Nursing Care Plan for Congestive Heart Failure Patient - NRSG353

This document discusses the nursing care plan for a patient with Congestive Heart Failure. It covers the disease, causes, incidence, and risk factors, along with the impact on the patient and their family. It also explains the pharmacodynamics & pharmacokinetics of one common class of drug relevant to the chosen patient. The document provides a nursing care plan for the first 8 hours post ward admission, including goals, interventions, and rationales.

Running Head: NRSG353
Assessment
Case Study 1
Student Name:…….
Submitted to:……….
University:…………

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Case Study 1
1. Outline the disease, causes, incidence and risk factors. Discuss the impact of the selected
disease on the patient and their family
Congestive Heart Failure (CHF) refers to a chronic health condition in which the heart muscles
lose their strength of filling and pumping out blood due to thickening of ventricles. The patient
suffers from systolic and diastolic dysfunction. The disease is marked by the symptoms like
shortness of breath, fatigue, edema and chest congestion. The most important risk factor of
Congestive Heart Failure in this case is a history of myocardial infarction (MI). Sharon is also
found to have high blood pressure, low heart rate, her lungs have inspiratory crackles at both the
lung bases.
The crackles (rales) occur due to high concentration of fluids in the airways occurring due to
transudate like congestive heart disease (Pietro, 2018). They are mostly associated with edema or
presence of fluids in the alveoli. The crackles produce short lung sounds and symbolize airways
obstructions.
SpO2 92% shows abnormally reduced level of oxygen in the blood.
The most common causes of CHF are high blood pressure, narrowing of arteries due to coronary
artery disease, and reduced flexibility of heart valves. Every year about 57000 Australian people
suffer from Congestive Heart Disease (Heart Foundation, 2018). The disease kills one Australian
in every 10 minutes. The disease is mostly prevalent in the people aged 60 years or more.
The risk factors of CHF are uncontrolled high blood pressure and high total cholesterol levels,
MI, obesity, diabetes, smoking habits and sedentary lifestyle (Heart Foundation, 2018). In the

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case study Sharon exhibits mostly similar risk factors such as high BP, Myocardial Infarction.
The condition takes place when the blood flow lowers down to the heart muscles due to blockage
in coronary arteries ultimately leading to tissue damage.
The Congestive Heart Failure affects the whole family. The expenses of medications and the
hospitalization cause additional burden on the income of the family. The treatment puts
additional stress over the old age patients. The patient may feel depression and anxiety. A study
by Duke University revealed that the patients who have strong family support are less likely to
get depressed due to CHF (Gray, 2012). The patient may have issues with tolerating the noise at
home. The patient’s emotional state also keeps on changing and the family will have to be ready
to deal with it. The elderly people have increasingly high chances of feeling lonely and getting
depression. They need extra care and cordial communication to shed off their depression.
Effective communication is required between the patient, healthcare providers and the families
of the patient. The treatment needs a combination of geriatrics, medication and cardiology (Heart
Failure Society of America, 2018). Caring for the old age patients demand active listening, and a
comprehensive management of disease symptoms.
2. Discuss three (3) common signs and symptoms of the selected disease and explain the
underlying pathophysiology of each
Common Sign &
Symptoms
Pathophysiology
Shortness of
Breath (SOB)
Uncomfortable breathing pattern, caused due to a combination of factors
like chemoreceptor stimulation, neuro-ventilatory dissociation, and
mechanical stimuli emerging from chest wall receptors and lungs. The

