Nursing Case Study: Acute Chronic Heart Failure Patient Management

This nursing case study delves into the management of Mrs. Brown, a 78-year-old patient admitted with acute chronic heart failure. The case study begins by detailing the patient's initial presentation, including symptoms such as dyspnea, increased respiratory rate, and atrial fibrillation. It explores the pathophysiology of the condition, linking it to Mrs. Brown's pre-existing heart failure and discussing the physiological mechanisms that lead to pulmonary and venous congestion. The study then highlights the crucial role of nursing professionals in rapid assessment, triage, and communication with the patient to manage anxiety and ensure proper breathing. Furthermore, it discusses the pharmacological interventions, specifically the use of Furosemide to reduce fluid accumulation and sublingual glyceryl trinitrate to decrease ventricular pressure, emphasizing the importance of monitoring vital signs and fluid balance after drug administration. The case study concludes by referencing relevant literature to support the discussed treatment strategies and physiological explanations.

Running head: NURSING ASSIGNMENT
NURSING CASE STUDY ASSIGNMENT
Name of the Student
Name of the University
Author note

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Answer 1
Mrs. Brown (78) was admitted to the emergency department of the healthcare facility
with several issues within which dyspnea, severe breathlessness and increased respiratory rate,
heart rate, pulse rate and high blood pressure was diagnosed as primary vital signs. The
healthcare physicians conducted ECG so that identification of the concern could be determined
and atrial fibrillations or abnormal heart rhythm and identification of acute exacerbation of
chronic left-sided heart failure was made. As per Wilcox, Kabrhel and Channick (2015), it was
said that acute chronic heart failure could occur due to preexisting heart disease or the patient has
history of heart failure. In this case, Mrs. Brown had history of heart failure and hence, this onset
of acute chronic heart failure could be connected to her pre-existing heart disorder. In this health
condition, the ventricles become stiff and they become unable to pump blood properly
throughout the body (Harjola et al., 2016). This situation leads to volume overload in the
pulmonary and venous congestion and hence, congestion in chest could be felt by the patient
(Güder & Rutten, 2014). Further this filling pressure in left side of heart ventricle leads to
depressed cardiac index and cardiac output. Further due to these effects tachycardia and
myocardial oxygen consumption increases due to which vasoconstrictor neurohormones
increases and hence, sodium or fluid retention occurs (Wilcox, Kabrhel & Channick, 2015). This
phenomenon increases the wall pressure of the heart muscles and hence excessive stress and
simultaneously decreased renal perfusion is observed. These aspects leads to the onset of
symptoms such as increased blood pressure, increased heart rate due to tachycardia increased
respiratory rate due to increased oxygen consumption and chest congestion due to stress and
stiffness in the heart muscles due to this disorder (Güder & Rutten, 2014).

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Further, in pathophysiology of this disorder, it could be said that if the heart muscles and
its stress could not be relieved within a specific time, it could become unable to maintain the
ideal cardiac output and becomes insufficient in meeting the demands of peripheral blood
circulation and hence, it is required to provide the patient suffering from acute chronic heart
failure with quick medication so that conditions could be easily treated and muscle relaxation
could be imparted in the heart muscles (Wilcox, Kabrhel & Channick, 2015). Besides these,
there are several factors which are associated with the occurrence of acute chronic heart failure
such as bacterial infection or congestion in the lungs, lack of proper medication after the first
surgery, thyrotoxic crisis, anemia, and reduction in the renal function and increased volume load
(Güder & Rutten, 2014). There is no such information available about the addiction and
associated details were provided and hence, the history of heart failure could be seen as the onset
of heart congestion and associated secondary left sided heart failure. As per Harjola et al. (2016),
the heart failure seen in Mrs. Brown is classified as systolic heart failure as dysfunction in the
left ventricle was seen in the symptom and through ECG tests it was seen that the heart muscles
are making abnormal rhythms which is known as atrial fibrillations.
Answer 2
Nursing professionals play an important role in the treatment process of patients with
acute heart failure associated disorders as rapid and quick action and interventions are required
while providing care to such patients (Mebazaa et al., 2014). Therefore, the strategies used in the
care process should complement the speed and intensity required to treat such patients and
improve their condition rapidly. The first strategy which should be used is conducting immediate
assessment of the disease and triage so that identification of the intensity of the disorder could be
done (Mahramus et al., 2015). The nurse should be able to conduct rapid triage so that proper

