Clinical Case of Congestive Cardiac Failure

This clinical case discusses the causes, symptoms, and management of congestive cardiac failure. It explains the pathophysiology behind the condition and the role of medications in its treatment. The case also highlights the importance of nursing interventions and care plans for patients with congestive cardiac failure.

Clinical case of congestive cardiac failure 1
CLINICAL CASE OF CONGESTIVE CARDIAC FAILURE
Student’s Name
Institutional Affiliation

Clinical case of congestive cardiac failure 2
Question 1
Congestive cardiac failure is a severe medical condition caused by inability of the heart to
function efficiently. It arises when the heart is unable to pump blood effectively to the rest of the
body. The heart muscle also called the myocardium is a smooth muscle that is designed to
contract by itself. The left ventricle of the heart is responsible for pumping blood to the rest of
the body parts except the lungs via the aorta. The right side on the other hand is responsible for
pumping blood to the lungs for oxygenation via the pulmonary artery. The most commonly used
term for congestive cardiac failure is heart failure. It is a chronic condition and worsens over
time if not managed. When the heart fails, distal parts of the body including the legs and arms do
not get enough blood supply and this has its consequences (Miller, 2016).
Mrs. McKenzie is an example of a patient suffering from congestive cardiac failure. The
condition has a wide range of manifestations. As the name suggests there is a significant fluid
buildup around the heart and within the chest area. As shown in Mrs. McKenzie’s case, there is
a considerable fluid accumulation in the lungs and swelling of the arms, legs, ankles. The clinical
manifestation of the condition vary depending on the side of the heart that is affected (Harjola et
al, 2017). Both sides of the heart can be affected hence the general term. In cases where there is
left sided heart failure, the fluid accumulation mainly takes place in the lungs thus the
presentation of symptoms related to pulmonary edema. On the other hand if it is a right sided
failure, there is more of fluid accumulation in the legs, ankles and arms. This presentation is
referred to as peripheral edema.
The major causes of congestive cardiac failure are other diseases that affect the heart.
Some of these cardiac related diseases can be severe and fatal hence require immediate attention.
These diseases include myocardial infarction, severe hypertension, coronary artery disease and

Clinical case of congestive cardiac failure 3
other diseases that may affect valves of the heart such as rheumatic fever. These conditions can
be prevented by healthy lifestyles and early detection and management can be beneficial to
prevent development of the disease (Reddy et al, 2016). Hypertension for example is as a result
of raised blood pressure that can be prevented by checking salt levels in the diet. There are
several risk factors that influence development of cardiac failure. These include diabetic
conditions, obesity and thyroid disease. These risk factors can also be prevented by healthy diet
and lifestyles.
The incidence of the disease is influenced by a number of factors. For example, there is
high incidence rate of the disease associated with old age. The occurrence of the disease among
people aged 65 years and above is higher than that of any other age group (Buglioni & Burnett,
2015). On the other hand, there is a low incidence of the disease among people less than 40 years
of age. About three percent of the population aged 40 to 60 years are affected by the disease.
This is in contrast to over five percent of the population above 60 years of age which are affected
by the same disease. The disease has a huge influence to the patient’s health and life as a whole.
The fear of death and job loss is commonly associated with affected persons. The families of the
affected also suffer considerable depression and may be directly affected if the patient was the
bread winner at home.
Question 2
There are a number of symptoms and clinical manifestations related to this condition. The
patient experiences pulmonary edema. This is the accumulation of fluid in the lungs and alveoli.
This directly affects the respiratory functions of the patient. In such a case, the patient presents
with shortness of breath also referred in medical terms as dyspnea. The shortness of breath
considerably worsens with little exertion. The severity of the condition is measured by its

