Congestive Heart Failure Assignment Solution

Congestive Heart Failure

TABLE OF CONTENTS
REFERENCES................................................................................................................................9

Congestive heart failure (CHF) is a chronic progressive condition which affects pumping
power of heart muscles. High Cholesterol, obesity and High blood pressure are the major risk
factors for CHF (Klabunde, 2015). The case study outlines pathophysiology and aetiology of for
deriving nursing management priorities for the 80-year-old patient Mr Johnson. The essay will
outline evidence-based literature to support and rationale nursing care for the patient. The study
will be based on three specific themes that is fundamentals of cardiovascular pathophysiology,
Assessment, planning and management of care
An 80 year old man, who will be referred to as Mr Johnson to protect his identity admitted
to the ward with fatigue, shortness of breath and swelling in both legs with the history of Chronic
Atrial Fibrillation (AF), Pulmonary Hypertension, Coronary Artery Bypass Grafting(CABG),
Gastro-Oesophageal Reflux Disease(GORD), Tricuspid Regurgitation(TR) and Sleep Apnoea.
Apart from this, wife of Mr Johnson reported that he is taking back support of two pillows when
sleeping from last one week. On admission Complete set of observation were attended.
Observations showed Mr Johnson was afebrile, tachycardia, tachyapnea and hypertensive. 12
lead ECG was performed as it can indicate Left ventricular hypertrophy and or right ventricular
hypertrophy with common associated arrhythmias such as AF. In case of Mr Johnson was AF.
From the clinical assessment, it was found that he has bilateral crackles with bilateral lower leg
oedema. Chest radiograph taken in context with physical assessment showed pulmonary oedema.
Echocardiogram is the gold standard diagnostic tool to assess the structure and functions of the
heart and to identify the underlying cause of the heart failure (Olson, 2014). Echocardiogram was
performed which showed ejection fraction was 40 percent. Pathology also collected which
includes full blood count, urea and creatine levels(U&E), serum natriuretic peptides, Liver
functional test, thyroid function Test, glucose levels and Lipid profile, including INR levels
(Olson, 2014).
Congestive heart failure develops when pumping champers of ventricles become stiff and
not fill properly between beats. There are two conditions of heart failure that is diastolic in which
heart can not fill and systolic when heart can not pump. According to Marcus and et.al., 2014,
heart failure occurs with normal ejection fraction which happens due to hypertension when heart
muscles becomes stiff. High blood pressure affects arteries in lungs and right side of heart.
According to Atherton and et.al., 2018, Blood pressure and lipid lowering decrease the risk of
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developing Heart Failure. Indication of high blood pressure for Mr Johnson is bilateral crackles
which is making difficult for him to sleep at night for one week. Further, coronary artery disease
is another cause of heart failure in case of Mr Michael which is derived from the history of
treatment by CABG.
The common symptoms recorded for Mr Johnson of fatigue, shortness of breath and also
has swelling in both legs. However, Prabhu and et.al., 2017, outlined anatomy of congestive
heart failure which present symptoms of CHF that is Dyspnea, oedema which is swelling in leg,
feet and ankle, weakness, fatigue, irregular heartbeat, persistent cough, pink blood tinged
phlegm, weight gain fluid retention, etc.
Congestive heart failure is a clinical syndrome which arises as consequence of abnormality
in cardiac structure, conduction or function rhythm (Congestive Heart failure, 2019). Stage A is
disorder is Ventricular dysfunction results mainly due to hypertension and myocardial injury
(myocardial infraction diabetes, rheumatic fever, metabolic syndrome and renal failure).
Myocardial injury in case of Mr. Michael Johnson is reflected in history of Chronic Atrial
fibrillation, pulmonary hypertension, Coronary artery bypass grafting, Gastro-oesophageal reflux
disease and tricuspid regurgitation.
