Heart Issues

This document provides information about congestive heart failure, including its causes, symptoms, and treatment options. It also discusses the impact of heart failure on patients and their families. Additionally, it includes nursing care plans and information on the pharmacokinetics of heart failure medications.

Running Head: HEART ISSUES
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Heart failure
student
4/13/2019

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Table of Contents
Congestive heart failure...............................................................................................................................2
Symptoms................................................................................................................................................3
Pharmacokinetics and pharmacodynamics..............................................................................................4
Nursing care plan.....................................................................................................................................6
References...................................................................................................................................................8

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Answer 1; Congestive heart failure
Congestive heart failure is the illness in which the patient’s heart muscle is weakened and
unable to pump the blood properly. The primary or main chambers of the human heart called
verticals can alter the size and its thickness, and either unable to contract or squeeze or unable to
relax. This particular condition stimulates the fluid detention, specifically in the lungs legs and
the abdominal part. It can be caused by different other conditions that impair the heart muscles
such as coronary artery disorder, heart attack, cardiomyopathy, conditions that the heart
overwork like valve disease and hypertension (Verbrugge, Dupont, Steels, Grieten, Malbrain,
Tang, & Mullens, 2013).
Incidence
According to a report published by healthengine (2019) it projected that nearly 300,000
Australian presently suffering from congestive heart failure and nearly 30, 000 new incidence of
this health condition are identified each year. In wester European region more than 5 million
patients expirienced congestive heart failure, whereas in USA nearly 5 million sufferers are
there. The prevalence of this cardiovascular issue in African American peoples is recorded 25
per cent higher compared to the white people. Nearly 1.4 million individuals with CHF are less
than 60 years old, and more than 5 per cent of individuals with this disease aged 60 to 69 year
(healthengine, 2019).
Risk factors
Risk factors associated with this health conditions are pregnancy, irregular heart rhythms,
rheumatic fever, infectious endocarditis and myocarditis, heart attacks, myocardial infarction,

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pulmonary embolism, overexercise, sudden upsurge in the salt in the food, extreme humidity and
heat in the environment, emotional crisis (Verbrugge et al., 2013). Another risk factor associated
with CHD is Diabetes (specifically diabetes type 2). People with increased weight and type 2
diabetes are at high risk of CHD. People who smoke tobacco products like cigarette have higher
probability to develop this health condition. A person with deficiency of red blood cells
(anaemia) may also develop this issues compare to the people with normal level of RBCs. Hypo
and hyperthyroidism, heart arrhythmias, atrial fibrillation, emphysema, and lupus are the
additional conditions that may enhance the risk of developing congestive heart failure
(Khatibzadeh, Farzadfar, Oliver, Ezzati, & Moran, 2013).
Impacts on patients and their family
Impacts of congestive heart failure in the patient’s life are more negative than one can
think. As mentioned in the case study Mrs Sharon McKenzie experienced worsening of breathing
issues when she used to walk with her husband and does her gardening. These issues might stop
her from performing these daily life tasks. Congestive heart failure sometimes become chronic
and life threating, this might develop stress in both patient and her family. Impacts this health
conditions may involve financial crisis on the family as its treatment process for CHF is lengthier
(Suman-Horduna, et al., 2013)
Answer 2; Symptoms
Symptoms associated with this health issues includes congested lungs, fluid retentions,
fatigue and dizziness, irregular and rapid heartbeat, nausea, swelling in legs, ankles, abdomen or
hands, and shortness of breathing (Schuetz et a., 2014). Among all the symptoms swelling or
ankles and legs, dizziness and shortness of breath are the most common symptoms of this health