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environment for the safe clinical practice could be prepared and within that rapid changes in the
symptoms and recording the improvements or decreasing health condition could be done
(Mebazaa et al., 2014). Further treating patients anxiety, stress, and maintaining proper breathing
is present among the primary nursing strategy that should be implemented in case of Mrs.
Brown. The second Nursing strategy would be conducting proper communication with the
patient so that each smaller concern of the patient could be collected as it could impact her
adverse health condition and hence, these are the two nursing strategies or interventions that
should be implemented in the care process of Mrs. Brown, who is suffering from acute chronic
health failure (Mahramus et al., 2015).
Answer 3
A. In the pathophysiology of acute congestive heart disorder of Mrs. Brown, it was seen
that due to the increased blood pressure and it also leads to activation of
vasoconstrictor neurohormones and hence, the body starts accumulating the sodium
and simultaneously the body fluid retention capacity increases (DuBois et al., 2014).
In such condition, to decrease the fluid accumulated in the patient’s body Furosemide
is provided as it helps to inhibit the Na-K-Cl transportation and hence, such minerals
are excreted from the body through the urine and decreases the feeling of congestion
or heaviness (Lustri et al., 2017). Hence, it works by decreasing the pressure from the
heart muscles.
In the treatment of acute heart failure of Mrs. Brown, sublingual glyceryl trinitrate
was also implemented which is a drug which acts by decreasing the ventricular
pressure in smaller doses and in higher dose it helps to decrease the systemic vascular
resistance associated pressure (Ramachandran et al., 2014). The glyceryl trinitrate

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present in the drug is a vasodilator which helps to relax the vascular smooth muscles
and helps to dilate the atrial and venous cells (Pedersen et al., 2015).
B. These two drugs are very crucial and after implementation in the care process for the
patient, it should be properly assessed and the vital signs should be collected so that
the changes could be easily identified (Pedersen et al., 2015). After implementation of
sublingual glyceryl trinitrate, it is important to assess the vital signs and specifically
the blood pressure so that the action of the drug in dilating blood vessels and
normalizing blood pressure could be easily identified (Ramachandran et al., 2014).
Further, after application of Furosemide, the input and output of fluid through body
should be properly assessed as excess body fluid loss could increase dehydration
associated complication in patient and also could worsen her anemia associated
symptoms (DuBois et al., 2014). Hence, proper identification and monitoring is
important after application of both the drugs.

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References
DuBois, B. N., Pearson, J., Mahmood, T., Nguyen, D., Thornburg, K., & Cherala, G. (2014).
Perinatal growth restriction decreases diuretic action of furosemide in adult
rats. European journal of pharmacology, 728, 39-47.
Güder, G., & Rutten, F. H. (2014). Comorbidity of heart failure and chronic obstructive
pulmonary disease: more than coincidence. Current heart failure reports, 11(3), 337-346.
Harjola, V. P., Mebazaa, A., Čelutkienė, J., Bettex, D., Bueno, H., Chioncel, O., ... & Leite‐
Moreira, A. (2016). Contemporary management of acute right ventricular failure: a
statement from the Heart Failure Association and the Working Group on Pulmonary
Circulation and Right Ventricular Function of the European Society of
Cardiology. European journal of heart failure, 18(3), 226-241.
Lustri, W. R., Lazarini, S. C., Lustri, B. C., Corbi, P. P., Silva, M. A. C., Nogueira, F. A. R., ... &
da Silva Barud, H. (2017). Spectroscopic characterization and biological studies in vitro
of a new silver complex with furosemide: prospective of application as an antimicrobial
agent. Journal of Molecular Structure, 1134, 386-394.
Mahramus, T., Penoyer, D. A., Frewin, S., Chamberlain, L., Wilson, D., & Sole, M. L. (2014).
Assessment of an educational intervention on nurses' knowledge and retention of heart
failure self-care principles and the Teach Back method. Heart & Lung: The Journal of
Acute and Critical Care, 43(3), 204-212.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., ... &
McDonagh, T. (2015). Recommendations on pre‐hospital & early hospital management

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of acute heart failure: a consensus paper from the Heart Failure Association of the
European Society of Cardiology, the European Society of Emergency Medicine and the
Society of Academic Emergency Medicine. European journal of heart failure, 17(6),
544-558.
Pedersen, S. H., Ramachandran, R., Amrutkar, D. V., Petersen, S., Olesen, J., & Jansen-Olesen,
I. (2015). Mechanisms of glyceryl trinitrate provoked mast cell
degranulation. Cephalalgia, 35(14), 1287-1297.
Ramachandran, R., Bhatt, D. K., Ploug, K. B., Hay-Schmidt, A., Jansen-Olesen, I., Gupta, S., &
Olesen, J. (2014). Nitric oxide synthase, calcitonin gene-related peptide and NK-1
receptor mechanisms are involved in GTN-induced neuronal
activation. Cephalalgia, 34(2), 136-147.
Wilcox, S. R., Kabrhel, C., & Channick, R. N. (2015). Pulmonary hypertension and right
ventricular failure in emergency medicine. Annals of emergency medicine, 66(6), 619-
628.