NRSG353 Case Study: Congestive Cardiac Failure in Elderly Woman

This case study provides a detailed analysis of congestive cardiac failure in a 77-year-old woman, Mrs. Sharon McKenzie, whose condition is primarily attributed to hypertension and a history of myocardial infarction. The analysis covers the causes, incidence, and risk factors associated with congestive cardiac failure, particularly in elderly patients, highlighting the impact on both the patient and their family. It identifies common signs and symptoms, linking them to their underlying pathophysiology, and discusses two common drug classes used in treatment: ACE inhibitors and beta-blockers, explaining their physiological effects. Furthermore, the case study outlines essential nursing care strategies, including supportive care, management of electrolyte imbalances, and hemodynamic compromise, emphasizing the importance of regular monitoring and medication adjustments. The solution refers to the appropriate treatment of bradycardia, as revealed by the ECG report, and provides relevant references to support the analysis and recommendations.

Congestive cardiac failure
Congestive cardiac failure is such a chronic progressive condition where the heart
functioning as the pump is not adequate for meeting the needs of the body. In other words,
affects the pumping power of the heart muscles(Aoyama, 2011). Congestive cardiac failure
originates when the ventricles are not able to pump the sufficient blood to the different part of
the body . In the case of the Mrs. Sharon McKenzie cause of the congestive cardiac failure is
as a result of hypertension which in the case of Mrs. Sharon McKenzie is to be high risk
hypertension. Along with this, the narrowing of the coronary arteries can also be the cause of
the heart disease (Aoyama, 2011). The incidence of the disease among Mrs. Sharon
McKenzie is believed to be higher due to swelling in her ankles and feet and shortness of the
breath are the few symptoms related to the disease. Having the history of the Myocardial
infarction (MI) for 12 years which occurs due to damage to the heart muscle is also one of the
incidences of the cardiac failure(Aoyama, 2011). Mrs. Sharon McKenzie is77 year old and
hence is the common risk factor among the patients of the elderly age.
The risk factors which are more vulnerable among the case of the 77 year old woman is the
decline in the renal function as a result of the age and with this, there is a decrease in the
volume distribution of the digoxin . Among this, there is also an enlargement in the number
of comorbid circumstances, together with chronic obstructive pulmonary disease and
cardiovascular, which heighten susceptibility to cardiac failure disease (Odawara, 2011). In
the case, Mrs. Sharon likely to drop into such condition as a result of the medication digoxin,
and other digitalis is drug alongside with the advanced effectual drugs that interrelate within
such as flecainide, verapamil, amiodarone, quinidine, and others (Horvath & Bers, 2014).
Likewise, Mrs. McKenzie’s was as well taking medicine like furosemide, enalapril, and
warfarin (Horvath & Bers, 2014).

The daily intake of the 250 mcg of digoxin, is said to be the high dose among the adult
patients and mainly among the patients suffering from the congestive cardiac failure, as in the
case (Horvath & Bers, 2014). The body obtains the healing effect as soon as it stores around
8 to 12 mcg/kg with minimum danger of toxicity among patients having risk of the heart
failure and breathing rhythm or normal sinus (Horvath & Bers, 2014).
Congestive cardiac failure is a life threatening condition and severely impacts the patient and
their families (Odawara, 2011). The ill health of Mrs. Sharon McKenzie also suffers her
family members mentally disturbed. Certain times the patient suffering from the cardiac
failure lacks the social support, higher the support socially higher will the rate of healing
(Farmakis, Triposkiadis, Lekakis & Parissis, 2016).
Common signs and symptoms:
The individuals suffering from the cardiac failure will observe certain signs and
symptoms which are discussed in the table below with the pathophysiology
Signs and symptoms pathophysiology
Severe ventricular arrhythmias:
The patients complain dizziness, fluttering,
lightheadedness, pounding, quivering, chest
discomfort, breath shortness, and painful fast
heart beats are reported commonly among the
patients (Taytawat, 2013).
Arrhythmogenesis is most likely the general
procedure and marks from re-entry. It results
in the change in the state of mood and mind
too(Taytawat, 2013).
Triggered action happen as early after
depolarization and overdue after
depolarization begin spontaneous numerous
depolarization, impetuous ventricular

arrhythmias
Hypokalemia:
The symptoms of the low potassium results
tiredness, pain in arms, weakness, pain in the
muscles of legs and this at times is so severe
that causes the inability of moving the arms
and legs(Taytawat, 2013).
Tingling
Vomiting or Nausea
Bloating and Abdominal cramping
Constipation
Feeling the heart beat erratically
The rate of passing the urine is too high
concurrently feeling thirsty (Taytawat, 2013).
Low levels of the potassium results myositis
hyper excitable or hypo-polarized (Taytawat,
2013).
Hyperkalemia
The higher rate of the potassium in the blood
affects the functioning of the heart.
Hyperkalemia symptoms include
Slow heart rate
Abnormal heart rhythm
Weakness (Desai, 2012)
Hyperkalemia result due to rise in the level of
potassium in the body and secondary due to
an imbalance of intake vs. emission or as of
misdistribution between extra and intra
cellular space (Desai, 2012)
Neurologic Symptoms: Neurological symptoms physiologies are not