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condition. In CHF the heart is no longer capable of pumping blood efficiently these results in
fluid accumulations in different part of the body. CHF is of different type when it affects the left
side of the patient, Edema in the legs and ankles takes place. In Edema caused by CHF
(specifically in right sided) if a finger placed on the swollen area it leaves imprint. Fatigue and
dizziness may become problematic for the patient with CHF. This particular condition occurs
because the heart is incapable to pump sufficient blood to the body parts and muscles. This
means that there is a lack of oxygen in the muscles which require to the body functioning
(Jurgens, Lee, Reitano, & Riegel, 2013). The body needs oxygen to perform different body
activities, in the deficiency of oxygen and other essential nutrients the patient feel fatigue and
dizziness. When enough blood is not reached to the brain it affects the functioning of the brain
which ultimately results in lethargy and dizziness. Shortness of breath is also the main issues for
people with this health condition. As with most others symptoms faced by individuals with
congestive heart failure, sensing short of breath happens as the result of inefficient blood pumped
to the different body parts like lungs and liver over time. Is specific, as the muscles of the heart
weakens or become stiffen they turn into less capable to sustain with the supply of the blood.
This can cause the blood to back up or accumulate in the ducts travelling form the patient’s lungs
to the heart. In these conditions the fluid can be leak into the lung and accumulate there. This
cased the lungs to unable exchanges O2 and CO2 due to the fluid and the patient may feel
shortness of breath (Rustad, Stern, Hebert, & Musselman, 2013).
Answer 3; Pharmacokinetics and pharmacodynamics
The medical pharmacokinetics and the pharmacodynamics of the drug enalapril and its
relevant de-esterified active metabolites can be determined in Mrs Sharon McKenzie who is
suffering from congestive heart failure and other issues like bradycardia. After the administration

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of solitary doses of enalapril, in the CHF patient, (Mrs Sharon McKenzie) levels of serum and
urine removal of enalapril and can be dogged. Upended and the supine heart rate and BP (blood
pressure) can be measured as the expulsion fraction in case of Mrs Sharon McKenzie and renin
action, levels of aldosterone and changing enzyme action in the patient (Gómez-Díez, Muñoz,
Caballero, Riber, Castejón, & Serrano-Rodríguez, 2014). Seeming oral clearance after providing
5 mg of enalapril was lesser in the CHF patient. The removal of this drug is likewise sluggish in
the patients with congestive heart failure after 5 mg enalapril, respectively. The enalapril
medicinal area under the curve of concentration-time is augmented excessively to the doses in
Mrs Sharon McKenzie. Enalapril dropped the blood pressure (BP) of the patient by 2 h afterward
dosing, and the peak effects of this particular drug can be seen in 4-5 h after administration.
Supine heart rates are unchanged after 20 mg, but augmented after increasing the doses; standing
heart rates are briefly augmented afterward providing enalapril (Claassen, Willmann, Eissing,
Preusser, & Block, 2013). Concentration of quick peak plasma (1 hour) and quick clearance
(untraceable by four hours) by the de-esterification in the patient’s liver to a main lively diacid
metabolite, enalaprilat. Highest plasma enalaprilat absorptions happen 2 to 4 hours afterward
administration of oral enalapril (Gómez-Díez et al., 2014). Elimination afterward is biphasic,
incliding initial stage which imitates renal percolation (removal half-life is 2 to 6 hours) and a
following continued phase (removal half-life 36 hours), the concluding expressive equilibration
of this medicine from the tissue delivery sites. The protracted stage does not subsidize to buildup
of drug on recurrent administration, nonetheless is supposed to be of pharmacological meaning
in intermediating drug special effects (Lainscak, Vitale, Seferovic, Spoletini, Trobec, & Rosano,
2016).

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Answer 4; Nursing care plan
Nursing upkeep for the individual with heart failure issue comprises support to advance
heart pump task by numerous nursing interventions, inhibition, and observation of complications,
and delivering a education plan for lifestyle alterations (Vedel, & Khanassov, 2015).
Assessment
Mrs Sharon McKenzie was assessed with congestive heart failure, bradycrcdia, cardiac
enlargement, and the lower lobe infiltrates. Her vital sign assessment indicates that she had
170/110 mmhg BP, HR 54 bpm, 30 bpm respiratory rate, SpO2 were 92 % on rom air. Nurses
should asses her vital sigh at the regular intervals to examine her heart condition. She should also
be assessed for any negative effects of the prescribed drug (Lainscak et al., 2016).
Nursing diagnosis
The diagnosis for Mrs Sharon McKenzie shows that she had sinus bradycardia, cardiac
enlargement, cold feet and fingers, impaired health upkeep related to deficiency of information
about diet limits and disease (Rustad, Stern, Hebert, & Musselman, 2013).
Expected outcomes
The expected outcomes specify that Mrs Sharon McKenzie will validate stability in the
heart rate and decreases in edema, abdominal distension. She is supposed to demonstrate better
activity tolerance. • Verbalize considerate of diet limitations (Buck, Harkness, Wion, Carroll,
Cosman, Kaasalainen, & Strachan, 2015).
Planning and implementation

