NRSG353 Assessment: Analysis of Congestive Heart Failure Case Study

This document presents a comprehensive case study analysis of congestive heart failure (CHF), addressing key aspects of the disease based on a provided case study. The analysis begins with an outline of CHF, encompassing its causes, incidence, and risk factors, along with a discussion of its impact on both patients and their families. It then delves into three common symptoms – dizziness, shortness of breath, and swollen ankles – explaining their underlying pathophysiology. The study further explores the pharmacodynamics and pharmacokinetics of Frusemide, a common diuretic used in CHF treatment. Finally, it outlines nursing goals and interventions, providing rationales for each, covering areas such as blood clot reduction, edema management, shortness of breath relief, blood vessel relaxation, and potassium level maintenance, supported by relevant research and references. This analysis is a valuable resource for students studying healthcare and nursing.

Running head: CONGESTIVE HEART FAILURE
Name of the student;
Name of the university:
Author’s note:

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CONGESTIVE HEART FAILURE
Question 1:
Outline of the disease:
With the growing prevalence of the chronic illness, congestive heart failure is highlighted
as one of the chronic diseases which contributed to the mortality rate . Aspromonte and
Colivicchi (2017), Highlighted that congestive heart failure is a chronic condition that affects the
pumping ability of heart muscles. It is especially referred to the situation in which fluid builds up
around the heart and causes the heart muscles to pump blood inefficiently. The common feature
of the disease is that it minimizes the function of left myocardium. However, accumulated
evidence highlighted the impairment of the endocardium, heart valves and vessels as a result of
congestive heart failure (Arrigo et al., 2016). Environment factors such as sedentary lifestyle,
high sodium and lipid diet, obesity, enlargement of the heart can give rise to the situation where
heart muscles unable to pump blood efficiently (Bekelman et al., 2016). The risk factors resulted
in the symptoms such as rapid weight gain, shortness of breath dizziness, swollen ankle, and high
blood pressure.
Risk factors and incident of the disease:
As discussed by Mentz and O'connor (2016), few potential risk factors such as
sedentary lifestyle, high sodium, and lipid diet, obesity, enlargement of the heart, tobacco and
alcohol consumption, family history with the heart diseases may contribute to the development
of congestive heart failure. The recent statistics reported that in the current era at least 300000
million individuals in Australia are diagnosed with the disease every year, highlighting that 4%
of the population aged 45 are diagnosed with the congestive heart failure (Rajadurai et al., 2017).

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CONGESTIVE HEART FAILURE
Savarese and Lund (2017), highlighted that 50 to 75% of the patients with congestive heart
failure die within five years of diagnosis. Approximately 5 million individuals in Australia are
living with congestive heart failure and each year approximately 50000 of new cases are
diagnosed in Australia (Al-Omary et al., 2018). Prevalence of congestive heart failure is
increased from 1-3% to 10 % (Gonzalez-Chica et al., 2016). The congestive heart failure
contributed to 11 million physician visits and hospital every year, further highlighting that the
occurrence of the disease is equally frequently in men and women.
Impact of the disease on patient and family members:
Because of unpredicted nature of the disease, a significant number of patient is currently
living a life of misery. Gonzalez-Chica et al.( 2016), highlighted that lack of control over
disease cause patients to be insecure, helpless and dependent on people of surroundings. When
patients are labeled as sick, the family members exposed to a high level of psychological distress
such as anxiety and depression. Since family members are involved in decision making, high
level of stress compelled them to make irrational decisions.
Figure: congestive heart failure
Source: (Bekelman et al., 2016).

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CONGESTIVE HEART FAILURE
Question 2:
Symptoms Underlying pathophysiology
1. Dizziness In the case study , when Mrs. Sharon
McKenzie, a woman of 77 years presented in
the emergency department with the symptoms
of the heart , she stated that she was feeling
dizzy. Dizziness is considered as one of the
common symptoms. Mille (2016), highlighted
that dizziness observed because of reduction
of blood flow as well as oxygen level in brain.
However, many researchers also stated that
dizziness can be observed as a result of the
medications consumed by patient.
2. Shortness of breath Like dizziness, shortness of breath is one of
the common and prominent symptoms of
congestive heart failure. Shortness of breath
observed because of pulmonary edema. When
heart muscles unable to pump the blood
efficiently because of environmental factors
discussed before, blood flows back to the vain

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which takes up the blood through lungs. As a
result, the fluid builds into the alveoli of the
lung because of increased pressure in the
blood vessels (Jankowska et al., 2016). The
built up fluid reduces the oxygen saturation in
the as well as it deposited in the lungs nada as
a result patients experienced shortness of
breath. As observed in this case study, her
diagnosis suggested that her blood pressure
was 170/110 mmHg , indicating high blood
pressure. Her oxygen saturation is Sp02 at
92% on RA. For a normal individuals the
oxygen saturation should be in-between 96%
to 98%. However, in this case the 92% of the
oxygen saturation highlighted that she was
suffering from shortness of breath (Kang et
al., 2017).
3. Swollen ankle. In the case study, it was observed that
swollen ankle is one of the symptoms of Mrs.
McKenzie when she was presented in the
emergency department. Swelling of ankles is
observed because of the fluid accumulation in
the extremities such as ankles because of

