Comprehensive Case Study: Congestive Heart Failure Patient Care

This case study presents a detailed analysis of congestive heart failure (CHF), defining the condition as the heart's inability to meet the body's metabolic demands. It explores various causes, including coronary artery disease, high blood pressure, abnormal heartbeats, and cardiomyopathy, along with associated risk factors such as diabetes and alcohol use. The study highlights the negative impacts of CHF on patients and their families, including restricted lifestyles and emotional distress. It details the common symptoms, such as shortness of breath, fatigue, edema, and irregular heartbeats. The study also examines treatment approaches, focusing on ACE inhibitors and beta-blockers and their mechanisms of action. Furthermore, the case study outlines critical nursing interventions in an emergency department setting, emphasizing the importance of objective monitoring, laboratory tests, and appropriate treatments like oxygen therapy, noninvasive ventilation, and medication administration. The document also provides a detailed overview of the patient's care, including the importance of proper documentation, and collaboration between medical professionals, and patient reassessment. The study concludes with a list of relevant references. The case study is a great resource for students on Desklib.

Running head: CONGESTIVE HEART FAILURE CASE STUDY
CONGESTIVE HEART FAILURE CASE STUDY
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CONGESTIVE HEART FAILURE CASE STUDY
Question 1;
Congestive heart failure can be defined as the situation when the heart cannot pup enough
amount of blood in order to meet the metabolic needs of the body. Heart failures can be
characterized as a chronic condition with acute exacerbations as well as with periods of abrupt
worsening of the different symptoms. There are different causes of congestive heart disorders out
of which coronary arterial disease is one of them (Smith et al. 2018). This disorder mainly results
in the development of fatty deposits also known as plaques in the arterial walls. Blood cannot
flow easily through the arteries and often results in cardiac ischemia. If this ischemia lasts for
long, it may lead to the death of the heart muscles resulting in severe chest pain. High blood
pressure may also result in heart muscles to work harder and this extra exertion of pressure for
the muscles to work makes them stiff. They thereby become weak and cannot pump efficiently.
Abnormal heart beat may also be a cause of congestive heart failure as such heart rhythms may
make the heart beat too fast casing the heart to work extra. Slow beating also leads in failure of
the heart. Cardiomyopathy is the damage of the heart muscles that may take place from the
excessive use of substances by patients (Chester et al., 2018). It may also lead to congestive heart
failure. In other cases, virus also become responsible for the causing inflammation of the heart
resulting in left sided heart failure. Some of the risk factors that remain associated with
congestive heart disorders are the high blood pressure as well as coronary heart diseases.
Besides, heart attack as well as diabetes may also act as risk factors for the disorders. Some
diabetes medications also expose the individuals to the different forms of congestive heart
failures. Viruses, tobacco and alcohol use, congenital heart disorders, sleep apnoea and many
others all lead to the occurrence of the diseases. The congestive heart failure mainly has a very
negative impact on the patient as well as the family. The patient has to lead a restricted life

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where he or she may not conduct all activities that he or she could do when they were well.
Moreover, they also have to be very careful so that they do not go through similar symptoms that
might be harmful for them and threaten their life. Such life may make them depressed and
anxious and they feel frustrated about their life (Mehla et al., 2018). The caregivers or family
members also undergo depression when they see their dear one suffering like this. They also go
through financial turmoil due to flow of money on the healthcare and through physical turmoil,
as they have to take care of the patients and keep them safe form danger.
Question 2;
The first symptom that remains associated with congestive heart failure is the congested lungs as
well as shortness of breath. This is also noted in the patient who was admitted in the emergency
ward. Researchers are of the opinion that when fluid is accumulated in the lungs, it can result in
the shortness of the breath. Lung congestion is also responsible for developing a dry, hacking
cough as well as wheezing. The second symptoms that remain associated with the disorder is the
occurrence of dizziness, weakness as well as fatigue. Such symptoms were also noted in the
patient who was admitted. Improper blood flow from the heart had resulted in less blood entry to
the major organs as well as in the muscles (White et al., 2018). These resulted in the feeling of
tiredness and weakness. Researchers are of the opinion that as blood that flows to the brain in
this condition is quite less, therefore, the patient also feels dizzy. Another symptom that was
observed in the patient and is a common sign for all patients with congestive heart failure is the
edema or swollen features in the body. Researchers are of the opinion that congestive heart
failures cause less blood flow to kidneys (Morisawa et al., 2018). These result in the retention of
the amount of water and fluid in the body that result in swollen ankles, abdomen causing, legs
and weight gain. The patient also had swollen body parts in the case study. Another important

