Left-Sided Congestive Cardiac Failure: A Detailed Patient Case Study

This case study presents a detailed analysis of Mr. John Hale, a 72-year-old male admitted to the cardiac ward with left-sided congestive cardiac failure. The study covers his history, including a prior diagnosis of CHF, bypass surgery, atrial fibrillation, and hypercholesterolemia, as well as his heavy smoking history and family history of coronary artery disease. It details his medications, vital signs at admission, and a comprehensive pathophysiological explanation of his condition, linking symptoms like dyspnea, pulmonary crackles, and edema to the underlying mechanisms of heart failure. The study also outlines diagnostic tests and expected findings, such as echocardiogram results, chest x-ray findings, and ECG results, alongside a discussion of treatment strategies, including medication management with Perindopril and diuretics, and the crucial role of nurses in patient education and monitoring. The case study emphasizes the importance of managing fluid balance, monitoring serum electrolytes, and adjusting medication to improve patient outcomes.

Running head: CONGESTIVE CARDIAC FAILURE
CONGESTIVE CARDIAC FAILURE
Name of the Student
Name of the University
Author’s Note:

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Mr. John Hale was admitted to the cardiac ward of the hospital with a left sided
congestive cardiac failure. Mr. Hale is a 72 years old Caucasian male who states during the
admission that he has trouble breathing over the last three days and he has been experiencing
episode of shortness of breath. In addition, his feet are puffed- up and he is unable to put his shoe
on. The patient, Mr. Hale, also admitted that he has fluid problem in intermittent manner over the
last 5 years. The hospital’s has attended and examined Mr. Hale and he was admitted for the
management and treatment of left sided congestive cardiac failure.
At the time of the admission, Mr. Hale’s family history, past medical history was
collected and it is described in the following sections below.
History:
 Age: 72
 Weight: 76 kg
 Height: 170 cm
 Allergies: NKA
 Next of kin: Kate (Wife)
 Children: Two son
Mr. Hale lives with his family and they are married for 40 years. They live together in his
family house. His elder son lives abroad and his younger son lived nearby his place. His younger
son is always keep in touch with him and helps them for setting up appointment with doctor and

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visiting them. Mr. Hale and his wife are very sociable and they mingle with the local community
very much.
Past medical History:
The past medical history of Mr. Hale is mentioned below:
 Mr. Hale was diagnosed with left sided congestive cardiac failure 10 year earlier.
 Mr. hale had bypass surgery (Coronary artery bypass graft) 10 years back.
 Atrial fibrillation
 Hypercholesterolemia
 Mr. Hale was a heavy smoker
 Mr. Hale has a family history of coronary artery disease.
Medicine:
Being a congestive cardiac failure patient and his above mentioned condition, Mr. Hale had
to take a lot of medicine and the list of the medication is provided below:
 Aspirin in morning
 Digoxin in morning (one)
 Perindopil for his heart in morning
 Warfarin in night
 Lasix as diuretics
 Regular blood test, in interval of two days.
The patient who suffers from congestive cardiac failure has reduce blood pressure than what
is required by the body. This happens due to the ability to pump blood by the left ventricles. Due

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to the lesser blood pressure, human body tries to compensate the blood pressure difference. In
order to do that body release large amount of cortisol. Fat particles starts to mobilize around the
body as result of this cortisol release. This fat particles tends to deposit on the blood vessels and
as a result patient with congestive cardiac failure tends to have blocked artery which require
bypass surgery (Ronaldson et al., 2015). Hypercholesterolemia and atrial fibrillation might have
for the same reason and smoking is risk factor for the cardiac failure and heavy smokers are
more likely develop cardiac failure.
Vital signs at the time of the admission:
Mr. Hale’s vital signs were measured at the time of the admission and they are presented
below:
 Blood pressure – 96/51
 Pulse – 81 (irregular)
 Body temperature – 36.90 C
 SaO2 – 93 per cent at room air
 Respiratory rate – 22 bpm
 Crackling noise at the base of the right lung.
Patho- physiology:
Heart failure can be defined as an anomalous myocardial condition. This abnormality,
regardless of its cause, effects in the heart's incapacity to supply sufficient blood and oxygen to
meet the body's needs. The systemic venous and pulmonary hypertension occurs when
the right and left ventricles fail to pump blood which leads to the congestive heart failure
syndrome (Tham et al., 2015).

