Nursing Care Plan for Congestive Heart Failure

Running head: NURSING
Nursing
Name of the student:
Name of the University:
Author’s note

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Answer 1:
Outline of disease and causes:
The review of sign and symptoms of Mrs. Sharon McKenzie, a 77 years old patient with
symptom of shortness of breath, swollen ankles and nausea suggest that the patient is suffering
from congestive cardiac failure. It is a condition associated with narrowing of the arteries and
decreases ability of the heart to pump blood efficiently. It is mainly caused by the diagnosis of
heart disease like coronary artery disease, rheumatic heart failure, high blood pressure and
chronic obstructive pulmonary disease in patient which damages and weakens the heart muscles.
For example, patients with coronary artery disease are at increased risk of congestive heart
failure because of build-up of plaques in the arteries and reduction in the blood flow to the heart.
Similarly, conditions like hypertension increases risk of heart failure, as high blood pressure
makes it harder for heart to circulate blood throughout the body. The continuous extra exertion
makes the heart muscles stiff and weakened thus affecting their pumping function. Increase in
blood pressure exposed cardiac myocytes to elevated mechanical stress which result in left
ventricular hypertrophy and cardiac changes (Ziaeia & Fonarow, 2016). This ultimately leads to
congestive heart failure.
Incidence and risk factors:
Obesity, hypertension, smoking and cholesterol are some major risk factor associated
with cardiovascular morbidity and increase in risk of congestive heart failure. Congestive cardiac
failure is a major burden for patient and health care system of developed countries globally. It is
a rising global health issue as more than 37.7 million people globally are affected by the disorder
(Ziaeia & Fonarow, 2016). Evidence reveals that about 50-75% of patients with heart failure die

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within five years of diagnosis. Another alarming statistics is that heart failure is the cause behind
increase in overall health care expenditure and prolonged hospital stay. In developed countries,
the prevalence rate of cardiac failure is 1-3% and the incidence increases by more than 10% in
people aged 75 years and above (Sahle et al., 2016). Although there is no Australian based
statistics on prevalence of heart failure in Australia, review of overseas finding suggest that more
than 3, 00, 000 Australians have developed heart failure and 30, 000 new cases are diagnosed
every year (Australian Institute of Health and Welfare, 2017). Hence, controlling risk factor is
necessary to reduce the burden of heart disease.
Impact of the disease on patient and their family:
The diagnosis of congestive heart failure is associated with significant impact on quality
of life of people and disruption in routine activities because of the regular need to seek medical
care. A study revealed that people living with heart failure limited quality of life of patient and
such patients develop frustration because of their inability to perform daily life activities. They
lose their confidence. Some also face challenges in self-management of the disease (Fry et al.,
2016). The impact of the cardiac failure on family members is that it is associated with
disruption of their schedule as they need to engage in care giving task. Patient’s family
experiences mental stress due to poor knowledge about management of the condition and
hospitalization of their loved ones (Hwang et al., 2011).
Answer 2:
Three common sign and symptoms:

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Three common symptom of congestive cardiac failure includes shortness of breath,
oedema and irregular heart beat. All these symptoms have been found for Mrs. Sharon McKenzie
too.
Underlying pathphysiology of each symptom
Shortness of breath or dyspnoea is a common symptom in patient with congestive heart
failure. This symptom is seen because of increased ventilator demand in patient and constraints
on tidal volume expansion resulting in development of mechanical limitation of ventilation.
These pathophysiological changes in patient with heart failure contribute to exertional dyspnea.
This hallmark symptom occurs because of inflammatory activation and its affect on airway
responsiveness leading to breathlessness and chest tighteness. (Dubé, Agostoni & Laveneziana,
2016).
Mrs. Sharon was found with swollen ankles indicating edema. Edema in patient with
congestive heart failure occurs because of the humoral and neurohumoral mechanism in the body
that lead to sodium and water reabsorption by the kidney and increase in extracellular fluid
volume. This mechanism promotes fluid extravasation and contributes to edema formation in
patient (Gargani et al., 2015). In addition, the symptom of irregular heart beat or cardiac
arrhythmia occurs because of loss of heart muscle, decreased myocardial contractility and
volume overload. Systolic dysfunction occurs in patient resulting in reduced ejection fractio.
This results in change in heart rate and rhythm due to activation of pathophysiological
mechanisms like Frank-starling mechanism, increase in catecholamine level, and activation of
the rennin-angiotensin system. Due to this changes, cardiac output is reduces and patients
develop symptom of irregular heart beat (Volpe, Carnovali & Mastromarino, 2016).