NRSG353 Case Study: Congestive Heart Failure - Analysis & Treatment

This case study comprehensively analyzes congestive heart failure, detailing its causes such as coronary artery disease, high blood pressure, and genetic factors, as well as associated risk factors like diabetes, obesity, and tobacco use. It outlines the impact on patients and their families, including emotional distress, financial burdens, and lifestyle restrictions. The study identifies five key symptoms—fluid retention, shortness of breath, dizziness, nausea, and rapid heartbeat—linking each to its underlying pathophysiology. It also describes two common classes of drugs used in treatment: ACE inhibitors and beta-blockers, explaining their physiological effects on blood pressure and heart function. Finally, the case study emphasizes the importance of a sequential approach to emergency care, focusing on rapid diagnosis, symptom management, and appropriate triage, while highlighting the critical skills needed by nurses in the emergency department. This document is available on Desklib, a platform offering a range of study resources including past papers and solved assignments.

Running head: CONGESTIVE HEART FAILURE CASE STUDY 1
CONGESTIVE HEART FAILURE CASE STUDY 1
Name of the student
Name of the university;
Author note;

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CONGESTIVE HEART FAILURE CASE STUDY 1
Question 1;
Congestive heart failure can be described as the progressive heart condition that is seen to
mainly affect the pumping power of the different heart muscle in the affected individual. In this
condition, the heart is seen to fail miserably to pump efficiently like the way it should pump in
normal individuals. Researchers are of the opinion that certain strenuous conditions like
narrowing of the arteries of the heart causes coronary artery disease that results in these
symptoms. High blood pressure may result in leaving the heart in weak condition or make it stiff
in such a way by which it fails to fill and pump effectively. Researchers are of the opinion that
the main pumping chambers of the heart may become stiff and may not fill properly in between
the beats (Feltner et al., 2014). This may result in occurrence of situations of congestive heart
failures. In many other cases, the muscles of the heart are seen to be weakened as well as
damaged resulting in a condition when the ventricles become stretched to a large point. In such
condition, the heart cannot pump efficiently throughout the body resulting in occurrence of
negative symptoms of the disorders. As time passes, heart no longer can keep up with the
demand of pumping adequate amount of blood to the rest of the body and this causes the
disorder. Coronary heart disease and heart attack are also causes of the disorder where fatty
deposits called plaques are built and deposited in the arteries resulting in the narrowing if the
arteries. Often in many situations, damaged valves are observed which mainly occurs from heart
disorders or heart defects. Such faulty valves are seen to make the heart work harder resulting in
its weakening over time. Genetic factors, excessive alcohol uptake, or tobacco smoking may
result in damaging of the heart muscles called myopathy for which congestive heart failures may
also occur (Carthon et al., 2015). Hypertension may cause the heart to work harder and therefore
the extra exertion in turn make the heart muscles stiff for which they can no longer pump blood

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CONGESTIVE HEART FAILURE CASE STUDY 1
effectively. These causes result in the occurrence of congestive heart failure. The different risk
factors that are associated with congestive disorders are high blood pressure and heart attack.
Coronary heart disorders resulting in narrowing of the blood vessels also result in occurrence of
the disorder. Diabetes as well as certain diabetic medications all results in occurrence of the
disorders (Vedel & Khanassov, 2015). Congenital heart defects, sleep dyspnoea, alcohol use,
valvular heart diseases, viruses and tobacco use are also certain risk factors. Obesity and
irregular heart diseases also result in this disorder.
The patient suffering from coronary heart disorders may develop complications like
kidney damage and heart valve problems, liver problems and heart problems. All these situations
will make her life restricted as she has to undergo a strict routine of healthcare and self-
management that might be strenuous and frustrating for her. She may become depressed and
anxious about his ill health that may make her suffer emotionally and mentally (Mebaza et al.,
2015). Her family members will be affected emotional from the suffering of the patient and ma
become depressed. Moreover, the family members also gave to go through financial and physical
turmoil for which quality of life am be affected.
Question 2:
One of the most important symptom of the congestive heart failure is the retention of
fluid and water in the body which cases swollen of different parts of the body. Less amount of
blood is seen to reach the kidney. This in turn results in a situation of edema where ankles, legs
as well as abdomen get swollen. Another important symptom that occurs in patients suffering
with the disorder is the shortness of breath. Congested lungs are also seen to occur and this
mainly takes place de to accumulation of fluid in the lungs. When fluid becomes collected in the

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CONGESTIVE HEART FAILURE CASE STUDY 1
lungs, it may result in development of shortness of breath that in turn cases extreme difficulty in
breathing. Wheezing as well as development of dry cough is also a common phenomenon that
takes place due to lung congestion (Carpenter et al., 2015). Another important symptom that is
quite common in the disorder is the feeling of dizziness and fatigue and occurrence of weakness.
Restricted flow of blood to the brain than it is required results in development of confusion in the
patients. This causes dizziness in the person. Moreover, limited flow of blood to the muscles and
other major organs of the body make the patient feel weak and tired, as successful respiration
cannot take place de to limited flow of blood (Mebaza et al., 2015). Another important symptom
would be the occurrence of the nausea and feeling of loss of appetite by the patient. It mainly
occurs when fluid is seen to accumulate in the places that surround the digestive tract as well as
the liver. The fifth symptom that can be also suggested here is the presence of rapid heartbeats
where the heartbeats also get quite irregular. As the heart fails to keep up with the pace that is
required to send blood to the different parts of the body, they try their best to beat fast and send
blood but fail miserably. Therefore, the heartbeats become rapid but irregular. In case of the
patient, all the above mentioned symptoms are present like loss of appetite, nausea, irregular
heartbeat, shortness of breath, dizziness, weakness, fatigue and others (Rai et al., 2017). All these
symptoms will ensure the nursing professionals that the patient is suffering from congestive heart
failure.
Question 3;
One of the most important classes of drugs is called the Angiotensinogen-converting enzyme
called the ACE inhibitors. They are fond to be highly successful in management of congestive
heart failure cases. This class of drug is seen to be helping in the blocking of the activity of
angiotensin in blood. Angiotensin is mainly responsible for making the blood vessels narrow