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Dyspnea, pulmonary crackles and orthopnea are symptoms and signs of a pleural
effusion and pulmonary edema at left ventricular heart disorder. When left ventricle cannot pump
enough blood to meet the demands of the body, two major effects can be visible which
are symptoms and signs of reduced heart rate and congestion of lung. Increased pressure on the
left side of the cardiovascular area is leads to the pulmonary system which causes the congestion
in lung. Fluid releases through enlarged capillaries and to flow through the air spaces in lung
(Viau et al., 2015).
As per the recent studies, Edema tends to appear in the body as a failure of right
ventricular mechanism (Chen et al., 2016). It is occurs once the right ventricle cannot effectively
pump enough blood due to the increased pulmonary pressure. With the right ventricle not being
able to propel blood in to the lungs, peripheral congestion is caused and its incapacity to contain
all the venous blood which in general goes back on the right part of the heart. Venous blood in
the systemic circulation is expressed backward. Enhanced vein volume and pressure forces the
blood in to the peripheral edema or interstitial tissue (Chen et al., 2016).
Objective data collection suggests that the patient will be respiratory distress, and the
patient will be needing a number of pillows for breathing comfortably at the time of rest
(orthopnea), secondary abdominal distension to ascites, edema (site, pitting), weight gain,
accidental breathing sonority, abnormal heart sounds like galloping and murmuring, jugular
venous distension and activity intolerance. Kidney blood flow is reduced, which leads to
oliguria. Tissue oxygen deficit leads to cyanosis and general weakening.
Diagnostic test and expected findings:

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The echocardiogram is the most non-invasive device for assessing an individual with
heart condition. Echocardiography is generally performed to determine the presence of
pericardial fluid, heart failure, the valvular heart disease, and exposure fraction (Cardinale et al.,
2014). Second, a chest x-ray likely to reveal lung congestion, heart enlargement, and pleural
effusion. Third, ECG shows heart dysrhythmia. In addition, right and left ventricular function is
assessed with pulmonary artery catheterisation. The stress tests are also performed to determine
tolerance of activity and seriousness of the underlying ischemic cardiovascular disease (Schober,
Wetli & Drost, 2014).
The complete vital assessments were performed at the time of the admission and the
findings were presented above. During the vital assessments, particular focus should be given on
the detection of tachycardia, tachypnea, hypertension, and hypertension. In addition, few more
physical examination should be performed. A physician should look for enlarge heart and third
sound of the heart beat (S3). It is expected that patient will congestive cardiac arrest will have S3
gallop. The patient should also be checked for fluid sound in the lungs and whether the jugular
vein in the lung is enlarged. Additionally patient should be checked for edema as well as pleural
effusion (fluid between the space of ribs and lungs). Along with that, patient should be checked
whether there is a fluid sound in the lungs. Most of the cases, patients will have a crackling
sound at the lungs (Mentz & O'connor, 2016).
Furthermore, the evaluation and management of Mr. Hale should be assisted with
laboratory tests that include calcium, potassium, sodium, magnesium, and electrolytes. High
blood creatinine and urea results from reduced glomerular filtration which signifies higher blood
urea nitrogen and the patient’s values of liver function will likely to be slightly high. BNP is a
heart-secluded neurohormone used in monitoring chronic heart failure and BNP is released in the

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body in reaction to ventricular load volume and pressure expansion (Skovgaard, Hasbak &
Kjaer, 2014).
Treatment for congestive cardiac failure and nurses’ role in it:
Nurse plays a vital function in the counseling and education of patients. Education for
signs and symptoms along with weight management, advice on food and exercise, and medicines
should be provided to patients. The patient should be made aware of the signs and syndromes for
deteriorating congestive failure in the heart such as increased orthopneal degradation or
development, dyspnea, intolerance of exercise and weight gain (Harjola et al., 2016).
The primary nursing diagnosis of edema, exercise dyspnoea and increased weight are
excess fluid volume. Mr. Hale's expected result is a fluid imbalance. Fluid equilibrium is
illustrated as peripheral tangible pulses, not present peripheral edema, orthostatic hypotension,
hydration of the skin and a stable body weight. Patients should be monitor and weighted for fluid
retention and loss of weight should be monitored daily to achieve the expected result (Lemyze &
Mallat, 2014). Level of Serum electrolytes and therapeutic effects of diuretic are to be monitored
and evaluated as a treatment response. Respiratory patterns for early pulmo identification
symptoms should also be monitored.
Perindopril can be administered for heart failure owing to the situation of Mr. Hale (ACE
or angiotensin converting enzyme inhibitors). The ACE inhibitors stop Angiotensin I from being
transformed to Angiotensin II and which also prevents bradykinin breakdown. They diminish the
vasoconstriction effect, sodium retention and release of aldosterone by angiotensin II.
Angiotensin’s effect on nervous activity and its role as a growth factor is also reduced.

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Hyperkalaemia, headache, hypotension, tiredness, cough, nausea, dizziness, and renal
impairment are common adverse effects of ACE inhibitors (DiNicolantonio et al., 2014).
In case of Mr Hale, nurses require to know that cardiac failure is generally treated with
digoxin and diuretic which are associated with ACE inhibitor. Hence, the first nursing point of
precaution will be to prescribe Perindopril. Secondly, a low salt diet is advised to help reduce
blood pressure. However, due to an increased risk of hyperkalaemia, potassium containing salt
substitutes should not be recommended. Thirdly, renal function and blood pressure should be
monitored before initiating treatment in patients with congestive heart failure and regularly
during treatment (Tang et al., 2013).

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