Case Study Analysis: Nursing Management of Heart Failure and Cardiogenic Pulmonary Edema

This case study analysis focuses on the nursing management of heart failure and cardiogenic pulmonary edema in a patient. It discusses the assessment, pathophysiology, signs and symptoms, and nursing interventions for these conditions.

CASE STUDY ANALYSIS
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Introduction
Nursing management is essential in patient diagnosis and care process. This assessment
analysis focuses on patient Reggie aged 42 years old an indigenous Australia man. During
early childhood the patient was diagnosed with rheumatic heart disease, since then, there has
been a recurrent episode of recurrent acute decompensation of the heart failure condition.
This assessment reflects on two nursing issues for the patient with respect to the needed
urgent care needed for proper diagnosis. Identified nursing issues to force entail occurrence
and development of acute decompensation of the patient rheumatic disease linking to heart
failure and risk of heart failure in itself. Path physiology process of the two nursing problems
for the patient will be assessed and analyzed. In order to improve the patient status key,
nursing interventions have been identified for the patient so as to improve the overall disease
state of patient Reggie.
Assessment review
The first key nursing problem for the patient is heart failure, which refers to the
inability of the heart to pump enough blood to sufficiently maintain the blood flow to
maintain the overall needs of the body. The underlying rheumatic disease of the patient is
exuberating the heart failure state. Patient rheumatic heart disease state reflects on the overall
compilation of the rheumatic fever which the valves are damaged. The underlying disease of
the patient on the heart function is worsening the state and development of heart failure
which is a risk factor based on the patient status. Development of heart failure for the patient
has been increased by the underlying health issue on the patient status (Ponikowski et al.,
2016).
Underlying data assessment observed from the patient indicates a state of general
fatigue breathing difficulties and elevated weight in the previous months. The patient further
has pitting bilateral edema on his legs depicting accumulation of fluid and retention rate is
high. Further, the respiratory status depicts a state of elevated breathing rate due to the
weakened status of the heart at 28bs while there is low oxygen saturation at 92%.
Auscultation assessment of the patient reveals coarse crackles and increased high blood
pressure.
The Path physiology of acute heart failure depicts the state of clinical syndrome

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outcome brought about by the induced functional abnormalities occurring in the cardiac
leading to lowered output levels of cardiac output intracardiac diastolic pressures. The typical
occurrence of heart failure depicts a state of the hemodynamic model depicting downstream
hypoperfusion and the upstream congestion. Acute heart failure leads to acute
decompensation of the chronic heart failure caused due to the progressive congestion being
precipitated by various factors (Arrigo et al., 2017).
The induction of cardiac dysfunction leads to activation of the neuro-humoral pathway
in order to allow the counter the negative hemodynamic effects resultant due to heart failure.
The activation of neurohumoral leads to impairment of the sodium excretion in the kidneys
leading to accumulation of sodium and secondary accumulation of fluids (Essandoh et al.,
2015). Further, in persistence form, the neurohumoral activation leads to induction of
maladaptive processes which leads to remodeling of detrimental ventricles and dysfunction of
the organs (Arrigo & Rudiger, 2017).
The cascadation action of the congestive subclinical stage of the hemodynamic
congestion occurring as a result of cardiac filling and the venous pressures is followed by
fluids distribution into the lungs area and other visceral areas leading to overload signifying
clinical congestion. The correlation of the hydrostatic pressures and formation of edema is
poor. The accumulation of the chronic sodium in the heart leads to impairment on the
function of interstitial glycosaminoglycan network leading to a reduced capacity of the buffer
additional sodium and maintains of low interstitial edema (Nijst et al., 2015).
Many patients of AHF often display an elevated increase in body weight and
precipitation of the congestion due to sudden redistribution of the fluid. The activation of
sympathetic is shown to induce transient vasoconstriction leading to increased volume
displacement in the peripheral and the venous systems of the splanchnic of the pulmonary
circulation.
The resultant mismatch between the ventricular and vascular coupling relationship
leads to increased after load and lowered levels of venous capacitances leading to increased
alteration to of hypertensive AHF. The resultant fluid accumulation tends and redistribution
leads to the promotion of systematic congestion, but the occurring distribution carries based
on different situations of clinical activity (Jhund & McMurray, 2016).
The key patient problem, signs and symptoms are depicted by the patient status

