Congestive Heart Failure: Causes, Symptoms, and Management

This document provides an analysis of congestive heart failure, including its causes, symptoms, and impact on patients and their families. It also discusses the pharmacokinetics and pharmaco-dynamics of common drugs used in treatment. Additionally, it offers insights into nursing goals and interventions for managing the condition.

Running head: CASE STUDY 1 ANALYSIS
CASE STUDY 1 ANALYSIS
Name of the student:
Name of the university:
Author note:

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CASE STUDY 1 ANALYSIS
Disease and causes, incidence and risks and impact of the disorder on patient and family:
Congestive heart failure can be described as the chronic condition, which mainly affects
the pumping ability of the muscles of the heart. It mainly refers to that of the particular stage in
which fluid is seen to build up surrounding the heart and thereby causes the heart to pump in an
inefficient manner. This disorder may result from many other health conditions that have the
ability to directly affect the cardiovascular systems. The different conditions make the heart
weak (Buck et al., 2015). In case of heart failure, the main pumping chambers of the heart which
are ventricles become stiff and do not get filled up properly between the beats. It has been also
seen that in some cases of congestive heart failure, the heart muscle might become damaged as
well as weakened. Even the ventricles are also seen to stretch to the point that the heart cannot
pump blood efficiently throughout the body (Riley et al., 2016). Over the time, the heart can no
longer keep up with the normal demands placed on it to pump blood to the rest of the body and
these results in congestive heart failure. These might have taken place in Sharon and therefore,
she might have been affected by CHF.
Different symptoms that are usually noticed at first are fatigue, swelling in the ankles,
legs and feet as well as weight gain and increase in the need for urination mainly in the night.
Irregular heartbeats, cough developing from the congested lungs, wheezing as well as shortness
of breath also show that pulmonary edema might be present (Vedel et al., 2015). Chest pain that
radiates through the upper body as well as rapid breathing along with skin appearing blue due to
lack of oxygen and fainting are other symptoms. Sharon is also seen to suffer from shortness of
breath, mild nausea, dizziness and swollen ankles as well and all these show that she suffer from
CHF.

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CASE STUDY 1 ANALYSIS
One of the risk factors of CHF may be hypertension when the individual has high blood
pressure than that of the normal. Hypertension can result from different causes like that of the
narrowing of the arteries making it difficult for the blood in flowing through them. It might also
occur due to coronary artery disorders where cholesterol and different types of other fatty
substances block the coronary arteries. These arteries are actually the small arteries that can
supply blood to the heart causing the arteries in becoming narrow that restrict blood flow
leading to the damage of the arteries. Valve conditions can also lead CHF (Mirkin et al., 2017).
Valves regulate the flow of blood through the heart by opening and closing the blood in and out
of the chambers. Valves that do not open and close correctly might force the ventricles to work
harder for pumping the blood causing the disorder.
Individuals are expiring in the nation due to this disorder where one in every 12
Australians is facing such severe deaths and is affecting around one in six Australians accounting
for about 4.2 million people. In the year 2017, about 43477 deaths have been accounted as a
result of cardiovascular disorders. Heart failure is found to be the cause of 1 to 2% of the
Australian population and is found to be more dominant among 10%of the elderly.
Patients suffering from CHF might also face from many complications over the period of
time like kidney failure as failure of the heart might result in reduced blood flow to kidneys
resulting in the latter’s failure. Heart rhythm problems and liver damages also result. All these
result in huge pain and suffering of the patients affecting the quality of life. Patients and their
family members suffer from stress and anxiety because of the suffering of patients (Moore,
2016). Families are seen to suffer from feelings of guilt as well. Patients and caregivers have to

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CASE STUDY 1 ANALYSIS
go through restricted lives making them feel frustrated. Financial stabilities might be affected
due to expenditures on healthcare services and resources. Sharon has developed CHF and her
and her family members can develop such issues accordingly.
Three common signs, symptoms, and pathophysiology that underlie the symptoms:
Symptoms pathophysiology
Sharon had developed
swollen ankles in
CHF which might be
because of the
conditions of edema
When an individual suffer from CHF, one or both of the ventricles of the heart
lose their ability to pump blood effectively. As result of these, researchers have
found that fluid gets accumulated in feet, legs as well as ankle resulting in the
structures to get swollen causing edema (Clark et al., 2016). This can also take
place in the abdomen. Therefore, Sharon is also seen to have swollen ankles
Sharon was seen to
suffer shortness of
breath
Pulmonary edema can be defined as the conditions where the lungs of the
individuals get filled up with fluid. During the time of CHF, it is seen that the
heart can no longer pump blood throughout the body. This contributes in creating
a backup pressure in the small blood vessels of the lungs. These ultimately make
the vessels to leak fluid (Ziaeian et al., 2016). When such fluid gets filled up in
the lungs, oxygen cannot be put into the blood system causing deprivation of
oxygen to the rest of the body. Therefore, when pulmonary edema occurs, body
struggle in getting enough oxygen resulting in shortness of breath.
Sharon is seen to feel
dizzy as well.
Individuals have complained of feeling dizzy when standing up quickly. Feeling
of fainting is also seen to be common symptoms in people suffering from this
disorder. Studies are of the opinion that these might be because of abnormal
rhythms of the heart or narrowing of the arteries of heart (Binaei et al., 2016).
Blood flow to the brain might get reduced and as a result of these, individuals
might feel light headed or dizzy. Sudden loss of consciousness would show that

