Read this case study on congestive heart failure and learn about its causes, incidence, risk factors, impact, signs and symptoms, pathophysiology, medication administration, and more.
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Running head: NURSING ASSIGNMENT Case Study on congestive heart failure Name of the Student Name of the University Author Note
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1NURSING ASSIGNMENT Answer 1 Congestive heart failure (CVF) refers to the medical condition when the cardiac output of a person is unable to meet the requirements of the lungs and the entire body (Hall, Levant &DeFrances, 2012). This occurs due to inefficiency of the heart to pump sufficient amount of blood, thereby disrupting blood flow. Cause- There is a variety of reasons that can be attributed for congestive heart failure. Heart attack- This results in sudden blockage of the coronary artery, thereby directly reducing or stopping blood flow to the cardiac muscles. This result in formation of a scarred area that fails to function appropriately (Authors/Task Force Members et al., 2012). Coronary artery disease- This disease of the arteries that supply oxygen rich blood to the heart involves a decrease in blood flow to the muscles. Narrowing or blockage of arteries also results in deprivation of nutrients and oxygen, thereby leading to heart failure (Heusch et al., 2014). Cardiomyopathy- This is a direct manifestation of damage to the cardiac muscles due to infections or substance abuse (Summerfield et al., 2012). All of the aforementioned conditions prevent the heart from pumping blood efficiently and result in CHF. Incidence- Prevalence of CHF in Australia has been found to range between 1-2%, with a huge proportion of the cases going unreported or undiagnosed (Sahle et al., 2016). More than 5.7million adults in the United States are found to suffer from CHF. It accounted for 1 in 9
2NURSING ASSIGNMENT deaths in the year 2009. Moreover, more than half of the people who develop CHF die within 5 years of getting diagnosed (Benjamin et al., 2017). Risk factors- The risk factors are given below: High blood pressure Atherosclerosis Previous history of heart attacks Disorders of the heart rhythm (Bayes-Genis et al., 2014) Smoking Alcohol consumption (Calvillo–King et al., 2013) High blood glucose levels Obesity Genetic factors Valvular heart disease Thus, history of myocardial infarction and signs of hypertension in the patient can be regarded as the major risk factors that predispose her to CHF. Impact- Congestive heart failure severely affects the quality of life of the patients by limiting them in performing daily activities. Most common physical symptoms are related to fatigue, oedema, dyspnoea, chest pain and sleeping difficulties that adverse effects their quality of life (Evangelista et al., 2012). Such worsening symptoms increases risks of recurrent hospitalization and creates a major financial burden on the patient along with the family members. Poor psychological status, such as, bad mood and financial trouble add to emotional
3NURSING ASSIGNMENT distress and limits social activities. Depression is also found to occur in such circumstances, which in turn disrupts relationship with family members (Fry et al., 2016). Answer 2 Signs and symptomsPathophysiology Irregular heartbeatAbnormal heart rhythm occurs when the heart beatsslow,orfast.Sharondemonstrateda heart rate of 54 bpm, much lower than the normal rate of 60-100 bpm. This condition (bradychardia) can be linked to disruption of the vital systems of the heart due to inadequate blood supply to the cardiac muscles (Fox et al., 2014). Less efficiency of the heart in pumping blood makes the latter move at a slower rate and results in low heartbeat, thereby increasing risks of heart failure. SwellingAnkles and legs are considered as common sites of swelling due to gravitational effect of thebodyfluids.Sharonreportedswollen ankles which can be linked to congestive heart failure in that failure of the right ventricle to pump blood results in accumulation of fluid in the lower legs and feet in the patient. This resultedinoedema(King,Kingery&Baretta
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4NURSING ASSIGNMENT Casey, 2012). Shortness of breathCommonly referred to as pulmonary oedema the condition results due to accumulation of fluid in the lungs. Blood present in the body have backed up in the blood vessels in the patient, which return blood to the heart from the lungs. Due to inefficiency of the heart, fluid has leaked into the lungs of the patient and resulted in shortness of breath (Kosmala et al., 2013). HypertensionInabilityoftheheartmusclestoprovide adequate amount of blood to the body can often result due to blocking on narrowing of blood vessels due to hypertension. The patient showed high blood pressure which indicates that lesselasticity of the narrowed arteries has made it difficult for blood to travel easily and smoothlythroughoutthebody,thereby resultinginthehearttoworkhard (Parati&Esler, 2012). Overtime this will lead to thickening and enlargement of the heart to meet demand for nutrients and oxygen.
