NRSG353 Nursing Case Study: Congestive Heart Failure - A Case Analysis

This nursing case study provides a comprehensive analysis of Congestive Heart Failure (CHF) through the lens of a patient, Mrs. Sharon McKenzie, who presents with symptoms like shortness of breath, swollen ankles, and elevated blood pressure. The analysis includes an outline of CHF, covering its causes, risk factors, and prevalence, followed by a discussion of common signs and symptoms along with their underlying pathophysiology. A detailed care plan is developed, focusing on interventions such as medication administration (enalapril and diuretics), fluid balance management, and oxygen therapy, with specific goals to decrease blood pressure, reduce fluid accumulation, and restore normal breathing patterns. The study also delves into the pharmacokinetics and pharmacodynamics of relevant medications, emphasizing their role in managing CHF and improving patient outcomes. This case study underscores the importance of holistic nursing care in managing complex conditions like CHF.

Running head: NURSING ASSIGNMENT
CASE STUDY ANALYSIS OF MRS. SHARON MCKENZIE
Name of the student
Name of the University
Author note

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Answer 1
Disease outline
Congestive Heart Failure (CHF) is a health condition, in which affected patient’s heart
muscles become weak and unable to pump ample amount of blood in their organs and tissues
(D’amario et al., 2017). This is a severe and chronic condition, due to which the systole and
diastole motion of heart is affected, increasing the heart rate, blood pressure and irregular
heartbeat. As per Srikanthan et al. (2017), the CHF is primarily associated to the ventricular heart
muscles, which pumps oxygenated blood from heart chambers to the entire body and due to this
complication, patient’s heart becomes unable to pump blood properly (Benotti et al., 2017). Due
to this scarcity, vital organs of the body starts accumulating fluids around their smooth muscles,
in which kidney, heart, liver and smooth muscles of leg and hands are crucial. Further, due to
accumulation of blood, the patient starts feeling discomfort as well as shortness of breath occurs
(D’amario et al., 2017). In this provided case study, it was seen that Mrs. Sharon McKenzie (77)
has a history of myocardial infarction, and showed symptoms such as swollen ankle, cold feet,
and shortness of breath which indicated towards the condition of CHF.
Cause, risk factor and prevalence in Australia
The causes of CHF are associated to the lifestyle and heart disorders of the patient. As
per Shah et al. (2016), people with weak heart muscles, specifically weak ventricular heart
muscle shows the symptoms of CHF because the weak heart muscles are unable to pump
adequate blood to the entire body, due to which, the heart creates extra pressure on its ventricles
and blood vessels (American Diabetes Association, 2016). Due to this extra pressure, the heart
muscles beats irregularly, by increasing heart rate and blood pressure in the blood vessels, as this

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is the way, the heart could meet the blood requirement of different bodily organs (Benotti et al.,
2017). Hence, CHF condition occurs. Further, it was seen through research outcomes of
Chatterjee et al. (2017), that people with past history of myocardial infarction, has the chances of
acquiring CHF, because of weaker heart muscles. Moreover, in such situation, if patients
perform extensive exercise or cardiac works, chances of CHF increases.
While analyzing the prevalence of the CHF among Australians, it was found that
Australian government do not have any national or local data about the prevalence of this
disorder (Australian Institute of Health and Welfare, 2019). However, there are international
studies that has indicated towards the fact that more than 300,000 people were found affected
with this health condition and within that 30,000 cases were identified within a year. More than
4% of the people over age of 45 were found to be affected with CHF (Australian Institute of
Health and Welfare, 2019).
Risk factors associated to CHF is history of heart related disorders, such as myocardial
infarction, that weakens the heart muscle, increased blood pressure, drastic change in diet and
consumption of fat and oil, bacterial or viral infection, plaque formation in the blood vessels
could also lead to this chronic heart condition (Chatterjee et al., 2017). These aspects were also
seen in the case study of Mrs. McKenzie.
Answer 2
Table of sign, symptom and associated pathophysiology is as follows:
Sign symptoms of CHF in Mrs. McKenzie Pathophysiology of the symptoms
The first symptom of CHF in Mrs. McKenzie
was associated to her shortness of breath.
As per shortness of breath is among the
primary symptoms which the patient with

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CHF develops due to the accumulation of
fluid around the smooth muscle of bodily
organs (Patel et al., 2017). If the lungs of
patient accumulated excess fluid around it, the
patient may feel heavy around their chest and
starts facing abnormalities in their breathing
(D’amario et al., 2017). In the case, study, it
was seen that Mrs. McKenzie was facing
shortness of breath, each time she performed
any strenuous action. Further, she had past
history of myocardial infarction, that
weakness her heart muscle leading to CHF.
The second crucial symptom which was seen
in case of Mrs. McKenzie was her increased
blood pressure and elevated respiratory rate,
which required immediate intervention
In CHF, patient’s heart muscle becomes
unable to pump adequate blood to the body
organs, however it is important to meet the
need of blood, for which, the heart puts extra
pressure on its ventricles and in the course,
the pressure of blood in the vessels increases.
Hence, elevated blood pressure is seen in
congestive heart failure (Forsyth, 2017).
In this case study, Mrs. McKenzie’s
respiratory rate and blood pressure was also
elevated that indicated towards the occurrence
of CHF.
The third symptom which required medical
assistance was her swollen ankle and cold
feet, which indicated towards accumulated
fluid around her bones and smooth muscles.
Further, it was evident through research of
Ward et al. (2018). that patient with CHF,
while accumulating fluid around the body,
organs and muscles, liver, kidney, lungs, heart
and the leg and arm muscles are the first one
to start accumulating fluids around them ,e
hence, swollen ankle is a common symptom
among patients with congestive heart failure.
In this case study, hence, swollen ankle was
observed as the primary symptom for Mrs.
McKenzie.
Answer 3
The drug which has been chosen for the patient, belong to the glycoside class of drug.
The primary function of the drug inside the human body is to increase the strength of the heart