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SOB is also linked to hormonal imbalance in the patient’s brain making
the respiratory control ineffective (University of Guelph, 2017).
When the heart gets inefficient in pumping the blood, the blood may get
collected in the veins which transport it through the lungs. This extra fluid
in the blood vessels lowers down the movement of oxygen in the lungs.
Edema and fluid
retention
The distribution of oxygenated blood in the body parts relies on the output
from the heart like hbpm and blood pressure. Weak cardiac muscles due to
MI may pump the blood to lesser extent to the body organs like kidney
which responds back by retaining the water or fluids (Feili, 2014). It
increases the swelling in the limbs, abdomen and other body parts making
the body congested. The patient also feels excessive feeling to urinate to
let the body get rid of extra liquid. Blood also retains in the ventricles
which do not accept or collect the blood from the organs. Sharon’s cold
feet and fingers can be seen as less common symptoms.
Nausea, Dizziness
& Weakness
Fatigue occurs due to impaired blood supply in cardiac muscles and low
cardiac output and reduced pulmonary diffusion. Any such factors
increase the stress on cardiac muscles leading to dysfunction of ventricles.
Stomach bloating may also lead to nausea, weakness, loss of appetite and
dizziness. Sharon’s ECG also shows
Poor ventricular dysfunction leads to reduced cardiac output and lowers
the stroke volume. The neurohormonal response in response to low
Oxygen level in the blood activates the sympathetic system, and rennin
angiotensin aldosterone system (Al-Shehri, 2017). The resulting

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mechanism leads to vasoconstriction that is elevated levels of sympathetic
tone, endothelins, angiotensin II and impaired release of nitric oxide. High
levels of fluid and sodium retention further elevates the aldosterone and
vasopressin hormones. All this further increases the dilation and stress on
ventricular walls resulting into worsened ventricular activity. All this
finally increases the probability of recurrent congestive heart failures.
3. Discuss the pharmacodynamics & pharmacokinetics of one (1) common class of drug relevant
to the chosen patient
The medication of Sharon includes a common class of drugs known as Positive Inotropic Drugs.
It includes Digoxin 250 mcg on daily basis. These drugs have hemodymanic, neurohormonal and
electrophysiological effect on the body. They increase the capability of myocardial contraction
without affecting the loading conditions and heart rate changes. However, these factors are quite
variable and may get altered due to presence of inotropic drugs. These drugs have vasodilator
properties and they generally increase the heart rate and myocardial consumption of oxygen.
They are used to treat the refractory cardiac failures. They also stabilize the potassium and
sodium ions in the body.
Digoxin initiates collective impact on the heart, elevating the tendency of contraction, reducing
the heart rate, increases the parasympathetic factors and reduces the sympathetic factors.
Digoxin inhibits the enzyme Na-K-ATPase which regulates the concentration of potassium and
sodium ions inside the cell, eventually elevating the contractility of heart. Thus it elevates the
intracellular concentration of Ca and Na (Quashie, Ukomadu, Francio & Brown, 2017).

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Overall this category of drugs enhances the functionality of cardiac muscles, The drugs also
causes hemodynamic effect by elevating the cardiac output, elevating the ejection fraction of left
ventricle and reducing the wedge pressure of capillaries.
The pharmacokinetics involves the distribution, absorption, excretion and metabolism of the
drug in the body. Inotropic drugs are generally prescribed to treat the cardiac problems in elderly
patients. It is necessary to assess the appropriate dose of the drugs in these patients due to aging
and associated physiological changes. The aging changes the absorption of medicine. Low
production of saliva adversely affects the oral absorption. The changes in body composition and
organ perfusion influence the drug distribution. The metabolism of kidneys also reduces with age
thereby reducing the metabolism of drugs. Kidneys also have low rates of elimination.
These drugs enhance the cognitive capacity of the elderly patients and lowering down the
cognitive dysfunction.
3. In order of priority, develop a nursing care plan for your chosen patient who has just
arrived on the ward from ED. Nursing care plan goals, interventions and rationales must
relate to the first 8 hours post ward admission
The Nursing Care Plan during the first 8 hours of admission in the ward involves monitoring the
heart rate of the patient, Oxygen saturation levels, Brain Natriuretic Peptide range, monitor the
swelling and assess the respiratory functions of the body. The care is aimed to reduce the
progression of cardiac workload, control the retention of fluids and enhance the function of heart.
Initially the diagnosis of the symptoms involves history review, diagnostic findings and physical
examination. The comprehensive care includes analyzing the multisystem effect of disease on