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indicating a state of increased weight gain and retention of body fluids occasioned by the
hemodynamic activity due to weakening state of heart function. Further, the patient is
experiencing pitting edema reflecting the inability to eject fluid in the tissues and further the
chests auscultation state indicating coarse crackles sound showing signs of increased
decompensation state. Further high blood pressure depicts a hypertensive state of the patient
is significant. These signs and symptoms depict the state of acute chronic heart failure on the
patient health state. There is a marked reduction in the efficiency of the heart muscle through
damaged or excess loading (Yancy et al., 2017). This can be attributed to a wider variety of
issues which can entail the hypertension state of the patient.
The key nursing intervention entails management of respiratory function and
administration of diuretics drugs. Assessment of the functionality of respiratory function is an
essential aspect and listening to the breath sounds and close monitoring for oxygen saturation
is critical for the patient. There can be an occurrence of fluid back up in the lungs leading to
shortness of breath during the exertion phase. As a nurse ensuring the patient is administered
with oxygen as needed is essential in keeping the oxygen levels adequate (Maggioni et al.,
2013).
Administration of diuretics for the patient is essential in the management of fluid
retention issues. Administering Furosemide drug is an essential nursing role in this aspect
entail administration of the diuretic drug is to have a pee plan for the patients. The action of
diuretics on the patient functions on the ability of the nephrons. The key goal of diuretics is to
ensure that the kidneys remove excess salt in the body and fluids. It is critical for the sodium
to be removed in the body. Administering Furosemide loop is essential on the lope of Henley
and leading to excretion of sodium, potassium and calcium ions (Gheorghiu & Barkley,
2017).
The key objective of management of the patient state is offering goal-directed care,
which aims at correcting the levels of fluid activity. Appropriate management of fluid
restriction is, reduced sodium consumption and usage of anti diuretics are essential for
managing the acute failure state of the patient (Marrouche et al., 2018).
Cardiogenic pulmonary edema nursing problem for the patient entails the occurrence of
acute decompensated state of the patient is occasioned by the failure of the cardiac output of
the patient due to the body’s inability to meet the metabolic needs/ the fluid overload is

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causing unstable condition which requires treatment for the management of impaired
perfusion on the systemic organs thus hampering the key function. The occurrence of this
state on the patient leads to prolonged hospitalization and increased levels of illness and
deaths (Mebazaa et al., 2015).
The state of ADHF leads to the occurrence of cardiogenic pulmonary edema which is a
fetal distress due to failure of the respiratory system. The classical presentation entails
development to dyspnoea. This is linked to fluid accumulation in the lungs and the alveolar
spaces leading to accumulated levels of the cardiac filling (Harrison et al., 2016).
The patient data assessment reveals elevate levels of pitting edema depicting and
elevated levels of fluid retention in the body. The occurring has resulted in the patient clinical
representation reflecting the accumulation of fluid retention in the alveolar occasioned and
precipitated with the crackle sounds on the chests. The occurrence of cardiogenic pulmonary
edema depicts increased hydrostatic pressure being elevated on the patient pulmonary venous
pressure, leading to an accumulation of fluid.
The pathophysiological state of the patient state of cardiopulmonary edema is
characteristics by an increased level of capillary pressure which leads to an increase in the
pulmonary venous and the elevation of left atrial pressure. The underlying primary factor is
the rapid and acute elevation of the left ventricle filling on the left atrial pressure (Botes et al.,
2018).
The occurrence of fluid transudation is further increased by the rise in the pulmonary
capillary pressure which results from increased venous pulmonary and left atrial pressure.
This takes place in the absence of the initial change of permeability. The resulting effect leads
to the filtration of protein liquid moving across the pulmonary endothelium into the
interstitial of the pulmonary site causing a decreased state of diffusion, shortness of breath
and hypoxia states (Wang et al., 2018).
The levels of cardiogenic pulmonary edema can lead to risks of pulmonary capillary
stress failure which is linked to transduction of protein fluid balance which is attributed to
low protein responding to the pulmonary capillary [pressure which leads to increased levels
of the permeability ability of the capillary wall and eventually lead to failure of blood gas
barrier ability (Obata et al., 2016). The occurring stress failure of pulmonary capillaries leads
to high levels of permeability. The stress failure of the pulmonary capillary can lead to flash