5NURSING ASSIGNMENT DizzinessDizziness often occurs due to inability of the heart to pump blood in enough amounts.The patientcomplaintsofdizzinessorfeeling lightheaded which can be related to reduction of blood flow to the brain due to weakened heart (Conraadset al., 2012). Thisdirectly resulted in sudden loss of consciousness and dizziness in the patient. Answer 3 Angiotensin converting enzyme inhibitors referred to pharmaceutical drugs that are primarily used for treatment of congestive heart failure and hypertension. The basic property of these drugs lie in the fact that they help in relaxation of the blood vessels and result in a decrease in the overall blood, there thereby lowering blood pressure and bringing about a reduction in oxygen demand from the heart. These classes of drugs are found to inhibit angiotensin converting enzyme, which forms an essential component of rennin-angiotensin-aldosterone system (van Vark et al., 2012). The aforementioned system primarily regulates mechanism of blood pressure. They generally block conversion of angiotensin Ito angiotensin II, thereby lowering arteriolar resistance and increasing venous capacity. Subsequently, the cardiac output gets decreased, and lower resistance are faced in the blood vessels.The drugs also result in bringing about a decrease in blood volume, which in turn brings back the blood pressure to normal level (Cheng et al., 2014). Most common drugs that belong to this class include enalapril that has been administered to Sharon.
6NURSING ASSIGNMENT Beta blockers form another class of medications particularly administered for managing abnormal heart rhythm and protecting the heart from myocardial infarction, after previous history of attack. They are also used for treatment of hypertension. These drugs act as competitive antagonist and block receptor sites, specific for catecholamine, such as, nor- epinephrine and epinephrine, located on adrenergic beta receptors of sympathetic nervous system. These beta receptors are primarily found in cardiac muscle, arteries, smooth muscle, and kidney (Rienstra et al., 2013). The beta blocker drugs are found to interfere with binding of epinephrine to the receptor, thereby weakening effects of stress hormones.In addition, they are also found to influence the rennin-angiotensin system by decreasing secretion of renin, which in turn results in a reduction in oxygen demand of the heart, thereby lowering the capacity of the bloodtocarryoxygen(Swedbergetal.,2012).Catecholamineisresponsibleforseveral deleterious effects, such as, increasing the oxygen demand and reducing efficiency of cardiac contraction. Thus, these beta blockers are found to counteract high sympathetic activity, and result in an improvedejectionfraction,thereby reducing absoluterisksof deathdue to congestive heart failure (Lymperopoulos, Rengo & Koch, 2013). Answer 4 ABCDE assessment-This assessment will contain evaluation or investigation of airway, breathing,circulation, disability and exposure of the patient. This is the first assessment to be conducted onMrs. McKenzie, following her admission to the emergency care department. This examination will help in checking if her airway is compromised, or there is danger of choking. Assessing the breathing patterns will help in evaluating effectiveness of oxygen delivery and ease of breathing (Munroe et al., 2013). The presence of intact oxygen flow will also be investigated. The patient will also be assessed
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7NURSING ASSIGNMENT for presence of radial pulse, moisture, skin colour, and temperature. The level of consciousness will determine if she is drowsy, restless, disoriented, unconscious, or agitated. Monitoring vital signs of the patient- Low cardiac output is found to affect the vital signs adversely. The pulse rate likely to be high that acts as a compensatory mechanism to hypoxia and low cardiac output.Disproportionately elevated blood pressure levels will also indicate circulatory congestion that can be associated to poor venous return by the heart. Shallow respiration due to lack of energy and low body temperature metabolism and likely to be seen (Feltner et al., 2014). Hence, it is essential to monitor them and note any likely abnormal changes. Head-to-toe assessment-Head to toe assessment will encompass all the body systems and the observations will help in providing a clear information on the overall condition of the patient (Uchida et al., 2014). Focused assessment– Focused assessments will follow any kind of unusual or abnormal findings and the examination will involve collection of objective data using the medical techniques of palpation, inspection, auscultation, and percussion. Focused assessment for Sharon would be respiratory, cardiovascular, and musculoskeletal. a)Respiratory assessment will involve examination of presence of shortness of breath and willdeterminepresenceofcracklingsoundfromthelungs,whichwouldsignify increasing breathing effort in the patient. b)Cardiovascular assessment will involve examination of the jugular distinction, the chest wall, and chest pain, as reported by Mrs. McKenzie. This will help to recognize cardiovascular pathology.The electrocardiograph is the most common test used for
8NURSING ASSIGNMENT investigating condition of the heart. An ECG will be conducted upon Sharon for detecting probablesigns of cardiac abnormalities. Heart beat recordings will be taken at times when the patient reports symptoms of chest pain, black outs, or palpitations (Ponikowski et al., 2014). c)Musculoskeletal assessments will be conducted to determine if oedema in her ankles have created impairment in mobility. This will be followed by a fall risk assessment that will determine her postural control and balance. Medication administration- Therapeutic and side effects of all prescribed medication should be taken into account before administering them to the patient, in order to ensure her progress, and prevent further treatment related adverse outcomes. Formulating dietary modification pattern- Owing to the fact that diet plays a significant role in maintenance for healthy heart. Modifying diets will minimise risk of fluid retention and subsequent ischemic heart diseases. Efforts will be taken to recommend small servings of meal to reduce workload of the heart (Nieuwenhuis et al., 2012).