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CASE STUDY 1 ANALYSIS
the blood flow of the brain is severely impacted.
Pharmacokinetics and pharmaco-dynamics of one common class of drugs:
Warfarin can be described as the coumarin anticoagulant and is a racemic mixture of the
two active isomers. This class of drugs of anticoagulants can be used in the prevention as well as
treatment of the thromboembolic disorders like venous thrombosis, pulmonary embolism as well
as pulmonary embolism and even in cases of ischemic stroke in patients with atrial fibrillation.
This group of medication is seen to inhibit the vitamin k reductase that cause depletion of the
reduced form of vitamin K. Vitamin k is the cofactor for the carboxylation of glutamate residues
on the N-terminal regions of vitamin K-dependent proteins and this limits the gamma-
carboxylation and subsequent activation of the vitamin K-dependent coagulant proteins
(Fergusan et al., 2017). With the action of the anti-coagulants, the preparation of the vitamin K-
dependent coagulation factors II, VII, IX, and X and anticoagulant proteins C and S is seen to
undergo inhibition. As depression occurs among three of the four types of vitamin K-dependent
coagulation factors (factors II, VII, and X), it causes reduction in the prothrombin levels as well
as in the amount of the thrombin generated and bound to fibrin. Thereby, anticoagulants reduces
the thrombogenicity of the clots.
These drugs are rapidly absorbed after oral administration with that of the considerable
inter-individual variations. They are also found to be absorbed percutaneously. Their volume of
distribution is .01 L/kg and has 99% bound parimarily to albumin. They can be metabolized
stereo- and regio-selectively by hepatic microsomal enzymes as well as by cytochrome P450

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CASE STUDY 1 ANALYSIS
(CYP) 2C9 to yield the 6- and 7-hydroxylated metabolites or by CYP1A1, 1A2, and 3A4 to yield
6-, 8-, and 10-hydroxylated metabolites. The elimination happens entirely by metabolism and
very little is excreted unchanged in urine. The metabolites are excreted mainly through urine and
to lesser extent into the bile (Iungkaran et al., 2015).
Nursing goals and interventions:
Nursing goal Interventions with rationale
Management of the shortness of the breath Oxygen therapy can be applied for Sharon. In case
of CHF, the heart muscles fail to pump blood
efficiently and therefore blood is not pumped in the
way that it actually does when the heart is in
normal condition without any disorder. Therefore,
the different body parts do not get enough oxygen
as required. Therefore, in such situations, nurses
need to initiate oxygen therapy sessions (Luttik et
al., 2016). This therapy mainly helps the patients
by allowing them to breathe in extra oxygen for
making sure that all the parts of the bodies are
getting enough oxygen. This can help in prevention
of failures of different organs that might take place
because of the inability of the oxygen in reaching
the different organs. In this way, damages to
important organs like kidney, heart as well as brain
can be prevented. With this intervention, the nurses
can manage not only the breathing problems of

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CASE STUDY 1 ANALYSIS
Sharon but also would help in overcoming swelling
of ankles.. Nurses can also use more pillows
allowing Sharon to sleep in the recliner chair and
providing her cushion for supporting Sharon while
resting upright.
Preventing further deterioration of the condition of
Sharon and preventing her from relapsing once
again.
Studies are of the opinion that monitoring the vital
signs of the patients in time to time would help the
nurses in identifying whether any deteriorating
situations are present or not or that the patient is
under stable condition out of danger (Clark et al.,
2016). The vital signs monitoring makes the nurses
aware of deteriorating situation making them take
ready actions when threatening values are
observed. The basic sets of vital signs
measurements mainly include blood pressure, pulse
rate, respiration rate, temperature and heart rate
(Condon et al., 2016). Time to time ECG, SpO2
and weight should be also measured to find out
how Sharon is responding to treatments and
whether she is recovering or deteriorating. All such
information needs to be documented from time to
time so that the trend in the values can be identified
to understand how the patient is recovering and
what further interventions need to be taken (Binaei
et al., 2016).
Management of blood pressure and edema. Pharmacological treatment should be carried on by

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CASE STUDY 1 ANALYSIS
the nurses. the set of medications that need to be
given to Sharon is beta-blockers. This mainly helps
by countering the effects of that of the sympathetic
nervous system and help in reduction of the blood
pressure. They work by creating blockage to the
effects of the epinephrine hormone. When beta
blocker would be given to Sharon, the heart rhythm
would slow down with lesser force and this would
cause reduction of the blood pressure in Sharon.
Beta blockers mainly help by opening up the blood
vessels and helping in improvement of the blood
flow (Nieminen et al., 2015). Another medication
that can be provided is the diuretics that can help in
relieving congestive symptoms and that of fluid
retention. This would help in the management of
the symptoms of edema and fluid accumulation in
the lungs as well (Daamen et al., 2016). Another set
of drugs that can be also provided is the
Angiotensin Converting Enzyme inhibitors. This
enzyme helps in preventing the enzyme in the body
that causes production of angiotensin II which
actually causes narrowing of the blood vessels
thereby increasing blood pressure and making the
heart to work faster (Li et al., 2016). Angiotensin
Converting Enzyme inhibitors mainly helps in
preventing the action of the enzyme thereby

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CASE STUDY 1 ANALYSIS
relaxing the blood vessels and blood pressure gets
reduced.
References:

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Binaei, N., Moeini, M., Sadeghi, M., Najafi, M., & Mohagheghian, Z. (2016). Effects of hope
promoting interventions based on religious beliefs on quality of life of patients with
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research, 21(1), 77. doi: 10.4103/1735-9066.174755
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., ... & Strachan,
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Ferguson, C., Inglis, S. C., Newton, P. J., Middleton, S., Macdonald, P. S., & Davidson, P. M.
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