Causes, Incidence and Risk Factors of Congestive Cardiac Failure

This document discusses the causes, incidence and risk factors of congestive cardiac failure, its impact on the patient and family, common signs and symptoms and their underlying pathophysiology, two common classes of drugs used for patients with congestive cardiac failure and their physiological effects, and nursing care strategies to be used within the first 24 hours post admission for a patient with congestive cardiac failure.

Case Study

TABLE OF CONTENTS
1. Causes, incidence and risk factors of the identified condition and its impact on the patient
and family....................................................................................................................................1
2. Five common signs and symptoms of the identified condition with a link to their underlying
pathophysiology...........................................................................................................................2
3. Two common classes of drugs used for patients with the identified condition including
physiological effect of each class on the body. This does not mean specific drugs but rather the
class that these drugs belong to...................................................................................................3
4. 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.................................4
REFERENCES................................................................................................................................6

1. Causes, incidence and risk factors of the identified condition and its impact on the patient and
family
This is to state the causes of Congestive Cardiac Failure (CCF) in a 77 years old female
Mrs Sharon where she has a past medical history of MI being the biggest reason behind it. CCF
is basically referred to be a severely advanced condition of heart failure that impacts upon the
pumping power of one’s heart muscles. Being commonly regarded as heart failure, CCF refers to
an advanced phase of fluids building up everywhere around the heart making it difficult for the
heart to effectively pump blood (Tissot, da Cruz & Miyamoto, 2014). It is however a life
threatening ailment that requires prompt medicinal treatment. With a foremost cause of
myocardial infarction (MI), a high rate of blood pressure has stated to be yet another reason
behind the illness of Mrs Sharon where hypertension directly leads to CCF. It is due to a
foremost consequence of hypertension that tends to narrow down the arteries, making it difficult
for the blood to effortlessly flow in the body.
The incidence of CCF is higher in people aged more than 40 years where 10 out of 1000
individuals ageing nearly 65 years or above have a greater chance of dealing with a CCF. It is
specified to be a public health issue with a prevalence of more than 23 million elderly
populations, all over the globe. In Australia, it is known to affect near about 1.2 million people
and is often found to be a foremost reason behind deaths (Swedberg, Komajda & Shift
Investigators, 2012). In the year 2015, it has claimed nearly 20, 000 Australians by killing 1
Australian in every 27 minutes. There together exist some other associated risk factors that leads
to an increased chance of CCF. This involves cardiomyopathy where Mrs Sharon also suffered
from inflamed ankles. Also, it has a higher risk of development in case an individual is diabetic
and has thyroid related disorders with excessive and illegal use of several alcohol and drugs like
cocaine, etc. Illness related to heart valves with irregular heartbeats or any congenital heart
disease also results in it.
CCF results in affecting both the patient and their family members to a great extent. It is
where the patient suffers both mental and physical challenges to cope up with the associated
syndromes of CCF (Ramaraj & Movahed, 2010). An increased shortness of inhalation and pain
in chest are some physical issues faced by patients like Mrs Sharon with some deals with
psychological trauma and goes in the state of depression. Considering the impact on family, the
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social support meant to be received from the family members tends to shatter for being unable to
cope with the disease and the costs and other related factors associated with it.
2. Five common signs and symptoms of the identified condition with a link to their underlying
pathophysiology
Signs and Symptoms of CCF Pathophysiology
1. Enlarged heart This is on considering the presently identified
state of Mrs Sharon whose heart has increased
in size, resulting in atrocious consequences of
CCF. This is due to an abnormal heart valve
and high blood pressure.
2. Increased swelling on the lower limbs
like ankles and legs
Swollen ankles directly indicates the risk of
heart failure where swelling in ankles is a vital
sign of oedema that occurs due to the
accumulation of fluid in the body. It is with a
similar case of Mrs Sharon who is apparent to
deal with the issues mainly at the daytime
(Choueiri, Mayer & Schutz, 2011). It is
because of an increased gravity that in turn
raises the blood pressure. This is due to an
accumulated fluid from a decreased flow of
blood in the body due to the blood flowing out
of the heart and returning back by the veins.
3. Hypertension Hypertension is proven to be a significant risk
factor for heart related diseases that ultimately
leads to stroke with a similar case of Mrs
Sharon who is currently suffering from CCF.
Currently she is suffering from the stage 2
level of hypertension which is also known as
the secondary stage of hypertension. This is
due to the signs of stimulating sympathetic
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nervous system that plays a vital role in
normalizing the rate of blood pressure. Herein,
the potassium level of the patient has found to
be low in comparison to the standard level.
4. Pulmonary edema This is due to an excessive fluid in the lungs
that makes it difficult for the patient to breath
(Fukushima, Nakanishi & Iwai, 2011). Mrs
Sharon in the present case has shown some
high altitude symptoms of pulmonary edema
which is due to difficulty in inhalation without
exertion or exercise. Some other symptoms
involve her complaints of mild nausea and
dizziness.
5. Confusion or impaired memory Confusion being a common sign of old age is
severe at times and is often referred to be a
vital sign of delirium. On considering the
present case of Mrs Sharon, it is due to certain
medications that she has been prescribed for
the treatment of her MI. Although, her
consumption of medicine is irregular and does
not follow the prescribed norms.
3. Two common classes of drugs used for patients with the identified condition including