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muscles and control the elevated blood pressure and heartbeat (Shete et al., 2015). The following
section would provide the pharmacodynamics and pharmacokinetics of the drug class.
Pharmacokinetics
The pharmacokinetics of the drug was depended on four aspects of the drug onside the
body such as metabolism, absorption, distribution and excretion (Marzo et al., 2016). In the form
of oral drug administration, this class of drug showed various absorptions and the average
absorption of the oral drug administration was 70%. On the other hand, the intravenous drug
administration showed 90% absorption (Xu et al., 2016). Further, the primary distribution of the
drug was around the heart muscles, to strengthen it, besides in the kidney and intestine, activity
of the drug noted. Minimal metabolism of the drug is noted in the human intestine and the
primary route of excretion was noted through urination (Marzo et al., 2016). The primary reason
of inclusion of this drug ion the care process for Mrs. McKenzie was its half-life and activity
inside the human body.
Pharmacodynamics
The primary action of this class of drug revolves around the inotropic action, and
synchronizing the rhythm of the heart (Shete et al., 2015). The primary role of this drug is to
make the irregular heartbeat regular by affecting the SA nodes, and for this process it exerts
sympatholytic effect on the nodes so that cholinergic effect could be witnessed (Kumar,
Ashwlayan & Verma, 2018). Further, in case of congestive heart failure, it helps to maintain the
blood requirement of the body by increasing the force of the human body to increase the heart

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muscles abilities to pump more blood for the body organs. Therefore, it helps in restoring the
cardiac output and synchronize the irregular rhythm of the heart (Xu et al., 2016).
Answer 4
Care plan developed for Mrs. Sharon McKenzie
Goal of the care plan Intervention Rationale
The first goal of the care
plan would be decreasing
the elevated blood pressure
of the patient
The first intervention to meet
the goal would be assessing
the chronic condition of the
heart and providing the
patient with enalapril drug to
control the blood pressure
and increased rate. Besides
this, the patient would be
asked to restrict her
movement so that stress from
the heart muscles could be
relieved.
As per Ettehad et al. (2016),
enalapril drug is effective in
decreasing elevated blood
pressure, which is the primary
goal for the care process of
Mrs. McKenzie. Further,
restricted movement is also
an effective step to decrease
the risk factors of CHF.
The second goal of the care
plan would be decreasing
the accumulated fluid from
the organs of the patient
To achieve this goal, the
patient would be provided
with diuretic drugs which
enables the out flux of
accumulated fluids from the
human body. Further, the
fluid intake and output of the
patient would be monitored
so that due to out flux, patient
may develop dehydration.
Hence, it would be an
effective intervention to
maintain adequate fluid level
inside her body and
eliminating the risk of fluid
accumulation as well as
dehydration.
As per Pose et al. (2017),
application of diuretic drugs
is always associated with the
risk factor of dehydration and
hence, healthcare
professionals should monitor
the patient on which diuretic
drug has been implemented.
Hence, it was effective
intervention for the CHF of
Mrs. McKenzie.
The third goal would be
restoring the normal breath
pattern to decrease the
restlessness.
To decrease the
breathlessness of the patient,
she would be provided with
corticosteroids and this
In the research of Paggiaro et
al. (2016), it was seen that
healthcare professionals
incorporated corticosteroids

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medication would be
provided her in the form of
inhaler. She would be
provided with 3 puffs thrice
in a day so that chronic
condition of breathlessness
could be overcome by
relieving the smooth muscles
of the patient.
among patients with CHF to
decrease the severity of
breathlessness and it was
effective in decreasing the
crucial condition.
The fourth goal would be
maintaining fluid balance
chart
This would be done by
maintaining the fluid balance
chart so that fluid intake and
output could be managed.
Further, it was also seen
through research of samoni et
al. (2016), that fluid output
measurement and making a
chart of fluid balance use
could help the healthcare
professional to understand the
dose and extent of the drug
would be required for
decreasing the amount of
accumulated fluid.
The fifth medication would
be giving medication
Maintaining medication chart
would help to achieve the
goal.
As per Pose et al. (2017), this
would help the patient to
improve her CHF condition
properly.
Sixth intervention goal
would be providing the
patient with O2
This would be done by
providing the patient with
oxygen so that SpO2 rate
could be assessed.
This would help to relive the
patients breathing difficulty
and through this, her
requirement of oxygen could
be met.
Seventh goal would be
treating the increased
respiratory rate
Relieving of smooth muscles
of airway could help to
achieve this goal.
As per Paggiaro et al. (2016),
it is important for the patients
suffering from CHF to
provide medications to
relieve the smooth muscles so
that the affected health
condition could be treated.
Managing her diet and
nutrition would be the
eighth goal for patient
management
Proper diet and nutrition for
the patient would be
maintained
Diet is an important aspect
while treating CHF as it could
benefit the patient by
enhancing its ability.

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