Stage B is common in people with systolic left ventricular dysfunction which occurs due
to valve diseases and cardiomyopathy. Cardiomyopathy is a progressive situation of heart
disease which leads to thickening, enlargement and stiffness of heart muscles which reflects
decrease in cardiac output. According to Cubero and et.al., 2004, major cause of heart diseases
in elderly patient is diabetes, high blood pressure, chronic lung disease and angina. As per this, it
can be stated that the stage indicates inability of heart to maintain adequate oxygen supply. The
determinants of cardiac output comprise stroke volume and heart rate. Further, the stroke volume
is determined by the preload that is the volume that enters the left ventricle, contractility and
after which is an impedance of flow from left ventricle. The variable enables understanding over
pathophysiologic consequences of potential treatments and heart failure (Marrouche and et.al.,
2018). In accordance with this stage it is evident that when Mr. Michael Johnson was presented
in hospital he was unbale to breathe in room air and has 88 SPO2. Therefore, he was on
Continuous positive airway pressure (CPAP) while sleeping with 2 litres of Oxygen.
Stage C, Arterial underfilling is a Low-output cardiac failure and is hypothesis of body
fluid volume regulation. According to Figueroa and Peters, J.I., 2006, heart is dynamic pump and
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its functionality depends on what is pumped and what must pump against. Patient is at high risk
of development heart failure because of conditions which are strongly associated with occurrence
of CHF. For example, structure and functional abnormalities of pericardium, cardiac valves
and myocardium. Further, the patients who undergo structural heart disease are at the risk of
developing Heart failure which is reflected from left ventricular hypertrophy dilation or
hypercontractivity (Gerber and et.al., 2015). Furthermore, the patients with underlying structural
heart diseases comes with symptom which were assessed in case of Mr Johnson that is fatigue
and shortness of breath (Sidebottom and et.al., 2015). Arterial Underfilling is consequence which
occurs due to systolic and diastolic dysfunction reduced cardiac output in case of Mr Johnson led
to Hypertension which is organ dysfunction which is also termed as forward failure. Further,
compensation mechanism for CHS in case of Mr Johnson presents Renin-Angiotensin System
which regulates blood pressure and balance of fluid in body. Apart from this, the mechanism also
results in Sympathetic nervous system which is activated in CHS because of baroceptors which
can of high and low blood pressure which presents clinical deterioration of cardiac function.
Activation of Vasopressin is another mechanism which occurs after decrease in cardiac output.
It is peptide hormone formed in hypothalamus. Two principle sites of action hormone are blood
vessels and kidney. However, activation of compensatory mechanism results in three outcomes
that is Renal Na and Water retention and to prevent nurse focused on fluid restriction 1.5 litres
in case of Johnson. Second outcome to activation of compensatory mechanism is remodelling
and progressive worsening of LV function which is a progressive increase of the left
ventricular cavity. Apparently, third outcome is peripheral Vasoconstriction Hemodynamic
alterations which is autonomic response to exposure of cold, which restricts transfer of heat
from core to the environment through the skin. This reflects increasing body temperature of
patient which in case of Michael was 36.8 that is normal.
Clinical manifestation is subjective and objective observation by physician which helps in
deriving appropriate cause and symptom of the particular medication. Subjective observation of
Mr Michael is difficulty in breathing and weakness. Objective observation of patient comprises
shortness of breath, leg edema and crackles in lungs. Clinical deterioration in patient’s health
was assessed after report of wife reported about his way of sleeping from where it is observed
that Mr Michael has Bilateral crackles and bilateral lower leg oedema.
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Atherosclerotic Cardiovascular Diseases is developed when arteries become hard and
narrow due to build-up of plaque around artery wall. According to Masetic and Subasi, 2016,
pain in chest, leg, arm, shortness of breath, confusion and fatigue are the common symptoms of
Atherosclerosis. As per the assessment of Mr. Michael it can be said there are chances that he is
suffering Atherosclerosis which is leading build-up of fats, cholesterol and other substances on
the artery walls which can be a life-threatening clinical deterioration sign for the service user.
