Cardiac Oedema Nursing Care Experience

This assignment details a nursing student's personal experience caring for a patient experiencing cardiac oedema. The student describes the patient's mobility patterns and how they contributed to managing oedema development. They also highlight the importance of effective nursing care practices in treating this condition, particularly in cases where it might indicate multi-organ failure. References from relevant nursing and medical journals support the student's insights.

CNA255: Scenario 2- Mr Clive Jenkins
Consider the patient
situation
Mr Clive Jenkins is a 78 year old retired navy engineer with a history of Congestive Cardiac Failure after suffering a severe myocardial infarction 2
years ago that affected both ventricles. Since that time, Mr Jenkins has recently been diagnosed with Dementia and as a result, it has been
difficult for him to sustain the necessary life-style adjustments required to prevent exacerbations of his condition. This has resulted in several
admissions to hospital for management and review of his congestive heart failure. For this admission, Mr Jenkins was referred to hospital by his
GP after recently gaining weight (currently 95kg) since his last visit the week prior. The time now is 0800 and you have just come on for your
morning shift. Mr Jenkins has been on the ward for only two hours after spending the 18 hours in emergency waiting for a bed to become
available.
Collect Cues Review:
Please refer to documentation provided via the MyLO site.
Gather new information (patient assessment):
Upon undertaking a further assessment of Mr Jenkins you obtain the following new information:
Vital Signs
RR: 24
Sp02: 94% on 2lt via nasal prongs
Temp: afebrile
HR: 112bpm
BP: 150/90
Mr Jenkins appears ‘pleasantly confused’ as you speak to him where you notice he becomes short of breath as he attempts to reposition himself
in bed and is reluctant to get up as he feels so tired. You also note he has already drunk the 1 litre jug of water provided to him when he arrived.
Other information
BGL within normal range
GCS 14 (confused)
Peripheral pulses difficult to palpate due to presence of pitting oedema in both feet. Evident rash noted on left leg. Capillary return < 5 seconds.
Current weight 97kg.
Raised JVP
Passing urine in bottle.
Abdomen soft and non-tender. Bowel sounds present.
Recall:
Recall and apply your existing knowledge to the above situation to ensure you have a broad understanding of what is/may be occurring before
proceeding with the rest of the cycle (self-directed)

Process Information Interpret:
List the data that you consider to be normal/abnormal below (not included in word count)
Normal Abnormal
On assessment of the clinical symptoms presented by the patient,
the observations were noted down by the nursing professional. The
patient depicted a respiratory rate of 24 whereas the normal
respiratory rate should be between 25 -40 breaths per minute. The
partial pressure of oxygen depicted by the patient was 94% with
the help of nasal prongs. The patient did not show any signs of
fever
The patient recorded a heart beat rate of 112 per minute.
Additionally, the patient recorded a high blood pressure of
150/90 and appeared confused.
The high rate of heart beat along with high blood
pressure could be attributed to the insufficient pumping by the
heart.
Relate & Infer:
 Relate the two most significant abnormal findings to the underlying physiology/pathophysiology to justify why it is considered abnormal in
this context.
 Based on your interpretation of all the information/cues presented, form an overall opinion on what may be happening and justify your
answer (400 words).
Some of the other clinical symptoms expressed by Mr. Jenkins were also considered to analyse the detailed health condition presented
by the patient. Further analysis showed that the blood glucose level of the patient were within normal limits. Oedema was found to be
present on both feet of the patient. Rashes were also found to be present in the left leg of the patient. The patient also depicted raised
jugular blood pressure and was put on type IV oral administration along furesomide to treat build up of tissue fluid accumulation and
ramipril to relax muscles around small arteries, which can help in revival of the pumping capacity of the heart.
The three main clinical symptoms expressed in the patient were development of oedema, sinus tachycardia and mental
confustion. As mentioned by Hunter and Arthur (2016), congestive heart failure is one of the most important causes of peripheral
oedema. It is activated by a series of humoral and neurohumoral mechanisms that promotes sodium and water absorption by kidneys
and results in expansion of extracellular fluid resulting the swelling of hands and feet. The increased jugular vein pressure could also
promote fluid extravasation. The oedema is characterised by increased movement of fluid from the intravascular to the interstitial
space. It activates the renin-angiotensin-aldosterone- vasopressin (ADH) system resulting in renal sodium retention. As mentioned by
Mebazaa et al. (2015), combination of diuretics and vasodilators has been seen to relieve the formation of oedema to a greater extent.
Additionally, the patient also showed clinical symptoms of sinus tachycardia where an abnormal heart beat rate was noted in
the patient. The patient expressed heart rate of 112 beats per minute which was much above the normal heart rate of 72 beats per
minute. It could be attributed to the condition of sinus tachycardia present in the patient. The sinus tachycardia is a condition, which
arises as a result of the inability of the SA node to effectively transmit impulses. As mentioned by Platz et al. (2015), the
development of the condition could be attributed to the fall in arterial blood pressure. In here, the patient suffered from myocardial
infarction twice over which affected the pumping capacity of his ventricles. It is associated with increased sympathetic tone and may
result in restlessness and confusion within the patient. As argued by Gorter and de Boer (2018), the sinus tachycardia can occur in
moist of the conditions without any deep seated clinical cause and mostly settles down with proper rest. However, here the patient had