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presentation with minimal physical activity (Mentz & O'connor, 2016). The shortness of breath
for example can be exacerbated with minimal physical activity such as walking. In another case
it might be due to as little effort as lifting the arm and in another worse condition, it may present
even at rest. The stages of severity can be identified by monitoring such symptoms. The patient
might also present with increased breathlessness when lying flat (orthopnea) which can be
relieved by propping up the patient with pillows.
The pathophysiology behind this presentation is low oxygen supply to tissues due to low
blood supply. This causes the body to respond by increasing breathing rate. Another major sign
associated with this condition is swelling of the arms, legs and ankles as illustrated in
McKenzie’s case. The pathophysiology behind this classical symptom is the accumulation of
fluid in peripheral tissues from congestion in the systemic capillaries. Increased backflow of
blood due to decreased pressure and pumping power of the heart causes fluid to be sieved from
the capillaries into the tissues causing edema formation (Urso, Brucculeri & Caimi, 2015).
There are a number of forces that come into play when it comes to edema formation in
peripheral tissues. These forces include hydrostatic pressures, capillary pressure and oncotic
pressure. Edema formation in peripheral tissues is mainly a sign of right sided heart failure as
opposed to left sided failure (Harada et al, 2016). Another important sign of congestive cardiac
failure is decreased urinary output. The major cause of this is increased urge of urination.
According to Angelini et al. (2016), this is caused by the fact that there is increased fluid
accumulation within the body hence the nephrons act to increase elimination of the same as a
normal physiological response in an attempt to reverse the condition.
Question 3

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Frusemide was prescribed to Mrs. McKenzie in an attempt to manage the condition. It
falls under the broader classification of loop diuretics. The pharmacodynamics of a drug focusses
on the mechanism of action of the drug. Loop diuretics act on the thick ascending loop of Henle.
In this loop, they act by blocking a cotransporter of ions related to water retention. They act by
blocking the sodium, potassium, chloride symporter in the nephrons (Colombo et al, 2015). This
has a major influence on the disease management as there is reduced water reabsorption. Water
reabsorption in the kidney is influenced by sodium reabsorption in a directly proportional
mechanism (Boon & Durham, 2017). When sodium reabsorption is stopped by the effect of these
drugs, water reabsorption is also limited and more fluid is lost in urine.
The pharmacokinetics of drugs is a part of pharmacology that deals mainly with
absorption, distribution, metabolism and excretion of drugs. Loop diuretics have different
pharmacokinetics depending on the specific drug. Frusemide for example is absorbed from the
gastrointestinal system and its absorption is not influenced by food or fluid intake. In cases of
some clinical complications such as uremia however, its uptake is significantly low. It has a half-
life of about 60 minutes and its apparent volume of distribution is about 15 liters. Loop diuretics
have a short duration of action and this makes them suitable for diuresis (Arrigo et al, 2016).
Excretion is mainly by renal means.
Question 4
Congestive cardiac failure is a serious medical condition and therefore requires quick
intervention and a well-structured nursing care plan. The subjective data as explained by the
patient must be transformed into an objective data for the condition to be managed in the most
efficient manner. The physical examination of the patient such as Mrs. McKenzie is important to
obtain a detailed objective data. In this particular case, there was visible edema of the legs and

Clinical case of congestive cardiac failure 6
feet. Gambardella et al. (2016) states crackles in the base of the lung are significant diagnostic
measures in detecting pulmonary edema. The patient might complain of severe chest pains and
this data might be further dug deeper by the nurse to obtain information as to the character of the
pain and the location within the chest.
Monitoring of the heart rhythm is an important nursing intervention and rationale. A 12
lead ECG is used to monitor the progress and detect the severity of the condition. A person with
the condition tends to have low ECG voltage and this voltage increases significantly with
management of the condition (Gargani et al, 2015). Diet change plan can be part of the nursing
care plan in the management process of the patient. Salt intake levels should be reduced in the
diet of the patient. This is a long term management scheme as it should become part of the
patient’s diet routine even after treatment. Increased salt intake causes increased water retention
in the kidney which would rather worsen the condition rather than manage it. Assessment of the
patient’s respiratory function is an important nursing intervention as it helps the nurse understand
the progress of the condition.
Since the disease directly affects the lungs by accumulation of fluid, there is a significant
change in the respiratory process by the disease. Shortness of breath and increased breath rate are
important aspects of the disease that should be carefully monitored with treatment. Where the
treatment process is effective, the patient assumes a regular breathing rate and this is not affected
by exertion (Ter Maaten et al, 2015). Another important nursing strategy is the measurement of a
hormone important in monitoring progress. The brain natriuretic hormone is released by the heart
in stressful conditions. When the congestive cardiac failure has progressed and not responding to
treatment, there is a significant rise in the levels of this hormone. It is important for the nurse to
monitor and assist in medication of the patient. Administration of diuretics is of importance and

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monitoring of this process by the nurse is important as it ensures the patient does not skip any
dose hence assisting in the recovery process.

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