Case Study on Congestive Heart Failure

Case study on Congestive Heart Failure
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Introduction
In this case study, Mr. Smith who was 70 years old, presented to the General Practitioner at 10
am, and had an exacerbation of his CHF. The patient further complained of chest pains that
wereas pleuritic in nature, SOB, and a hacking cough characteriszed by bilateral bibasal coarse
crackles. Furthermore, the patient also complained of fatigue and weaknesses. His medical
history included hypercholesterolemia, MI, angina, hypertension, elevated BMI up to 34 and
finally T2DM. His medications include penicillin, atorvastatin 20m Mane, frusemide 20 mg
Mane and finally Metformin XR 1000mg BD. The patient described that his last meal was at
7am, 3 hours ago, comprised of bacon and eggs, sausages toast and hash browns. Prior to
presentation to the GP after 3 hoursthis 3 hours ago, the patient was walking on his farm land.
The vitals obtained include a temperature of 36.8, GCS 15, HR 105. The blood pressure was
170/90 and the Sp02 was 92%, and an RR of 24. The initial ECG showed new abnormalities,
while the initial blood indicated a negative troponin of TNI -0.02. Mr. Smith was then given his
regular medications and 5mg of Intravenous morphine and, 1gm of paracetamol that eventually
reduced the pain to 2/10 .PIVC in situ. From and the ACF-patent. From the case study, it is clear
that Mr. Smith is suffering from a certain health problem that needs urgent nursing
interventionss. Within the framework of this assignment, there will be an analysis of the priority
problem of Mr. Smith, the nursing interventions and finally the discharge planning for the
patient.
Primary priorities
According to the ABCDE framework of nursing assessment, impaired gas exchange is the health
care priority in this case, since it entails breathing. Impaired gas exchange in the case study was
evidenced by abnormal breathing and dyspnea (Athilingam 2016). This problem is due to edema,

since the blood cannot effectively pump blood, thus it accumulates in veins that take blood to the
lungs. The excessive fluids impairs movement of oxygen in the lungs, thus leading to impaired
gaseous exchange.
After adhering to the ABCDE framework, the second health care priority is decreased cardiac
output. This is due to vital signs and symptoms of the patient such as tachycardia, breathlessness,
hypotension, fatigue and thread pulse. Decreased cardiac output is a priority since pPatients with
congestive heart failure are likely to experience peripheral edema that is life threatening. This is
due to the likelihood of fluid overload (Bos-Touwen et al.et al 2015). According to recent
studies, renal perfusion begins to fail once the heart also starts to fail. The kidney then responds
by increased production of renin, thus more of aldosterone is produced. Subsequently, there is
elevated retention of sodium and water. During this time, more of the Vasopressin is secreted as
well. This further leads to further fluid retention and the urge to drink more fluids (Bratzke et
al.et al 2016). It is, then, the activation of both the renin-angiotensin, aldosterone and the AVP
which sustains more fluids, as well as vasoconstriction, which is due to angiotensin ii. In the long
run, homeostasis of the cardiovascular system is maintained, though at a cost of elevated
systemic venous pressure.
Interventions
Administering supplemental oxygen is one of the many nursing interventions in the case study.
During the nursing assessment, the pulse oximeter readings were 92%. This is an abnormal value
since the normal or healthy values should be more thanfrom 94% up to 100% (Yagawa 2013)
("Congestive Heart Failure" 2013). Therefore, the goal of this nursing intervention is to ensure
that the PaCO2 and PaO2 return to the normal levels. Scientists have conducted several studies on
the functions of the heart and found out that it is the heart that is responsible for supplying blood

to other parts of the body. However, In the case of Congestive Heart failure like, as in this case
study, the muscles of the heart become weak and as a result, the heart might not be able to pump
out normally. In the long runAs a consequence, the body does not get enough oxygen. This calls
for the need forof supplemental oxygen therapy.
The aim of sSupplemental oxygen therapy is for the patient to breathe in additional oxygen so
that it is enough or meets the demands of the body. However, this nursing intervention does not
cure congestive heart failure (Cui, Dong, Zheng, & Li 2019). However, it only prevents serious
complications that can be as a result of low oxygen in the body, like damage to the brain and the
heart. The intervention can also assist in symptoms like shortness of breath as well as swelling or
pleuriticpleuritic (Inflammation of the pleural cavity).
During the supplemental oxygen therapy, the nurse will provide an artificial source of oxygen
which the patient can breathe in either by the use of a mask that goes over the mouth and nose or
a nasal cannula. The nasal cannula is comprised of two small tubes, which the nurse ensures that
they sit both nostrils inside of the nose (Doherty, Fitzsimons, & McIlfatrick 2015). The oxygen
comes in either as a liquid or a gas from a cylinder in a certain tank. BesidesAs well, the nurse
can also provide a machine known as an oxygen concentrator. The factors that determine the best
method include the quantity of oxygen needed, how often the patient needs the oxygen and
finally the costs or the insurance cover for the patient.
The nurse will be required to determine the level of oxygen in the patient’s body, either by using
a blood test or a pulse oximeter. The pulse oximeter is to be placed either on the ear lobe, finger
or the toe. However, this method is not as accurate as the a blood test (Garbi & Allen 2017).
Once the nurse has found outmeasured the level of oxygen in the patient’s body, he/she can then
prescribe the level or quantity of oxygen and the frequency or time duration to be provided. The