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symptom is the rapid irregular heartbeats. In order to make blood reach to all parts of the body,
the heart tries to beat faster and this causes rapid as well as irregular heartbeats. Another
important symptom that is also noticed in patients is the loss of appetite and feeling of nausea.
This is mainly because the fluid is accumulated in the areas’ surrounding the digestive tract that
causes different issues where the patients feel loss of appetite as well as nausea (Qian et al.,
2016).
Question 3;
ACE inhibitors (angiotensin converting enzyme) help in treatment of congestive heart disorders
by mainly blocking the action of hormones that causes such disorders. The main function of the
drug is seen to be helping the heart to pump well by opening the vessels of the blood and thereby
reducing the blood pressure. Such inhibitors are seen to block the action of the protein that
causes the blood vessels to get narrow (Shojiet al., 2018). With the help of this class of drug, the
professionals can help the patients to relieve them of their heart failure symptoms such as build
and swelling and help them to live better. Some of the medicines that can be seen are quinapril,
ramipril, preindropil, altace, benazpril, lisisnpril and many others. Another class of drug which
are also used in the beta blockers. There are certain epinephrines, norepinephrines as well as
other similar hormones that are seen to act on the beta-receptors of the body tissues that thereby
produce a harmful stimulative effect on the body (Ruppar et al., 2016). These hormones mainly
provide pressure on the beta-receptors of the heart that result in more forceful contraction of the
heart muscle. Therefore, in such situations, beta blockers are fond to be highly helpful as they
cause the blockage of the actions of these stimulating hormones on the beta receptors of the
tissues of the bodies. Some of the beta blockers which are used extensively is the acebutolol

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(Sectral), bisoprolol (Zebeta), nadolol (Corgard), timolol (Blocadren), atenolol (Tenormin),
metoprolol (Lopressor, Lopressor LA, ToprolXL), and many others.
Question 4;
Once the patient is brought to the emergency department, it becomes important for the healthcare
professionals to evaluate critical step for determining the severity of the cardiopulmonary
instability. The nurse should undertake objective measurement of the dyspnoea severity
including the monitoring of the respiratory rate, intolerance of the supine position, degree of
hypoxia and effort of breathing. It would also involve checking heart rhythm and heart rate.
Different laboratory tests should be done which include ecg, chest xray and many others. Bnp
test should also be conducted (Vedel & Khanassov, 2015). The nursing interventions should
mainly include triaging to appropriate environment for providing safe clinical care to the patient.
The nurse should also conduct objective monitoring that would include change in signs and
symptoms to state whether the patient is responding to treatments. This would be followed by
proper discharge planning or transfer of the patient to multidisciplinary department for further
treatment. Here, although oxygen therapy is important for patients but researchers say that it is
best when the value of SpO2< 90%. In case of the patient, it is about 92percent and hence oxygen
therapy is not that important. However, noninvasive ventilation is found to be extremely
important for the patients with respiratory distress. It decreases respiratory distress and helps in
reduction of the rate of mechanical endotracheal intubation. Intravenous diuretics as well as
vasodilators need to be administered. 20 to 40 mg intravenous furosemide can be provided to
patient in such conditions. Intravenous vasodilator therapy can be also provided to the patients
who blood pressure is normal to high. Sublingual nitrates can also be considered (Unverzagt et
al., 2016). Evidence based, diseases modifying oral therapies can be provided to the patients in

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such conditions like the beta blockers, ACE, MRA, diuretics, nitrates and others. This should be
then followed by proper reassessment of the patient by the nurses. The patient should be checked
in every proper ways by which the stability of the patient should be ensured. The nurses should
continue to monitor the heart condition of the patient from time to time in order to entertain that
the patient condition is gradually becoming stable (Shah et al., 2018). The total monitoring
would be contributed for about 24 hours until the damage of the heart is stopped and the patient
is out of danger. Following the condition of the patient for about 24 hours, the emergency nurse
would conduct meeting with the other specialists and then transfer the patient to the general ward
where she should be then treated by the multidisciplinary team. The nurses should properly
document all the information so that the ongoing care of the patient is not disrupted and care
provided is of high quality (Jonkman et al., 2016).

