S00213148 Acute Care Nursing

S00213148
Acute Care Nursing
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Q.1.
There are various risk factors which are responsible for development of congestive
heart failure (CHF) including older age, high levels of cholesterol, diabetes mellitus, high
blood pressure and active smoking. In the given scenario, Mrs Sharon Mckenzie is 77 years
old which might be one the risk factor for CCF to her. According to recent literature, risk of
CHF increases with age, 2 % of the people between age 40 to 59 years and 5 % of the people
between 60 to 69 years develop CHF. In addition to this lack of physical activity, family
history, obesity and alcohol consumption are also responsible for CHF (Dhingra et al., 2014).
Since Mrs Mckenzie is elderly lady she might not be able to do sufficient physical activity,
even though she sometimes does gardening and walking with her husband this may also play
role to her recent condition. Similarly another contributing factor is hypertension, according
to given observation date in the scenario, she is hypertensive. Hypertensive females are at
four times higher risk as compared to non-hypertensive females for CHF. Female with
hypertension are more prone to congestive heart failure as compared to hypertensive female.
60 % of hypertensive female and 40 % of the hypertensive male are at risk of CHF
(Mahmood and Wang, 2013). Likewise, Lipoproteins play major role in CHF. CHF can
occur in patients with high levels of low-density lipoproteins (LDL) and low levels of high
density lipoproteins (HDL). Smoking and obesity is also prominent factor for CCF,36 %
people with smoking and 20 % people with obesity can develop CHF (Australian Institute of
Health and Welfare (2014). Dietary factors are also responsible for the development of CHF
like more consumption of saturated fats can lead to development of CHF. People with
augmented levels of β-type natriuretic peptides can develop CHF (Díaz-Toro et al., 2015).
Most of the cardiovascular abnormalities like coronary artery disease and heart attack,
faulty heart valves, cardiomyopathy, myocarditis, coronary artery disease, congenital heart
defects and heart arrhythmias are responsible for the occurrence of CHF, in case of Mrs
Mckenzie, she has history of MI which further increase risk of CCF to her. Moreover, few of
the medications consumption can lead to CHF development in people. These medications
include antidiabetic medications (rosiglitazone and pioglitazone), nonsteroidal anti-
inflammatory drugs (NSAIDs), certain anaesthetics, anti-arrhythmic medications,
antihypertensive and anticancer (Gotto Jr et al., 2012; DeSilva, 2013). In regards to Mrs
Mckenzie, she is on antihypertensive medication, which can increase risk of CCF to her.
Mortality rate is high in people with CHF. On the basis of recent statistics, approximately
half of the patients with CHF die within 5 years of diagnosis of CHF. In comparison to the
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normal people, approximately 10 % of the people would have sudden death (Australian
Institute of Health and Welfare ,2014). Due to her recent conditions her activity of daily
living can be significantly affected, she might not be able to do her usual activities and need
someone to supervise and assist her which can impact on her psychological condition. On the
other hand, family member need to involve in her care which can be stressful for them and
the cost of treatment might pose economic burden to them. Family members and care
providers should avoid exposure of risk factors to her. Her diet and medication consumption
adherence should be monitored by care provider and dietician. Positive communication
should be maintained with the adult patients and her family members should maintain
positive communication with her to improve her moral and wellbeing. Family members
should keep positive approach to improve her condition and they should not keep on
worrying about her diseased condition. Worrying about the patient condition can divert
family member’s attention from caring him (Cooper et al., 2015; Raman, 2016).
Q2. :
Symptom Pathophysiology
Dyspnoea Impaired cardiac output can lead to reduced supply of blood to different
tissues including cardiac skeletal muscle. It results in the increased left
ventricular filling pressure to maintain required cardiac output.
Consequently, there would be decreased pulmonary diffusion which leads
to occurrence of interstitial oedema. Interstitial oedema produces
breathlessness. Increased diastolic pressure require more amount of energy
which results in the augmented expenditure of myocardial energy. This
high energy requirement results in the ventricular remodelling, increased
myocardial oxygen demand and myocardial ischemia. From the provided
information, it is evident that Mrs McKenzie is also experiencing shortness
of breath (Güder et al., 2014; Hosenpud and Greenberg, 2013).
Swollen
ankle
Swollen ankle is the condition in which there is increased swelling in the
leg or ankle. Swelling in organ mainly occurs due to the accumulation of
fluid. Reduced cardiac output is mainly responsible for the accumulation of
fluid. Indigenous factors like atrial natriuretic peptide and β-type natriuretic
peptide are responsible for the vasodilation and decreased ventricular filling
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pressure. It results in the reduced cardiac preload and afterload. This results
in the increased back flow of blood to the heart through the veins.
Narrowing in the valve can lead to block in the blood flow, hence heart
would not be able to pump required amount of blood. Due to this
cardiovascular abnormality, Mrs McKenzie is having swollen ankle (Moe,
2013; Eisen, 2014).
Dizziness In patients with congestive heart failure, there would be reduced blood flow
to all the organs including brain. Due to this reduced blood flow to brain,
patients with CHF can experience dizziness. Abnormality in heart rate and
rhythm is mainly responsible for the reduced blood supply to brain. As a
result of this cardiovascular abnormality, Mrs McKenzie is experiencing
dizziness (Kovács et al., 2014; Hosenpud and Greenberg, 2013).
Tachycardia Patients with CHF are associated with life-threatening ventricular
arrhythmias. Ventricular dilation is responsible for ventricular arrhythmia.
Also, myocyte pathology like myocardial hypertrophy and myocardial
fibrosis are responsible for the ventricular arrhythmia (Ellis and Josephson,
2013; Eisen, 2014).
Lack of
appetite and
nausea
Less supply of blood to gastrointestinal tract in patients with CHF results in
lack of appetite and nausea. Due to less supply of blood, nerve endings in
the gastrointestinal tract can have irritation. Due to this irritation, these
nerve endings stimulate centres in brain which are responsible for nausea
and vomiting (Kemp and Conte, 2012; Hosenpud and Greenberg, 2013).
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