Heart rate and conduction can be discussed with the help of term Atrial arrhythmias
which is closely related to congestive heart failure (CHF). According to Stamp, Machado and
Allen, 2014, cardiac arrhythmia denotes abnormal heart rhythm due to its abnormal electrical
impulse origination and/or propagation. The irregular heart rates cause left ventricular
dysfunction and congestive heart failure. As per clinical observation of Mr Johnson there has
Atrial fibrillation which in turn may cause of congestive heart failure.
In accordance with this, it can be said the nursing priority for nurse when managing care
for Mr Michael Johnson needs to be focused on controlling pulmonary hypertension. Further,
nursing priority will be to monitor heart rate, pulse rate and dysponea. At the time of managing
care nurse will continuously administer oxygen medication, fluid intake and dietary fibre.
Cardiovascular assessment is a physical examination performed by physicians to outline
significant factors which can impact cardiovascular heath of person like, high blood cholesterol,
hypertension, use of cigarettes, diabetes, etc. Cardiovascular assessment of Mr Johnson is
evident to his deteriorating health as he has a history of Chronic AF, CABG, GORD and TR
Atherton and et.al., 2018, suggested echocardiogram in case heart failure is suspected or
newly diagnosed. Mr Johnson Ejection Fraction was 40 percent LV functions. Observations
outlined are Blood pressure 140/80, respiratory rate 30, Pulse rate 101, SPO2 88. Temperature if
patient was recorded at 36.8. In accordance with observation, it can be said that respiratory rate
of Mr Michael was not normal because he was unable to breathe in room air. (CAN U please
change this, I have mentioned this on second paragraph on admission profile)
Common drug dosage of patient comprise Diuretics for which dosage starts from
frusemide which was given via intravenous and regular twice a day which is recommended for
CHF associated with congestion to improve symptoms of fluid overload (Atherton and et.al.,
2018) . Apart from this, oral Beta Blockers 50mg metoprolol was prescribed with 1.5 litres fluid
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restriction. According to Matsue and et.al., 2017, medication is given to treat fluid build-up due
to heart failure kidney diseases and liver scarring. Other drugs warfarin dependents on INR
levels, lisinopril, bisoprolol, magnesium and potassium tablets regularly. (can we please add
more regarding first line therapy and validate on medication) ACE inhibitors is highly
recommended with LV systolic dysfunction which Mr Johnson is taking lisinopril (Aherton and
all., 2018).
Nursing care plan
Subjective Data of assessment of Mr Michael reflected that he was facing difficulty in
breathing and weakness. However, objective data recorded was showing Shortness of breath,
Leg edema and Crackles in lungs and vital signs were BP: 140/80 RR: 30 PR: 101 and Temp:
36.8. Diagnosis of patient was evident to Decrease in cardiac output and inability to breathe in
room air.
Medical history that is inference outlined comprise CAF, CABG , GORD and TR. The
history denotes inadequacy in cardiac output with rest to metabolic demands of the body.
According to Sidebottom and et.al., 2015, underlying causes of heart failure include rheumatic
fever or congenital heart disease.
Planning of care aim at gaining stability in cardiac status of Mr Michael after 24 hours
with no evidence of arrhythmias. Further, Respiratory rate will come in control as per set
parameters. Patient will be able to breath in room air. Moreover, in this, Mr Michael will be
stable in 24hours.
Nursing intervention will be daily monitoring weight, measurement of fluid intake and
output is the key management, including inspection of skin pallor and cyanosis, administration of
medication and diuretics cautiously and nurse will also monitor intake of dosage, care provider
will Monitor oxygen saturation and ABGs prescribed by doctors, palpate peripheral pulses and
assessment for abnormal heart and lung sounds (Vera and BSN 2013).
Rationale of chosen interventions are focused on inspection to assess inadequacy of
cardiac output. Assessment of improvement in cardiac functions, fluid in lower extremities and
to ensure lungs is mobilized and supports circulation it overtake the patients weaken
myocardium. Further, motive is to increase availability for gas exchange for alleviating signs of
activity intolerance and hypoxia, monitor irregularity and palpation of pulses and supports
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detection of left sided heat failure which can lead to chronic renal failure. Final stage of care
plan is evaluation where expected outcome is Decrease in dyspneic episodes, Aid in
maintaining normal respiratory status, patient is able to breathe in room air and regular follow-up
with prescription and therapeutic regimen.