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References;
Chester, R., Horwich, T., Srikanthan, P., Gornbein, J., Hundley, G., & Watson, K. (2018).
Reflection Magnitude, A Measure Of Arterial Stiffness, Predicts Incident Congestive
Congestive Heart Failure In Men But Not Women: Multi-Ethnic Study Of
Atherosclerosis (MESA). Journal of the American College of Cardiology, 67(13
Supplement), 1314.
Jonkman, N. H., Westland, H., Groenwold, R. H., Ågren, S., Anguita, M., Blue, L., ... &
Kempen, G. I. (2016). What are effective program characteristics of self-management
interventions in patients with heart failure? An individual patient data meta-
analysis. Journal of cardiac failure, 22(11), 861-871.
Mehla, P., Galin, I., Baksh, S., Bailey, S., Passik, C., & Jarrett, R. (2018). Spontaneous
fistulization of caseous mitral annular calcification: case of recurrent congestive heart
failure. Journal of the American College of Cardiology, 67(13 Supplement), 1122.
Morisawa, D., Hirotani, S., Sugahara, M., Fukui, M., Nakabo, A., Naito, Y., & Masuyama, T.
(2018). Hemodynamic Response Of Sildenafil Depends On Left Ventricular Chamber
Stiffness In Patients With Decompensated Congestive Heart Failure. Journal of the
American College of Cardiology, 63(12 Supplement), A931.
Qian, G., Fu, Z., Guo, J., Cao, F., & Chen, Y. (2016). Prevention of contrast-induced
nephropathy by central venous pressure–guided fluid administration in chronic kidney
disease and congestive heart failure patients. JACC: Cardiovascular Interventions, 9(1),
89-96.

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Ruppar, T. M., Cooper, P. S., Mehr, D. R., Delgado, J. M., & Dunbar‐Jacob, J. M. (2016).
Medication adherence interventions improve heart failure mortality and readmission
rates: systematic review and meta‐analysis of controlled trials. Journal of the American
Heart Association, 5(6), e002606.
Shah, K., Parekh, N., Clopton, P., Anand, I., Christenson, R., Daniels, L., ... & Neath, S. X.
(2018). Improved survival in patients with diastolic heart failure discharged on beta-
blocker and ace inhibitors. Journal of the American College of Cardiology, 61(10
Supplement), E634.
Shoji, S., Kanazawa, H., Yanagisawa, R., Tanaka, M., Fukuoka, R., Akita, K., ... & Yuasa, S.
(2018). Percutaneous Occlusion of Patent Ductus Arteriosus for an Elderly Patient With
Refractory Congestive Heart Failure. Circulation: Heart Failure, 11(2), e004764.
Smith, G., Shore, S., Mitchell, A., Moore, M., Morris, A., Speight, C., & Dickert, N. (2018).
Discussing Out-Of-Pocket Costs With Patients: Shared Decision-Making For Sacubutril-
Valsartan In Congestive Heart Failure. Journal of the American College of
Cardiology, 71(11 Supplement), A2626.
Unverzagt, S., Meyer, G., Mittmann, S., Samos, F. A., Unverzagt, M., & Prondzinsky, R. (2016).
Improving treatment adherence in heart failure: A systematic review and meta-analysis of
pharmacological and lifestyle interventions. Deutsches Ärzteblatt International, 113(25),
423.
Vedel, I., & Khanassov, V. (2015). Transitional care for patients with congestive heart failure: a
systematic review and meta-analysis. The Annals of Family Medicine, 13(6), 562-571.

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White, M., Tremblay-Gravel, M., Khairy, P., Roy, D., Leduc, H., Wyse, D. G., ... & Andrade, J.
(2018). Blood Pressure Levels Modulate Mortality In Patients With Atrial Fibrillation
And Heart Failure With Depressed But Not In Patients With Preserved Ejection
Fraction. Journal of the American College of Cardiology, 61(10 Supplement), E734.