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Hourly measurements of vital signs and the hemodynamic pressure are essential. She
should be Administered with prescribed drug and observe effects of recommended diuretics and
vasodilators. She should be Weigh everyday; strict consumption and output should also be there
after the discharge form ED. A nurse should enforce fluid limitation (Buck et al., 2015). Mrs
Sharon McKenzie should also be administered with oxygen per nasal cannula at 2 L/min when
required. A nurse should observe oxygen saturation unceasingly. The registered nurses must
Notify doctor if less than 94 per cent. She must be provided with High Fowler’s or position of
relaxation after the patient discharged form ED. Nurse must Notify doctor if observe any
significant alterations in laboratory values. The registered nurse must teach the patient about all
medicines and how to take and record the pulse. Provide info about anticoagulant treatment and
indications of bleeding.
Evaluation
After the successful interventions provided after the discharge from ED it is much easier
for the patient to breathe and feet and fingers are better. She is capable to sleep in the semi-
Fowler’s position and without pain. She issued related to bradycardia and other heart related
issues are resolved.

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References
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., & Strachan, P.
H. (2015). Caregivers’ contributions to heart failure self-care: a systematic
review. European Journal of Cardiovascular Nursing, 14(1), 79-89.
Claassen, K., Willmann, S., Eissing, T., Preusser, T., & Block, M. (2013). A detailed
physiologically based model to simulate the pharmacokinetics and hormonal
pharmacodynamics of enalapril on the circulating endocrine renin-angiotensin-
aldosterone system. Frontiers in physiology, 4, 4.
Gómez-Díez, M., Muñoz, A., Caballero, J. M. S., Riber, C., Castejón, F., & Serrano-Rodríguez,
J. M. (2014). Pharmacokinetics and pharmacodynamics of enalapril and its active
metabolite, enalaprilat, at four different doses in healthy horses. Research in veterinary
science, 97(1), 105-110.
Jurgens, C. Y., Lee, C. S., Reitano, J. M., & Riegel, B. (2013). Heart failure symptom
monitoring and response training. Heart & Lung: The Journal of Acute and Critical
Care, 42(4), 273-280.
Khatibzadeh, S., Farzadfar, F., Oliver, J., Ezzati, M., & Moran, A. (2013). Worldwide risk
factors for heart failure: a systematic review and pooled analysis. International journal
of cardiology, 168(2), 1186-1194.
Lainscak, M., Vitale, C., Seferovic, P., Spoletini, I., Trobec, K. C., & Rosano, G. M. (2016).
Pharmacokinetics and pharmacodynamics of cardiovascular drugs in chronic heart
failure. International journal of cardiology, 224, 191-198.

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Rustad, J. K., Stern, T. A., Hebert, K. A., & Musselman, D. L. (2013). Diagnosis and treatment
of depression in patients with congestive heart failure: a review of the literature. The
primary care companion for CNS disorders, 15(4).
Rustad, J. K., Stern, T. A., Hebert, K. A., & Musselman, D. L. (2013). Diagnosis and treatment
of depression in patients with congestive heart failure: a review of the literature. The
primary care companion for CNS disorders, 15(4).
Schuetz, P., Kutz, A., Grolimund, E., Haubitz, S., Demann, D., Vögeli, A., & Hoess, C. (2014).
Excluding infection through procalcitonin testing improves outcomes of congestive
heart failure patients presenting with acute respiratory symptoms: results from the
randomized ProHOSP trial. International journal of cardiology, 175(3), 464-472.
Suman-Horduna, I., Roy, D., Frasure-Smith, N., Talajic, M., Lespérance, F., Blondeau, L., &
AF-CHF Trial Investigators. (2013). Quality of life and functional capacity in patients
with atrial fibrillation and congestive heart failure. Journal of the American College of
Cardiology, 61(4), 455-460.
Vedel, I., & Khanassov, V. (2015). Transitional care for patients with congestive heart failure: a
systematic review and meta-analysis. The Annals of Family Medicine, 13(6), 562-571.
Verbrugge, F. H., Dupont, M., Steels, P., Grieten, L., Malbrain, M., Tang, W. W., & Mullens, W.
(2013). Abdominal contributions to cardiorenal dysfunction in congestive heart
failure. Journal of the American College of Cardiology, 62(6), 485-495.
healthengine (2019). Congestive heart failure. Retrieved form:
https://healthengine.com.au/info/congestive-heart-failure

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