Case Study Essay on Acute Exacerbation of Chronic Heart Failure

Running head: CASE STUDY ESSAY
Case study essay
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CASE STUDY ESSAY
The case study chosen for this assignment represents a patient name Dorothy Miller.
Dorothy is a 73 year old woman who lives alone and independently after being widowed
since she lost her husband 3 years ago due to pancreatic cancer. Dorothy presented to the
healthcare facility with the complaint of acute exacerbation of chronic heart failure and she
was rushed to the coronary care ward. Her past medical history includes cardiac failure
along with atrial fibrillation, elevated blood cholesterol level, non insulin Diabetes mellitus,
and fractured neck of femur. As a bedside nurse, the first and most important activity is to
carry out a few key assessments, including neurological, cardiovascular, and respiratory to
understand the exact complications that the patient is exhibiting the signs of. The
neurological assessment revealed that the patient is coherent; however, exhibiting signs of
confusion with respect to time and place. The cardiovascular assessment discovered that her
hands are cool to touch and are pale in colour along with her capillary refill time being
approximately 3 seconds with signs of pitting peripheral edema around ankles. After
palpating her pulse, I discovered that her pulse rate is 113 and irregular along with her blood
pressure be 95/54 mmHg which indicates and hypertension. Respiratory assessment
describes low oxygen saturation at 92% on trauma and high respiratory rate as 29 breaths per
minute which indicate at the patient being short of breath. The chest X-ray and other
assessments carried out on the patient discovered the patients to be developing pulmonary
edema as a result of actual fibrillation along with acute renal failure attributed to her
declining potassium levels at 5.7 mmol per litre.
Pathophysiology:
Discussing the pathophysiology of the condition that the patient has developed it has
to be mentioned that her congestive heart failure was the result of the atrial fibrillation, which
eventually lead to pulmonary edema (Kirchhof et al., 2016). The past medical history of the
patient reveals that she already had gone through an arrest and atrial fibrillation. Now it has

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CASE STUDY ESSAY
to be acknowledged in this case that the past medical history of Dorothy Millar, the elevated
cholesterol levels and non- insulin diabetes are extreme risk factors for developing
cardiovascular diseases and cardiac failures due to arteriosclerosis and arterial blockage.
Similarly, the age of the patient is also very important risk factor which further enhances the
risk of the patient going through multiple cardiac arrests due to deteriorating cardiac output
and engaging blockage. Hence, age, type 2 diabetes and high blood cholesterol levels coupled
with previous heart damage due to cardiac arrest enhanced her probability of suffering
another attack (Verma et al., 2015).
Arterial fibrillation can be defined as an abnormal heart written that is characterized
by Rapid and irregular beating of the Atria. The contribution factors to developing atrial
fibrillation are extremely high blood pressure and valvular heart diseases, although in this
case Dorothy did not have high blood pressure, but the coronary arterial disease due to
arteriosclerosis which is most possible outcome of her high blood cholesterol and type two
diabetes lead to the condition. As discussed by Douketis et al., (2015) atrial fibrillation can
be considered as one of the most common serious cardiac and process which has almost 10%
chance of affecting people aged from 70 years to 89. Atrial fibrillation is known to affect all
four stages of ventricular filling including isovolumetric relaxation, early Rapid filling,
diastasis, and atrial systole. Most cases represent the occurrence of atrial fibrillation to be
associated with thick ventricles and leading to diastolic dysfunction, which in turn leads to
three basic problems, impaired ventricular lusitropy, decreased ventricular compliance, and
increased atrial filling pressure. These three factors when combined leads to excess addition
of the diastolic dysfunction, which in turn can lead to cardiac arrest, which has been the case
for Dorothy as well (Gibson et al., 2016).
Her heart rate at 113 BPM and irregular indicates at the atrial fibrillation, which is
manifested as tachycardia in the patient and the drop in high blood pressure is due to the