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pulmonary edema with abrupt levels of a severe increase in pulmonary pressure levels (White
& Lowe, 2018).
The occurrence of lymphatics tends to lead to increasing the accumulation of liquids
and fluids in the pulmonary capillary pressure with the ability of the lymphatic system ability
to remove excess fluids in the lungs. In an acute state of pulmonary pressure, the lymphatic
systems tend not to increase the rise of the pulmonary capillary pressure. In classical systems,
pulmonary edema leads to damage to the lungs which is mediated but the high pressures in
the pulmonary circulation system. The cardiogenic heart failure can exuberate the state of the
patient leading to congestive failure state due to the inability of the heart to pump enough
blood to the pulmonary circulation in the lungs (Powell, Graham, O'Reilly & Punton, 2014).
The patient problems, signs and symptoms are indicated by the common clinical
manifestation of cardiogenic pulmonary edema entails restlessness during sleep time,
increased levels of dyspnoea, varying levels of cough, increased levels of anxiety and noisy
breathing. The most common symptoms and signs entail difficulty in breathing and other
occurring symptoms such as coughing, anxiety and shortness of breath. These are common
symptoms depicting this state of the patient. The patient is depicting increased breathing
noise occasioned by the wheezing cough. There are increased levels of fluid overload
occasioned by the development of pulmonary edema which is linked to fluid overload as
indicated by the patient pitting edema state (Lavin, Harper & Barr, 2015).
The key fundamental nursing management for this patient entails drug therapy and
management therapy for the patients. Key nursing management is to ensure the return of
pulmonary function through the support of vital functions. With a decreased level for
consciousness, there is a need for improved mechanical ventilation process on the patient.
The key underlying nursing intervention for the patient entails three aspects; firstly there is a
need for improved respiratory function, management f underlying disease and maintaining
lung function. Pulmonary can lead to fatal respiratory distress of cardiac arrest due to reduced
levels of oxygen in the lugs. This often requires supplementary oxygen to be administered to
the patient. Oxygen application was undertaken in high concentration in order to relieve
hypoxia and dyspenia. This is essential for the patient in order to promote improved recovery
process of the airway pathway. Key steps need to be instituted to ensure a venous return to
the heart. Further management of hypoxia on the patient can be managed using oxygen
supplementary under oxygen therapy medication for the patient (Bambi, Mati, De Felippis &

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Lucchini, et al., 2017).
Medication intervention is essential with the management of loop diuretics care, acute
cardiogenic pulmonary edema often responds positively to medical treatment. Administration
of loop diuretics in nursing care is essential in order to reduce respiratory distress. Diuretics
have vasodilator effects which lower the blood pressure levels. Key nursing activities during
the process of drug administration entail offering morphine treatment in small disease
intravenously. Nursing activities entail management of respiratory depression form the
patient and close monitoring of the blood pressure, heart rates and urinary output levels.
Further incorporating continuous positive airway pressure is essential further there is a need
for assessment of the electrolyte levels from the patient as it reduces mechanical ventilation
among the cardiogenic pulmonary edema and thus can significantly reduce the mortality rate
(Ghamloush et al., 2016).
Conclusion
This case study assessment on patient Reggie showed tow key nursing issues for the
patient. The development of heart failure and cardiogenic pulmonary edema state for the
patient is essential in overall diagnosis. The patient is likely to develop heart failure due to
the weakened state of the heart and development of cardiogenic pulmonary edema due to the
acute decompensation of his heart failure. The underlying state of the patient condition
rheumatic heart disease has increased patient risks towards the development of other
complicated problems in the nursing care process. The key underlying nursing intervention
for the patient entails management of acute heart failure. Administration of relevant diuretics
management is essential for the patient further, assessment of respiratory function for the
patient is essential in enhancing the overall process. In managing cardiogenic pulmonary
edema there is a need for administration of pharmacotherapy and management of the
respiratory state of the patient. Application of oxygen therapy is essential to enhance oxygen
flow to the lungs and further diuretics for management of the fluid retention in the body.

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