Q.1.Most important risk factors of congestive heart failure include older age, high levels ofcholesterol, diabetes mellitus, high blood pressure and active smoking. Other risk factorsinclude lack of physical activity, family history, obesity and alcohol consumption.Hypertensive female are four times more prone to congestive heart failure as compared to thenon-hypertensive female. Hypertension is responsible for the occurrence of congestive heartfailure in approximately 60 % female and 40 % male. However, it is evident thathypertension is more evident in males as compared to females in all age groups. High levelsof low-density lipoproteins and low levels of high density lipoproteins are also responsiblefor the occurrence of congestive heart failure. It is evident that smoking is responsible forapproximately 36 % cases and obesity is responsible for the approximately 20 % cases of thecongestive heart failure. Consumption of high amount of saturated fat is also responsible forthe occurrence of congestive heart failure. Increased levels of B-type natriuretic peptides arealso responsible for the occurrence of congestive heart failure (Mahmood and Wang, 2013). Other cardiovascular conditions like coronary artery disease and heart attack, faulty heartvalves, cardiomyopathy, myocarditis, congenital heart defects and heart arrhythmias are thecause of congestive heart failure. Other cardiovascular risk factors responsible for theoccurrence of congestive heart failure include coronary artery disease, heart attack,congenital heart defects, irregular heartbeats and valvular heart disease. Sleep apnoea andviral infection are also responsible for congestive heart failure. Consumption of medicationslike antidiabetic medications (rosiglitazone and pioglitazone), nonsteroidal anti-inflammatorydrugs (NSAIDs), certain anaesthetics, anti-arrhythmic medications, antihypertensive andanticancer are responsible for the occurrence of congestive heart failure. Approximately 2 %and 5 % of persons in the age group 40 to 59 years and 60 to 69 years experiences congestiveheart failure respectively. Approximately 50 % of the patients diagnosed with congestiveheart failure die within five years after diagnosis. Approximately 6 to 9 times more suddendeath can occur in congestive heart failure patients as compared to the normal patients.Family members of Mrs McKenzie should take responsibility to avoid exposure of riskfactors to her. Family members should monitor eating and medication consumption in her.Family members should maintain positive communication with her because it is evident thatit can be helpful in maintaining adoption and maintenance of health behaviours. Familymembers should focus on care of Mrs McKenzie rather than worrying about her diseased2
condition because worrying about patient condition can lead to inaction in care of patient(Dhingra et al., 2014; Raman, 2016). Q2. :SymptomPathophysiologyDyspneaReduced cardiac can lead toimpaired supply of blood tothe skeletal muscle. It leadsto the augmented leftventricular filling pressureto maintain optimum cardiacoutput. It can lead toreduced pulmonary diffusionand consequently interstitialedema which results in thebreathlessness. Raiseddiastolic pressure results inthe increased expenditure ofmyocardial energy. It leadsto ventricle remodelling,raised myocardial oxygendemand and myocardialischemia. Mrs McKenzieis also experiencingbreathlessness (Güder et al.,2014). Swollen ankle Swollen ankle indicatesincreased swelling in the legor ankle. It mainly occursdue to the increased fluidaccumulation in the body.This build-up of fluid occursin the body due to decreased3
blood flow out of the heart.Release of atrial natriureticpeptide and B-typenatriuretic peptide can leadto the vasodilation andreduced ventricular fellingpressure which reducescardiac preload andafterload. It leads to the backflow of blood to the heartthrough the veins. MrsMcKenzie also exhibitedsigns of swollen ankle (Moe,2013). DizzinessDizziness can occur inpatients of congestive heartfailure mainly due toreduced supply of blood tothe brain. Reduction in theblood supply to brain canoccur when there is heartrate or rhythm is abnormal.In such case, heart would beunable to pump adequateamount of blood due toblock in the blood flowwhich can occur due tonarrowing of the valve. InMrs McKenzie also, milddizziness was observed(Kovács et al., 2014). TachycardiaLife-threatening ventriculararrhythmias can occur inpatients with heart failure.4
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