physiological effect of each class on the body. This does not mean specific drugs but rather
the class that these drugs belong to.
There are different types of classes of drugs that can be used by patients for the condition
of Congestive cardiac failure. With this respect below given are two of them:
ACE inhibitors: This is a system that plays important role in development of issues like
congestive heart failure (Abraham, Compton and Hettrick, 2011). Among patients with
angiotensin converting enzyme inhibitors like quinapril, enalapril and captopril. These are shown
to improve increase exercise capacity, reduce diuretic requirements, correct hyponatremia,
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reduce symptoms of dyspnea and hemodynamics. With the help of ACE inhibitors, it enables to
reduce circulating levels of angiotensin II and reduces plasma vasopressin and norepinephrine
levels. These are effective enough for the patients with mild to moderate heart failure and people
with severe cardiac impairment (Tamariz, Harzand and Hare, 2011). In addition to this, they are
as effective for patients with myocardial failure and these can also be considered as first line
therapy. There are many researches carried out and it has determined promising results for
patients with myocardial infarction and preventing increase in heart size (Boxer, Kleppinger and
Kenny, 2010). Further, it also improves prognosis in patients who have severe heart failure and
others with hyponatremia.
Beta blockers: This is helpful enough to improve survival and especially prevent who are
struggling from death. The condition of patients gets improved when use of this type of class is
done. Further, it is generally used for the patients who are above the age of 65. The rate of
support that a patient gets with the help of this class is high (Harzand, Tamariz and Hare, 2012).
There are researches conducted and this is helpful enough to overcome the risks that are faced by
patients in effective manner. Apart from this class, there are other type of classes as well that are
also effective enough to support the rate of heart failure.
4. 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
As a registered nurse, there are some specific priorities that have been specified in order
to implement within 24 hours of the post admission of the patient because in various cases, it has
been observed that due to the negligence of the doctors and nurses, the patient may have to suffer
a huge loss and sometimes death as well (Abraham, Compton and Hettrick, 2011). So, there are
some nursing care strategies that can be implemented in order to provide an efficient amount of
support and treatment to the patient within 24 hours of their admission only. Although, every
such patient should be on the priority of the practitioner, but even if they are indulged in some
other emergency cases, the authority should ensure to provide the treatment within the 24 hours
of the admission only. One of a very well-known strategy implies the fact that despite of giving
more importance to the documentation, the hospital authority should ensure starting the
treatment of the patient so that they may not have to face any further loss because of such
factors. Once the treatment procedure has been started, then they can continue the documentation
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process (Tamariz, Harzand and Hare, 2011). Also, ensuring the cleanliness of all the wards,
whether the male or the female wards, they should be prior cleaned so that the patient may not
have to wait outside till the room gets cleaned. Making interactions with the patient can actually
help them to feel comfortable as the same in the case of Mrs Sharon also because it is obvious
enough that when a person gets admitted to such an environment, it somewhere affects the
mental stability of the person as well because the person is aware enough that in such an
environment, they cannot do as they want They feel bounded and it affects their mental health to
an extent. So, in such cases, interacting with them in a very friendly manner can make them feel
quite comfortable in such environment. Another important strategy is making a well interaction
with Mrs Sharon because it will help her to feel comfortable as well. This will further help as
once she will feel open and comfortable, she can also discuss her own thoughts and issues with
the nursing staff (Boxer, Kleppinger and Kenny, 2010). It will help the nursing staff to get more
clear about her situation, thus an efficient and appropriate care can be provided to her. Therefore,
these can be classified as the nursing care strategies that can be considered for Mrs Sharon as
well to provide them an efficient and appropriate level of treatment.
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REFERENCES
Abraham, W. T., Compton, S. & Hettrick, D. A. (2011). Intrathoracic impedance vs daily weight
monitoring for predicting worsening heart failure events: results of the Fluid Accumulation
Status Trial (FAST). Congestive Heart Failure. 17(2). 51-55.
Boxer, R., Kleppinger, A., & Kenny, A. (2010). The 6‐minute walk is associated with frailty and
predicts mortality in older adults with heart failure. Congestive Heart Failure, 16(5), 208-
213.
Choueiri, T. K., Mayer, E. L., & Schutz, F. A. (2011). Congestive heart failure risk in patients
with breast cancer treated with bevacizumab. Journal of Clinical Oncology, 29(6), 632-638.
Fukushima, Y., Nakanishi, M., & Iwai, N. (2011). Assessment of plasma miRNAs in congestive
heart failure. Circulation Journal, 75(2), 336-340.
Harzand, A., Tamariz, L., & Hare, J. M. (2012). Uric acid, heart failure survival, and the impact
of xanthine oxidase inhibition. Congestive Heart Failure, 18(3), 179-182.
Ramaraj, R., & Movahed, M. R. (2010). Reverse or inverted takotsubo cardiomyopathy (reverse
left ventricular apical ballooning syndrome) presents at a younger age compared with the mid
or apical variant and is always associated with triggering stress. Congestive heart failure,
16(6), 284-286.
Swedberg, K., Komajda, M., & Shift Investigators. (2012). Effects on outcomes of heart rate
reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-
blocker dose?: findings from the SHIFT (Systolic Heart failure treatment with the If inhibitor
ivabradine Trial) study. Journal of the American College of Cardiology, 59(22), 1938-1945.
Tamariz, L., Harzand, A., & Hare, J. (2011). Uric acid as a predictor of all‐cause mortality in
heart failure: a meta‐analysis. Congestive heart failure, 17(1), 25-30.
Tissot, C., da Cruz, E.M. & Miyamoto, S.D. (2014). Congestive Heart Failure. In Pediatric and
Congenital Cardiology, Cardiac Surgery and Intensive Care (pp. 2045-2062). Springer
London.
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