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CONGESTIVE HEART FAILURE CASE STUDY 1
which makes the person more exposed to the occurrence of the heart disorders. This class of the
drugs is also seen to relax the pressure of the blood and thereby improve the flow of the blood
through the blood vessels. The blood pressure is lowered and therefore, it becomes important
easier for the heart to pump blood (Luttik et al., 2016). This class of the enzyme is also seen to
be releasing a considerable amount of water and salt. This also contributes in lowering of the
blood pressure. Many randomized control trial had been conducted which had shown that drugs
like ramipril, quinapril, captopril, enalapril and lisinipril.
Another one of the most important class of drugs that are important to manage congestive
heart disorder is beta-blocker. Researchers have seen through their experiments that people who
are suffering from congestive heart disorders are seen to produce specific types of hormones
called the catecholamine. This hormone is therefore responsible for worsening the condition of
the heart of the patients. This class of drug is also seen to help in the widening if the blood
vessels helping the blood to flow smoothly through the arteries thereby reducing blood pressure.
Researchers have stated that this drug mainly helps the left ventricle of the heart to fill in more
blood completely which it was unable to do in the diseased condition. Researchers have also
stated that this drug is extremely useful for the patients who have heart failure along with high
blood sugar levels. Randomized control trial of this class of medication as put forward a number
of drugs like bisoprolol, carvediol as well as metoprolol (Ong et al., 2016). They have already
proven to be one of the most successful drug categories that are helpful in overcoming the
symptoms of congestive heart failure. This class of drug is seen to be reducing the different
destructive effects of the stimulation of catecholamine and thereby helps in treating both systolic
dysfunction and diastolic heart failure.

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CONGESTIVE HEART FAILURE CASE STUDY 1
Question 4;
Patients who develop congestive heart disorders are usually seen to go through a number
of similar sequential symptoms as their conditions worsen. Shortness of breath and irregular and
rapid beating results in poor condition of the patient that makes them anxious. Their symptoms
also remain associated with the occurrence of edema, weight loss, nauseas, and loss of weight as
well as fatigue. Therefore, when such patients are admitted to the emergency ward, the
professionals should follow a sequential pattern of attending the emergency so that the patient
remains to danger. The first step of the professionals is to set focus on the in-patient admission
which sold be followed by faster diagnosis of the acute and decompensate condition of the heart
failure (Hasanpour et al., 2016). This would be followed by proper management in-patient care
and then planned discharge of the individual patient after reassessment or transferring her to the
general ward. The priority of the professionals would not be on the long-term management of the
disorders but solely on the making, the patient come out of risk and danger situations.
On arrival of the patient in the emergency department, the healthcare professionals
should first take into consideration prompt recognition of the condition of the patient after
properly assessing the signs and symptoms of the disorder. Secondly, it is very important for the
professionals to alleviate the different emotional as well as the physical symptoms of the
breathlessness and therefore the professionals should transfer her to a proper and safe
environment to assure optimization of the outcomes. Researchers are of the opinion that every
emergency department should possess the triage nurses for acute heart failure but a nurse
practitioner can also perform the activity of such nurses are not present in the ward. The

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CONGESTIVE HEART FAILURE CASE STUDY 1
professionals should conduct an assessment of the severity only after properly eliciting the
history of the patient. Following this, the nurse should be referring a proper multidisciplinary
team and appoint the team to the patient at the same time of helping the members for properly
distinguishing the case of breathlessness and thereby initialing prompt symptom for relieving
therapy (Buck et al., 2015).
The nurses of the emergency department need to possess an important number of skills
that help them to provide best care to patients. These are proper critical thinking skills and proper
decision-making ability as well as be rapid and self confident in the activities. The expanded
skills set of the nurses would be mainly helping in conducting of proper diagnostic assessment of
the patient through clinical examination. They should identify proper signs of the congestions by
conducting diagnostic tests like sonograms, heart scan, electrocardiogram, chest x ray and others.
This would be followed by properly transferring the patient to appropriate level for care like the
cardiology ward, general medial ward or coronary care unit (Rai et al., 2017). In order to know,
whether the person is responsive to the interventions like medical administrations given to her
under emergencies, the nurses should conduct objective monitoring to identify different changes
in the signs and symptoms of the patient after administration. Immediately after medicine
administration, the nurse should properly monitor from time to time to assess the objective
measurement of hemodynamic status, heart rhythm, dyspnoea severity, and cardiac output as
well as others. However, before shifting the patient to general ward, the nurse should re-assess
the patient for symptoms of congestion, management of the levels of anxiety as well as the
analyzing of the laboratory blood tests.
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CONGESTIVE HEART FAILURE CASE STUDY 1
References:
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., ... & Strachan,
P. H. (2015). Caregivers’ contributions to heart failure self-care: a systematic
review. European Journal of Cardiovascular Nursing, 14(1), 79-89.
Carpenter, J. E., Short, N., Williams, T. E., Yandell, B., & Bowers, M. T. (2015). Improving
congestive heart failure care with a clinical decision unit. Nursing Economics, 33(5), 255.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of
hospital work environments and missed nursing care is linked to heart failure
readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, bmjqs-2014.
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Luttik, M. L., Jaarsma, T., & Strömberg, A. (2016). Changing needs of heart failure patients and
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