9NURSING ASSIGNMENT References Authors/Task Force Members, McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., ... & Gomez-Sanchez, M. A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatmentof Acute andChronic HeartFailure2012 of the EuropeanSocietyof Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC.Europeanheartjournal,33(14),1787-1847.Retrievedfrom: https://academic.oup.com/eurheartj/article/33/14/1787/526884 Bayes-Genis, A., de Antonio, M., Vila, J., Peñafiel, J., Galán, A., Barallat, J., ... &Lupón, J. (2014). Head-to-head comparison of 2 myocardial fibrosis biomarkers for long-term heart failure risk stratification: ST2 versus galectin-3.Journal of the American College of Cardiology,63(2),158-166.Retrievedfrom: https://www.sciencedirect.com/science/article/pii/S0735109713051504 Benjamin, E. J., Blaha, M. J., Chiuve, S. E., Cushman, M., Das, S. R., Deo, R., ... & Jiménez, M. C. (2017). Heart disease and stroke statistics-2017 update: a report from the American HeartAssociation.Circulation,135(10),e146-e603.Retrievedfrom: http://europepmc.org/articles/pmc5408160 Calvillo–King, L., Arnold, D., Eubank, K. J., Lo, M., Yunyongying, P., Stieglitz, H., & Halm, E. A. (2013). Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review.Journal of general internal medicine,28(2), 269-282. Retrieved from:https://link.springer.com/article/10.1007/s11606-012-2235-x
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10NURSING ASSIGNMENT Cheng, J., Zhang, W., Zhang, X., Han, F., Li, X., He, X., ... & Chen, J. (2014). Effect of angiotensin-converting enzyme inhibitors and angiotensin II receptor blockers on all- causemortality,cardiovasculardeaths,andcardiovasculareventsinpatientswith diabetes mellitus: a meta-analysis.JAMA internal medicine,174(5), 773-785. Retrieved from:https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/1847572?= Conraads, V. M., Deaton, C., Piotrowicz, E., Santaularia, N., Tierney, S., Piepoli, M. F., ... &Jaarsma, T. (2012). Adherence of heart failure patients to exercise: barriers and possible solutions.European journal of heart failure,14(5), 451-458. Retrieved from: https://onlinelibrary.wiley.com/doi/full/10.1093/eurjhf/hfs048?scrollTo=references Evangelista, L. S., Lombardo, D., Malik, S., Ballard-Hernandez, J., Motie, M., & Liao, S. (2012). Examining the effects of an outpatient palliative care consultation on symptom burden, depression, and quality of life in patients with symptomatic heart failure.Journal ofcardiacfailure,18(12),894-899.Retrievedfrom: https://www.onlinejcf.com/article/S1071-9164(12)01324-3/abstract Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., ... & Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons withheartfailure:asystematicreviewandmeta-analysis.Annalsofinternal medicine,160(11), 774-784. Retrieved from:http://annals.org/aim/fullarticle/1874735 Fox, K., Ford, I., Steg, P. G., Tardif, J. C., Tendera, M., & Ferrari, R. (2014). Ivabradine in stable coronaryarterydiseasewithoutclinicalheartfailure.NewEnglandJournalof Medicine,371(12),1091-1099.Retrievedfrom: https://www.nejm.org/doi/full/10.1056/NEJMoa1406430
11NURSING ASSIGNMENT Fry, M., McLachlan, S., Purdy, S., Sanders, T., Kadam, U. T., & Chew-Graham, C. A. (2016). The implications of living with heart failure; the impact on everyday life, family support, co-morbidities and access to healthcare: a secondary qualitative analysis.BMC family practice,17(1),139.Retrievedfrom: https://bmcfampract.biomedcentral.com/articles/10.1186/s12875-016-0537-5 Hall, M. J., Levant, S., &DeFrances, C. J. (2012). Hospitalization for congestive heart failure: UnitedStates,2000–2010.age,65(23),29.Retrievedfrom: https://www.ncbi.nlm.nih.gov/pubmed/23102190 Heusch, G., Libby, P., Gersh, B., Yellon, D., Böhm, M., Lopaschuk, G., & Opie, L. (2014). Cardiovascularremodellingincoronaryarterydiseaseandheartfailure.The Lancet,383(9932),1933-1943.Retrievedfrom: https://www.sciencedirect.com/science/article/pii/S0140673614601070 King,M.,Kingery,J.,&BarettaCasey,M.