Case study of chronic systolic heart failure of a diabetic female student

The patient was exhibiting symptoms of severe dysphonia, high respiratory rate, low oxygen saturation, high blood pressure, high pulse rate and bilateral basal crackles in lungs.Taking a deep insight into the situation, she exhibited atrial fibrillation which is defined as irregular and often rapid heart rate which can increase the risk of heart failure. In the case of the healthy individuals, the normal pulse rate is 60 to 100 beats per minute whereas, in the case of the patient, the pulse rate of the patient

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Name of the student:
Name of the University:
Author’s note

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Question 1:
The case study represents chronic systolic heart failure of Mrs brown who is 78 years
old female, admitted to the emergency department at 6 am after waking up with severe
breathlessness or dysphonia. Her family suggested that she had a history of heart failure for
approximately 2 years. The ECG monitor of the Mrs Brown showed atrial fibrillation and
diagnosis was done for acute exacerbations of systolic heart failure.
The patient was exhibiting symptoms of severe dysphonia, high respiratory rate, low
oxygen saturation, high blood pressure, high pulse rate and bilateral basal crackles in lungs.
Taking a deep insight into the situation, she exhibited atrial fibrillation which is defined as
irregular and often rapid heart rate which can increase the risk of heart failure. Hopper and
Easton (2017), suggested that the common cause of the atrial fibrillation include high blood
pressure, abnormal heart valve, sick sinus syndrome, lung diseases which were observed in this
patient of the case study. Ge et al. (2019), suggested that in the case of healthy individuals, the
heart is made up of four chambers where two uppers and two lower. In the upper-right chambers,
a group of cells called the sinus node to facilitate the production of each heartbeat (Zhang,
Schulz & Punyadeera, 2016). The signals usually travel through the upper heart chamber and
connecting pathways and with each movement of the blood causes the heart muscles to squeeze
for sending the signals to the heart and body.
In the case of atrial fibrillation, the signals produced from upper chambers become the
chaotic and electrical connection between atria and ventricle is bombarded with the impulses
(Savarese & Lund, 2017). Consequently, the proper function of the heart was disrupted which
facilitate high pulse rate and disrupt the synchronization between systolic and diastolic blood

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pressure. In this current context, the heart can’t pump with enough force for pushing the blood
into circulation in each resting period between each heartbeat. The lack of proper function of the
cardiac muscles is associated with abnormal pulse rate as observed in this case study. In the case
of the healthy individuals, the normal pulse rate is 60 to 100 beats per minute whereas, in the
case of the patient, the pulse rate of the patient was 120 beats per minute (Kober et al., 2016).
The atrial fibrillation of the patient also increases the respiratory rate due to low oxygen
saturation in the blood as cardiac muscles failed to provide enough amount of oxygen in the
blood. In the case of healthy individuals, the normal respiratory rate for usually is between 12
and 20 breaths per minute (Prabhu et al., 2019). The breathing rate of below 12 or above 20
breathes indicate a disruption of breathing process as observed in this case study. In case of the
patient, the respiratory rate was 24 breaths per minute, indicating abnormal respiratory rate due
to the inability of providing enough oxygen to the heart (Sahle et al., 2016). On the hand, the
respiratory rate is usually high because of the low oxygen level in the blood. In case of normal
individuals, the oxygen saturation should be in between 94 percent to 100 percent which
indicates adequate oxygen supply in the blood (Andersen et al., 2016). However, in this case,
the patient had an oxygen saturation of 85 percent, indicating very low saturation in the blood
which further affects the normal function of the cardiac muscles. In this case, due to the low
oxygen level, the patient experienced severe breathlessness which is called dysphonia. The
dysphonia can be observed due to the permanent damage to the lungs of the patient (Andersen et
al., 2016). The case study highlighted that bilateral basal crackles were observed in the case of
the patient. Chew et al. (2016), suggested that it refers to the presence of basal crackles in both
lungs. The crackles the patient is observed because of the small airway and collapsed by the fluid
buildup in the lungs or lack of aeration. Hence, while the patient exhibited different symptoms of

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chronic systolic heart failure, all clinical manifestations are interconnected with chronic heart
failure (Andersen et al., 2016).
Question 2:
In this current context, two nursing strategies would be oxygen therapy and high
protein-high vegetable- low carbohydrate diet without salt and Digoxin which would be provided
to the patient for managing the heart failure. Considering the first strategy, the supplemental
oxygen is a type of therapy which is has been used for more than century for managing chronic
systolic heart failure. The rationale behind using this therapy as a nursing strategy, it is used in
the clinical setting to prevent the damages of the cells and tissues of brain and heart which
otherwise severely affected in presence of low oxygen as observed in this case study (Khor et al.,
2017). Atherton et al. (2018), suggested that hyperbaric oxygen therapy is one of the most of the
crucial therapy which increases the amount of oxygen in the blood. An increase in blood oxygen
temporarily restores the normal levels of the blood gases as well as tissue function to promote
healing and reduces the shortness of breath which was experienced by the patient (Fraser et al.,
2016). Hence, it is one of the most suitable nursing intervention for managing chronic systolic
heart failure. Considering the second nursing strategy, the best suitable method for managing
chronic systolic heart failure would be the modification of diet into cardiac friendly diet along
with the administration of the medication such as Digoxin. The rationale behind providing the
cardiac friendly diet such as high protein, green vegetable, and low carbohydrate diet facilitate
the normal function of cardiac muscles and prevent the further damage of tissues of the heart
(Itsiopoulos et al., 2018). High protein diet such as fish, meats, poultry egg, vegetables such as
carrot, lettuce, spinach, and the tomato would be best suitable diet and it should be devoid of
sodium chloride as sodium chloride facilitate the increase of heart pressure. On the other hand,

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digoxin is cardiac glycosides which work by reducing the level of potassium and sodium inside
the cardiac cells (Lopes et al., 2018). Consequently, this reduces the strain on the heart and helps
it maintain a normal, steady and strong heartbeat (Chan et al., 2019).
Question 3:
As observed in this case, the patient was administrated with sublingual Glyceryl
Trinitrate and Lasix to reduce the symptoms of chronic systolic heart failure. Considering
Sublingual Glyceryl Trinitrate, it is a prodrug which is required to denitrated with the assistance
of nitrate anion or associated species in order to produce active metabolite nitric oxide
(Thompson, 2016).. The organic nitrate is used for reducing the pulmonary vascular resistance
where it acts as vasodialating agents. This drug is placed under the tongue which can be
absorbed by the sublingual gland directly goes to the heart for the relaxation of vascular smooth
muscle as it causes the relaxation of the atrial and ventricle by increasing the cGMP level within
the cell and stimulates dephosphorylation of myosin (Narayan et al., 2015). Hence it is suitable
pharmacological intervention for reducing high blood pressure and heart failure.
On the other hand, it is Lasix (furosemide) is a loop diuretic which prevents the body
from absorbing too much salt as salt absorption disrupts the normal synchronization of systolic
and diastolic blood pressure. It inhibits water reabsorption in the nephron by blocking the
sodium-potassium-chloride cotransporter (NKCC2) in the thick ascending limb of the loop of
Henley and passes the salts to the urine and reduces fluid retention in patient (Flather et al.,
2016). As the patient had crackles in the lungs and high blood pressure, diuretics would be best
possible management therapy for the patients.

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