Congestive Heart Failure Assignment Solution
Added on 2021-02-20
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Congestive Heart Failure
Congestive heart failure (CHF) is a chronic progressive condition which affects pumpingpower of heart muscles. High Cholesterol, obesity and High blood pressure are the major riskfactors for CHF (Klabunde, 2015). The case study outlines pathophysiology and aetiology of forderiving nursing management priorities for the 80-year-old patient Mr Johnson. The essay willoutline evidence-based literature to support and rationale nursing care for the patient. The studywill 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 admittedto the ward with fatigue, shortness of breath and swelling in both legs with the history of ChronicAtrial 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 whensleeping from last one week. On admission Complete set of observation were attended.Observations showed Mr Johnson was afebrile, tachycardia, tachyapnea and hypertensive. 12lead ECG was performed as it can indicate Left ventricular hypertrophy and or right ventricularhypertrophy 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 legoedema. 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 theheart and to identify the underlying cause of the heart failure (Olson, 2014). Echocardiogram wasperformed which showed ejection fraction was 40 percent. Pathology also collected whichincludes full blood count, urea and creatine levels(U&E), serum natriuretic peptides, Liverfunctional 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 andnot fill properly between beats. There are two conditions of heart failure that is diastolic in whichheart 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 heartmuscles 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 of3
developing Heart Failure. Indication of high blood pressure for Mr Johnson is bilateral crackleswhich is making difficult for him to sleep at night for one week. Further, coronary artery diseaseis another cause of heart failure in case of Mr Michael which is derived from the history oftreatment by CABG.The common symptoms recorded for Mr Johnson of fatigue, shortness of breath and alsohas swelling in both legs. However, Prabhu and et.al., 2017, outlined anatomy of congestiveheart 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 tingedphlegm, weight gain fluid retention, etc.Congestive heart failure is a clinical syndrome which arises as consequence of abnormalityin cardiac structure, conduction or function rhythm (Congestive Heart failure, 2019). Stage A isdisorder 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 Atrialfibrillation, pulmonary hypertension, Coronary artery bypass grafting, Gastro-oesophageal refluxdisease and tricuspid regurgitation.Stage B is common in people with systolic left ventricular dysfunction which occurs dueto valve diseases and cardiomyopathy. Cardiomyopathy is a progressive situation of heartdisease which leads to thickening, enlargement and stiffness of heart muscles which reflectsdecrease in cardiac output. According to Cubero and et.al., 2004, major cause of heart diseasesin elderly patient is diabetes, high blood pressure, chronic lung disease and angina. As per this, itcan be stated that the stage indicates inability of heart to maintain adequate oxygen supply.Thedeterminants of cardiac output comprise stroke volume and heart rate. Further, the stroke volumeis determined by the preload that is the volume that enters the left ventricle, contractility andafter which is an impedance of flow from left ventricle. The variable enables understanding overpathophysiologic 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 presentedin hospital he was unbale to breathe in room air and has 88 SPO2. Therefore, he was onContinuous 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 bodyfluid volume regulation.According to Figueroa and Peters, J.I., 2006, heart is dynamic pump and4
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