Visual disturbances, confusion, and
disorientation.
bright spots, blurry vision, or practicing blind
spots (Aoyama, 2011)
Urinate the less or more.
The body also becomes swollen (Aoyama,
2011).
simple to judge and are to be too complex
and getting of them are mostly incomplete
authentic physiologies of neurological
symptom are interrelated and intricate
(Aoyama, 2011)
Sinus Node Dysfunction:
Include weakness, syncope, effort intolerance
and palpitations.
Diagnosis through ECG
Pacemaker required for the Symptomatic
patients (Desai, 2012)
SND causes abnormalities in Sinus node
impulse structure and propagation that also
causes malformation in the atrium and in the
heart conduction system (Desai, 2012).
While studying the sign and the symptoms it is clear that in the case Mrs. Sharon McKenzie
is suffering from the congestive cardiac failure and hence requires the treatment related to the
disease.
Two common classes of drugs used for congestive cardiac failure patient:
The drugs classes which will be beneficial for treating Mrs. Sharon McKenzie an
elderly patient suffering from the congestive cardiac failure are discussed below:
The first drug class which proves to be beneficial during the treatment is the angiotensin-
converting enzyme (ACE) inhibitors which results in the broadness among the blood vessels
and further reduces the amount of the work that is to done by the heart along with this many

direct helpful consequences on the heart. Such drug helps in the reduction of the symptoms
and also the need or requirnment for the hospitalisation and is helpful in increasing the life of
the individual(Higgins et..al, 2013) .
The ACE inhibitors get the better outcome among the patients with systolic dysfunction,
several patients with hypertension practices congestive heart failure as a result of the diastolic
dysfunction that is associated with the left ventricular hypertrophy(Yu, Chair, Chan & Choi,
2016). ACE inhibitors result in reversing the left ventricular hypertrophy among the patients
suffering from hypertension. The meta-analysis effect of certain antihypertensive agents
recommends that ACE inhibitors be the largely effectual agent in dipping the left ventricular
hypertrophy(Yu, Chair, Chan & Choi, 2016). The other class of the drug which is to be
suggested is the Beta-blockers which lowers the heart rate and blocks the unnecessary
blockage that is present in the heart(Yu, Chair, Chan & Choi, 2016). Such classification of
the drug is also uselful in the heart disease and is mainly used with the ACE inhibitors for
providing an additional benefit. Beta blockers may for the time being worsen indicators but in
the long-term results an improvement in the functioning of the heart(Yu, Chair, Chan & Choi,
2016).
Beta blocker class drugs are supportive in improving the purpose of the deteriorating LV and
require preventing or reversing progressive LV dilation, chamber, sphericity, and
hypertrophy(Kollia, Giakoumidakis & Brokalaki, 2016) . The drug Beta blockers as well
decrease the rate of the heart beating and the stress among the LV wall (Kollia,
Giakoumidakis & Brokalaki, 2016). The recent research in the laboratories also proves that
the beta blockers satisfy the cardiomyocyte apoptosis in the heart failure. Discussed are the
basic benefits and advantageous of a beta blocker for the heart patients at any of the higher
stage (Kollia, Giakoumidakis & Brokalaki, 2016).

Nursing care strategies:
Mrs. Sharon was an elderly patient of age 77 years, she needs a due care and soft
treatment. She is also having the past history of the MI which is also to be kept in mind while
suggesting her medications and treatment related to the congestive cardiac failure. In the case
of congestive cardiac failure will have a regular monitoring of the renal function with this the
auscultator and edema of lungs(Hutchinson, Meyer & Marshall, 2015). The major aim of the
treatment is decreasing the level of the cardiac failure and conforting the immediate medical
help while confronting the breath shortness which includes the wide-ranging supportive care;
Discontinuing the digoxin and avoidance of additional exposure; management of the specific
antibody fragments such as digoxin immune Fab; treating certain specific complications such
as electrolyte abnormalities and dysrhythmias (Hutchinson, Meyer & Marshall, 2015).
Supportive care
The supportive care comprises to attach patients to the cardiac check, providing IV fluids to
the patient with volume depletion or hypotension, supplemental oxygen, or repletion of
electrolytes among the patients having the electrolyte abnormalities (Benjamin, 2012).
In the case of Mrs. Sharon McKenzie, hyperkalemia is corrected with insulin/glucose in the
case measured as life-threatening, as a result of risk constructing hypokalemia, because the
level of potassium in her case is low i.e. 2.5 mmol/l (Benjamin, 2012). In a study, it is cleared
that insulin act together straight with Na(+)/K(+) ATPase force and modify the effect of
digoxin (Nielsen, Duncan & Pozehl, 2018). This ropes the decision that patients suffering
from diabetes, insulin proves to have the cardio protective effects after digoxin intoxication
(Benjamin, 2012). Calcium is not applied for treating the hyperkalemia patients with assumed
digoxin toxicity and may induce the cardiac arrest (Nielsen, Duncan & Pozehl, 2018).
Bradycardia management

Mrs. Sharon McKenzie’s ECG report reveals sinus bradycardia, which is to be treated
through atropine. Atropine is advised after every 3 to 5 minutes till there is a reply or
maximum dose 3mg is reached (Nielsen, Duncan & Pozehl, 2018).
Hemodynamic compromise management
In the case, Mrs. Sharon McKenzie shows the hemodynamic insufficiency or hypotension,
dizziness or altered consciousness signs, digoxin resistant Fab is provided as the primary
management(Benjamin, 2012).
The monitoring and the change in the medicine are also one of the significant nursing
strategies at the time of congestive cardiac failure. Preferably, digoxin is to be discontinued
and an altered medicine for control of rate or the dissimilar inotrope is to be prescribed for
atrial flutter or respectively(Benjamin, 2012).

References
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Farmakis, D., Triposkiadis, F., Lekakis, J., & Parissis, J. (2016). Heart failure in
haemoglobinopathies: pathophysiology, clinical phenotypes,
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Higgins, R., Navaratnam, H., Murphy, B., Walker, S., & Marian UC Worcester, M. (2013).
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