been upon medications for the improvement of his cardiac dysfunction. Therefore, inability to follow with the effective doses of the
medications could have aggravated the patient condition.
Predict:
What may happen to your patient if you take NO action and why? (100 words)
In case no action is taken on time the condition of oedema may further aggravate in the patient. As mentioned by Platz et al. (2015),
an untreated oedema may led to increased risk of infection in the swollen area. It may also lead to scarring between the layers of the
tissues. As mentioned by Gorter and de Boer (2018), the oedema results in a loss of diffusibility function of the intersiticical cells
resulting in accumulation of toxic wastes which are transported to various parts of the body via the blood stream leading to increased
risk of organ failure. Since the patient already had suffered from a heart attack leaving a sinus tachycardia untreated would have
further triggered the risk of heart failure in the patient.
Identify the
Problem/s
List in order of priority at least three key nursing problems (not included in word count)
Hence, from reflection upon the current condition of the patient the three major issues, which could be identified over here are-
ineffective medication management owing to progressive dementia, sinus tachycardia and development of oedema.
Establish Goals &
Take Action
From the above (identify problems), use the top 2 nursing problems identified and for each of these establish one goal and then list related
actions you would undertake, including detailing any relevant nursing considerations (350 words)
Problem 1 Goal Related actions Rationale
Ineffective medication
management
effective medication
management
A number of steps could be
taken for management of the
patient condition. Some of
these are setting up of an alarm
for the patient, which could
remind regarding taking his
medications on time.
Additionally, giving a
telephonic reminder to the
patient on a daily basis can
also help in effectively
monitoring the condition of the
patient (Courtney-Pratt et al.
2015).
Since, Mr. Jenkins was
suffering from dementia he
would often forget taking his
medications and hence there
was a need to monitor the
medication patterns in the
patient. As mentioned by
Salminen et al. (2014),
inability to take the
medications on time could
further aggravate the condition
of congestive heart disorder in
the patient. The patient had
also depicted the situation of
sinus tachycardia which could

