs as blood was not allowed to be released from left ventricles of the heart.
Diuretics can be found to be extremely helpful in treatment of congestions that occur due to
pulmonary edema in ADHF helping the patient to overcome the condition of fluid retention not only in
lungs but also throughout the body. The current available loop diuretics that nurses can administer in the
patients are torsemide, fuorsemide, ethacrynic acids and even bumetanide. Researchers who have worked
on the functions of the medications in handling severe conditions of edema and ACHF have stated that
the medications mainly cause inhibition of the sodium re-absorption and thus causereduction in the water