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neurological, respiratory, cardiovascular, gastrointestinal, genitourinary, integumentary and
musculoskeletal system.
After admission, her BP was examined. The Respiratory rate was high, Blood pressure was high,
oxygen level in her blood was low. Her limbs were cold. She also had ECG, chest X-Ray and
complete blood tests. She is given necessary medications to control the symptoms.
Symptoms Nursing Intervention
Reduced Cardiac Output The heart palpitations, breathing problems and coughing
like symptoms will reflect the potential chest congestion,
crackles in lung bases and state of confusion.
Edema Amount of salt to be reduced in the food, medicines are
given for treatment of water retention and swelling.
High Blood Pressure Medications are given for controlling the blood pressure.
Increased Rate of Heart Beat Relaxation and rest is given for normalizing the cardiac
functions.
Inspiratory crackles Conserve energy and Promote rest . Encourage fluid intake,
promote humidification and hydration. Maintain balanced
nutrition, manage the further complications (Radiology info,
2019). In severe cases be ready to intubate the patient.
Cardiac Enlargement Monitor and manage the underlying problem, like high BP.
Reduce the stress level on cardiac muscles and relax the
muscles by medicines.
Sinus bradycardia Evaluate the symptoms through ECG, treatment through
medications. Thyroid tests, electrolyte test, Calcium and
glucose levels. Cardiac monitoring, intravenous assessment,
ensure the stability of patient.
Lower Lobe Infiltrates Infection can be treated through medicines. Patient’s WBC
count is less. He may be given medicines to increase
immunity.
Cold limbs Cold feet may be due to pneumonia and hypothyroidism
which can be treated through medicines (Gotter, 2017).
Very low potassium level Potassium is considered important for the normal
functioning of nerves, heart and muscles. It may be life
threatening and may need urgent medical attention (Viera &
Wouk, 2015).
Tendency to Forget Psychological condition can be improved through relaxation
therapy.

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References
Al-Shehri,F.(2017). Treatment of Heart Failure. Retrieved from
https://slideplayer.com/slide/6153058/
Feili,A.(2014). Congestive Heart Failure Explained. Retrieved from
https://www.youtube.com/watch?v=zy_fK1P2odM
Gotter,A.(2017). Why are my feet cold? Retrieved from https://www.healthline.com/health/cold-
feet
Gray, T.(2012). Heart Disease and its effect on the family. Retrieved from
http://www.valueoptions.com/solutions/2012/02-February/story2.htm
Heart Failure Society of America(2018). Module 7: Tips for Family and Friends on Heart
Failure. Retrieved from https://www.hfsa.org/patient/patient-tools/educational-
modules/module-7/
Heart Foundation (2018). Heart Disease in Australia. Retrieved from
https://www.heartfoundation.org.au/about-us/what-we-do/heart-disease-in-
australia
Pietro,M.(2018). Everything you need to know about bibasilar crackles. Retrieved from
https://www.medicalnewstoday.com/articles/322597.php
Quashie, Ukomadu, Francio & Brown (2017). The Effectiveness of Digoxin in Treating Heart
Failure. Journal of cardiology and current research. 8(5). 00297.
DOI: 10.15406/jccr.2017.08.00297
Radiology Info (2019). Pneumonia. Retrieved from https://www.radiologyinfo.org/en/info.cfm?
pg=pneumonia
University of Guelph (2017). Cause of breathlessness in heart failure patients discovered.
Retrieved from
https://www.sciencedaily.com/releases/2017/05/170517184504.htm
Viera,A. & Wouk,N. (2015). Potassium Disorders: Hypokalemia and Hyperkalemia. Am Fam
Physician. 92(6). 487-495. Retrieved from
https://www.aafp.org/afp/2015/0915/p487.html