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REFERENCES
Books and Journals
Atherton and et.al., 2018. National Heart Foundation of Australia and Cardiac Society of
Australia and New Zealand: Australian clinical guidelines for the management of heart
failure 2018. Medical Journal of Australia. 209(8). pp.363-369..
Brock, D. and et.al., 2013. Interprofessional education in team communication: working together
to improve patient safety. BMJ Qual Saf. 22(5). pp.414-423.
Cubero, J.S. and et.al., 2004. Heart failure: etiology and approach to diagnosis. Revista Española
de Cardiología (English Edition). 57(3). pp.250-259.
Figueroa, M.S. and Peters, J.I., 2006. Congestive heart failure: diagnosis, pathophysiology,
therapy, and implications for respiratory care. Respiratory care. 51(4). pp.403-412.
Gerber, Y. and et.al., 2015. A contemporary appraisal of the heart failure epidemic in Olmsted
County, Minnesota, 2000 to 2010. JAMA internal medicine. 175(6). pp.996-1004.
Hopkins, C. and et.al., 2016. UK publicly funded Clinical Trials Units supported a controlled
access approach to share individual participant data but highlighted concerns. Journal of
clinical epidemiology. 70. pp.17-25.
Marcus, N.J. and et.al., 2014. Carotid body denervation improves autonomic and cardiac
function and attenuates disordered breathing in congestive heart failure. The Journal of
physiology. 592(2). pp.391-408.
Marrouche, N.F. and et.al., 2018. Catheter ablation for atrial fibrillation with heart failure. New
England Journal of Medicine. 378(5). pp.417-427.
Masetic, Z. and Subasi, A., 2016. Congestive heart failure detection using random forest
classifier. Computer methods and programs in biomedicine. 130. pp.54-64.
Matsue, Y. and et.al., 2017. Time-to-furosemide treatment and mortality in patients hospitalized
with acute heart failure. Journal of the American College of Cardiology. 69(25). pp.3042-
3051.
Moore, L. and et.al., 2017. Barriers and facilitators to the implementation of person‐centred care
in different healthcare contexts. Scandinavian journal of caring sciences. 31(4). pp.662-
673.
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Moore, L. and et.al., 2017. Barriers and facilitators to the implementation of person‐centred care
in different healthcare contexts. Scandinavian journal of caring sciences. 31(4). pp.662-
673.
Olson, K 2014, Oxford handbook of cardiac nursing, 2nd edn, oxford university press, United
Kingdom. Pp. 193-210.
Prabhu, S. and et.al., 2017. Atrial fibrillation and heart failure—cause or effect? Heart, Lung and
Circulation. 26(9). pp.967-974.
Sidebottom, A.C. and et.al., 2015. Inpatient palliative care for patients with acute heart failure:
outcomes from a randomized trial. Journal of palliative medicine. 18(2). pp.134-142.
Stamp, K.D., Machado, M.A. and Allen, N.A., 2014. Transitional care programs improve
outcomes for heart failure patients: an integrative review. Journal of Cardiovascular
Nursing. 29(2). pp.140-154.
Townsend, M.C. and Morgan, K.I., 2017. Psychiatric mental health nursing: Concepts of care in
evidence-based practice. FA Davis.
Online
Klabunde, R. E., 2015. Cardiovascular physiology concepts, Pathophysiology of the heart
Failure. [Online]. Available through: <https://www.cvpharmacology.com/clinical
%20topics/heart%20failure>.
Vera, M. and BSN, R.N. 2013. 13 Heart Failure Nursing Care Plans. [Online]. Available
through: < https://nurseslabs.com/heart-failure-nursing-care-plans/>.
Congestive Heart failure. 2019. [Online]. Available through: <
https://www.healthline.com/health/congestive-heart-failure#types>.
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