Nursing Case Study: Exacerbation of Congestive Heart Failure

Nursing Case Study
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Introduction
This case study assesses patient Smith aged 70 years old presenting exacerbation of
congestive heart failure. The patient indicative symptoms entail complains of chest pain,
weakness, SOB, fatigue, hacking cough illustrating bilateral coarse crackles. The patient has
a past illness of hypercholesterolemia, MI, angina, hypertension, increased BMI 34 and type
II diabetes. This essay offers key primary priorities of the patient presentation. Further key
nursing interventions which entail ineffective breathing restoration, ineffective airway
clearance and fatigue management for the patient and discharge plan for the patient are
presented. The role of nurses in delivering appropriate nursing intervention for the patient is
essential for the care process (Riley et al., 2016). As a form of care process continuity,
enhancing the ability of the patient through an appropriate discharge plan is key in ensuring
the prevention of patient readmission.
Primary Priorities
Nursing care priorities are essential for patient care management. Prioritizing patient
management seeks to envision the implication of the patient overall state and improve the
quality of care (Conway et al., 2017). The key health care nursing priority for the patient
entails care for the acute respiratory syndrome and deteriorating state of congestive heart
failure. Assessment using the ABCD framework for acute respiratory syndrome entails a
review of airway depicted by the hacking cough with signs of bibasal coarse crackles. The
occurrence of shortness of breath further the patient is depicting low oxygen saturation. The
breathing assessment of the patient depicts severe shortness of breath and unusual labored
breathing coupled up with tiredness. The blood circulation of the patient display anomalies as
observed using the ECF negative troponin index. The disability state of the patient reveals a
general weakness with immense fatigue. Patient exposure levels as indicated by the
temperature readings indicate hyperthermia, thus lowering of body temperature is beneficial
for the patient.
Congestive heart failure state of the patient reflects the lowered function of the respiratory
function. The airway assessment of the patient depicts shortness of breath characterized by
breath exertion (Benhase et al., 2018). The breathing status of the patent is lowered
characterized by the increased heart rate levels and elevated respiratory rates. The blood
circulation of the patient is lowered due to the occurrence of low heart rate and prehistory

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angina and low respiratory rate. The patient does not display any disability state while
exposure levels indicated elevated temperature levels.
Interventions
Enabling and initiating nursing intervention for the patient is essential as it is critical
in managing exacerbating patient’s conditions and improves the overall disease state of the
patient (Rice, Say & Betihavas, 2018). There is a need to focus on the following key three
interventions; ineffective breathing patterns, fatigue management and clearance of breathing
pathway. Developing a comprehensive care intervention plan is essential to improve the
overall patient ability and to help in various nursing interventions and identification of other
complications which might arise from the patient assessment.
Intervention 1: Ineffective breathing pattern restoration
Ineffective breathing pattern for the patterns reveals changes and occurrence of shortness of
breath with activity, further utilization of accessory muscles has declined. The oxygen
saturation levels indicate 92%, while the heartbeat rates have high of 105 indicating an
increased burden on the heart breathing mechanism.
The occurrence of the abdominal wall excursion during the inspiration and expiration process
needs to be maintained to optimum levels for the patient. The ineffective breathing pattern is
often one of the key issues for intervention among patients with acute respiratory distress
(Kelley & Ferreira et al., 2017). This intervention assesses the depth, rate, timing and the
rhythm pattern of breathing. The ineffective breathing pattern is correlated with variation
respiratory rate, abdominal and thoracic pattern. Breathing rate can further alter various
circumstances such as heart failure, hypoxia, airway obstruction, infection and trauma
(Rutledge et al., 2018).
Enhancing clear pathways for effective airway processes in patient care is essential. There is
a need for appropriate management having difficulties in oxygenation in order to sustain
ventilation for the pulmonary. The need for promoting comfort and easing breathing
pathways improvement and the ability to engage in physical excises and prevention of
oxygenation problem such as tissue breakdown and skin (Borge et al., 2015).
Expected nursing outcomes for the patient entail improvement of patient saturation level to
be between 90%-100% per minute during the hospitalization period. Key assessment to be
monitored by the nurse entail the respiratory rates periodically in order to assess trends in the