be attributed to the inability of
the sinoauricular node to
pump. The ineffective
transmission of the nerve
impulses across the SA node
could also be related to the
situation where the patient had
forgotten to take medications
for his heart disorder for three
days.
Problem 2 Goal Related actions Rationale
Treatment of cardiac disorder
triggered oedema
dressing of the sites of the
oedema for the prevention of
further infection along with
providing daily exercise
activities to the patient
provision of community care
services such as free exercise
sessions to Mr. Jenkins, where
he could equally participate
with some of his peers could
have restored the movement
patterns of the patient.
This could have further
prevented the development of
oedema in the patient. The
home visit by the community
care nurses also helps in
ensuring that the infection
from the oedema is controlled
(Blomberg and Bisholt 2016).
As mentioned by Miraglia and
Asselin (2015), additional
support from the nursing
professional helps in removing
the conditions of helplessness
in the patient.
The development of oedema at
the site of the measurement of
pulse in the feet made it further
difficult for the physician to
monitor the patient effectively.
Evaluate outcomes &
Reflect on new
learning
Briefly describe how you would evaluate the effectiveness of the care provided (i.e. what do you want to happen?) and reflect on how this
encounter has informed your nursing practice if you were to encounter a similar situation in the future (150 words).

On providing the patient with a comprehensive care I came across a number of health improvements within the patient. Since Mr.
Jenkins suffered from dementia it was difficult for him to take care of his medications effectively. Owing to poor memory he failed to
take his medicines for three days which further resulted in the deterioration in his health. He also suffered from oedema, which further
ensured the presence of cardiac malfunctioning within the patient.
Due to the implementation of an effective nursing care regimen where daily reminders over phones were provided to the
patient along with weekly home visits it was seen that the patient showed much improvement in health. I think the exercise programs
were also helpful in controlling the overweight in the patients. The mobility patterns in the patient also helped to control the
development of oedema.
The experience encountered by me over here helped me in learning the effective nursing care practices, which could be undertaken
for the treatment of cardiac disorder related oedema in the patient as some of these oedema could develop in multi-organ failure events
in the most lethal case.
References :-
Blomberg, K. and Bisholt, B., 2016. Clinical group supervision for integrating ethical reasoning: Views from students and
supervisors. Nursing ethics, 23(7), pp.761-769.
Courtney-Pratt, H., Ford, K. and Marlow, A., 2015. Evaluating, understanding and improving the quality of clinical placements for
undergraduate nurses: A practice development approach. Nurse education in practice, 15(6), pp.512-516.
Gorter, T.M. and de Boer, R.A., 2018. Myocardial oedema and congestive heart failure: one piece of the puzzle? Reply. European
journal of heart failure, 20(4), pp.827-828.
Goudreau, J., Boyer, L. and Létourneau, D., 2014. Clinical nursing reasoning in nursing practice: A cognitive learning model based on
a think aloud methodology. Quality Advancement in Nursing Education-Avancées en formation infirmière, 1(1), p.4.
Huang, H.M., Huang, C.Y., Lee-Hsieh, J. and Cheng, S.F., 2018. Establishing the competences of clinical reasoning for nursing
students in Taiwan: From the nurse educators' perspectives. Nurse Education Today, pp.59-75.
Hunter, S. and Arthur, C., 2016. Clinical reasoning of nursing students on clinical placement: Clinical educators' perceptions. Nurse
education in practice, 18, pp.73-79.
Mebazaa, A., Yilmaz, M.B., Levy, P., Ponikowski, P., Peacock, W.F., Laribi, S., Ristic, A.D., Lambrinou, E., Masip, J., Riley, J.P.
and McDonagh, T., 2015. Recommendations on pre‐hospital & early hospital management of acute heart failure: a consensus paper
from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the
Society of Academic Emergency Medicine. European journal of heart failure, 17(6), pp.544-558.
Miraglia, R. and Asselin, M.E., 2015. The Lasater Clinical Judgment Rubric as a framework to enhance clinical judgment in novice
and experienced nurses. Journal for nurses in professional development, 31(5), pp.284-291.
Platz, E., Jhund, P.S., Campbell, R.T. and McMurray, J.J., 2015. Assessment and prevalence of pulmonary oedema in contemporary
acute heart failure trials: a systematic review. European journal of heart failure, 17(9), pp.906-916.
Salminen, H., Zary, N., Björklund, K., Toth-Pal, E. and Leanderson, C., 2014. Virtual patients in primary care: developing a reusable
model that fosters reflective practice and clinical reasoning. Journal of medical Internet research, 16(1), pp.105-185.