(2012).Diagnosisandevaluationofheart failure.heartfailure,100(21),23.Retrievedfrom: https://www.ncbi.nlm.nih.gov/pubmed/22962896 Kosmala, W., Holland, D. J., Rojek, A., Wright, L., Przewlocka-Kosmala, M., & Marwick, T. H. (2013). Effect of If-channel inhibition on hemodynamic status and exercise tolerance in heart failure with preserved ejection fraction: a randomized trial.Journal of the American CollegeofCardiology,62(15),1330-1338.Retrievedfrom: https://www.sciencedirect.com/science/article/pii/S0735109713027721
12NURSING ASSIGNMENT Lymperopoulos, A., Rengo, G., & Koch, W. J. (2013). Adrenergic nervous system in heart failure: pathophysiology and therapy.Circulation research,113(6), 739-753. Retrieved from:http://circres.ahajournals.org/content/113/6/739.short Munroe, B., Curtis, K., Considine, J., & Buckley, T. (2013). The impact structured patient assessment frameworks have on patient care: an integrative review.Journal of clinical nursing,22(21-22),2991-3005.Retrievedfrom: https://onlinelibrary.wiley.com/doi/full/10.1111/jocn.12226 Parati, G., &Esler,M. (2012). Thehuman sympatheticnervous system: itsrelevancein hypertension and heart failure.European heart journal,33(9), 1058-1066. Retrieved from:https://academic.oup.com/eurheartj/article/33/9/1058/582945 Ponikowski, P., Anker, S. D., AlHabib, K. F., Cowie, M. R., Force, T. L., Hu, S., ... &Samal, U. C.(2014).Heartfailure:preventingdiseaseanddeathworldwide.ESCHeart Failure,1(1),4-25.Retrievedfrom: https://onlinelibrary.wiley.com/doi/full/10.1002/ehf2.12005 Rienstra, M., Damman, K., Mulder, B. A., Van Gelder, I. C., McMurray, J. J., & Van Veldhuisen,D.J.(2013).Beta-blockersandoutcomeinheartfailureandatrial fibrillation:ameta-analysis.JACC:HeartFailure,1(1),21-28.Retrievedfrom: https://www.sciencedirect.com/science/article/pii/S2213177912000054 Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of heart failure in Australia: a systematic review.BMC cardiovascular disorders,16(1), 32. Retrievedfrom: https://bmccardiovascdisord.biomedcentral.com/articles/10.1186/s12872-016-0208-4
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13NURSING ASSIGNMENT Summerfield, N. J., Boswood, A., O'Grady, M. R., Gordon, S. G., Dukes‐McEwan, J., Oyama, M. A., ... &Braz‐Ruivo, L. (2012). Efficacyof pimobendan in the prevention of congestive heart failure or sudden death in Doberman Pinschers with preclinical dilated cardiomyopathy (the PROTECT Study).Journal of veterinary internal medicine,26(6), 1337-1349.Retrievedfrom:https://onlinelibrary.wiley.com/doi/full/10.1111/j.1939- 1676.2012.01026.x Swedberg, K., Komajda, M., Böhm, M., Borer, J., Robertson, M., Tavazzi, L., ... & Shift Investigators. (2012). Effects on outcomes of heart rate reduction by ivabradine in patients with congestive heart failure: is there an influence of beta-blocker dose?: findings from the SHIFT (Systolic Heart failure treatment with the If inhibitor ivabradine Trial)study.JournaloftheAmericanCollegeofCardiology,59(22),1938-1945. Retrieved from:https://www.sciencedirect.com/science/article/pii/S0735109712003750 Uchida, T., Farnan, J. M., Schwartz, J. E., & Heiman, H. L. (2014). Teaching the physical examination:alongitudinalstrategyfortomorrow’sphysicians.Academic Medicine,89(3),373-375.Retrievedfrom: https://journals.lww.com/academicmedicine/Fulltext/2014/03000/Teaching_the_Physical _Examination___A_Longitudinal.8.aspx van Vark, L. C., Bertrand, M., Akkerhuis, K. M., Brugts, J. J., Fox, K., Mourad, J. J., &Boersma, E. (2012). Angiotensin-converting enzyme inhibitors reduce mortality in hypertension: a meta-analysis of randomized clinical trials of renin–angiotensin–aldosterone system inhibitorsinvolving158998patients.Europeanheartjournal,33(16),2088-2097. Retrieved from:https://academic.oup.com/eurheartj/article/33/16/2088/447829