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reduce blood flow in heart (Ter Maaten et al.,
2017). The fluid built up in the tissues of feet
ankles causes’ edema.
Question 3:
For the chosen case study, frusamide is the choice of drug which is part of the diuretic
drug family. Pharmacodynamics and pharmacokinetics of diuretic would be discussed below.
Pharmacodynamics:
Diuretic is used for treating edema and hypertension associated with the congestive heart,
failure, renal disease, cirrhosis, and nephritic syndromes. It inhibits water reabsorption in the
nephron through blocking sodium potassium chloride co-transporter present in Henle's loop.
Diuretic acts as a competitive inhibition at the chloride binding site of the chloride binding site of
the cotransporter. The phenomenon consequently prevents the transport of sodium from the
lumen of the loop into the basolateral interstitium. As a result, the lumen becomes more
hypertonic and interstititium become less hypotonic, diminishing the osmotic gradient for water
reabsorption throughout the nephron (Dalbeth et al., 2017). Therefore, flushing of extra salt
through urine reduces the blood pressure and associated edema inpatient
Pharmacokinetics:

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The pharmacokinetics of a class of drug follows ADME principle which includes
absorption, distribution, metabolism, and elimination of the drug in the body. The
pharmacokinetics of the diuretic would be discussed below.
1. Absorption:
Accumulated evidence suggested that in the patient with congestive heart
failure, 60% of the absorption observed with normal renal function (Koyner et al., 2015).
2. The volume of distribution:
Although the volume of distribution is not well known, few researchers
suggested that apparent volume of distribution (Vdβ) ranges from 14 to 17L. 95% of the
drug bound to the plasma protein which diminished in the nephrosis (Cil et al., 2016).
4. Metabolism:
Maximum amount of diuretic metabolized through the renal pathway since it
helps in flushing extra salt from urine. Only a small amount is hepatically metabolized.
5. Route of elimination:
The half-life of diuretics is approximately 2 hours and excreted through urine.
The elimination through urine is frequent in case of IV administration rather than fluid
oral administration (Lamarche et al., 2016).
Question 4:
Nursing goal Intervention Rationale
1. To reduce blot
clot
Warfarin is required
to administrate to the
It is couramin anti-coagulants
which act on vitamin k and K

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CONGESTIVE HEART FAILURE
patient under the
supervision of the
doctor
dependent co factors such as
II, VII, IX, and X also
reduced. Therefore, the
reduced factors eliminates
blood clots. It is suitable for
patient who is suffering with
congestive heart
failure since it reduces
the blood clot and
improves the blood
circulation (Heery et al.,
2015).
To reduce swollen ankle
of patient
1.Elivation of legs
2. Diet devoid of sodium
chloride
3. Use of compression
socks.
1. Beaudoin et al. (2015),
suggested that elevation of
legs reduces the pressure
from extremities such as legs
and ankle which in further
reduce the fluid built up in
the tissues and promotes
blood flow from the
extremities to heart.
2. Diet devoid of
sodium chloride

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minimizes the fluid
built up in the tissues
which is eliminated
through the urine.
Therefore, it would
be suitable for
patient for
preventing further
fluid accumulation
and manage edema
in ankle. In this case
frusamide is also
effective along with
the diet (Cil et al.,
2016).
.
3. Riley et al. (2016),
suggested that compression
socks puts the pressure on
the legs which further
prevent the fluid built up.
To reduce the
shortness of breath
1. Oxygen therapy
2. Monitoring
Oxygen therapy
administrated to patient

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CONGESTIVE HEART FAILURE
patient with the
therapy
who cannot get enough
of the oxygen because
of health issues such
as congestive heart
failure and patient
experiences shortness
of breath. Patient with
the congestive heart
failure is unable to take
up the oxygen from
surrounds and requires
the additional support
of the oxygen therapy
(Heery et al., 2015).
Therefore, it is suitable
for patient to reduce
the shortness of breath
and dizziness.
To relax blood vessels. 1. Administration of
Frusemide
2. Administration of
Digoxin
1. Frusemide is a
diuretics which helps to
control the blood
pressure and edema in
patient with congestive

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CONGESTIVE HEART FAILURE
3. Administration of
Enalaprile
4.
heart failure, renal
disease and cirrhosis. It
flushes extra sodium out
of the body to promote
blood flow. Therefore, it
is suitable for patient
(Evangelista et al., 2016).
2. Digoxin is used to treat
heart failure and administrate
in combination with other
drugs. The drug reduces
irregular heartbeat of patient.
As observed in this case
study , x ray showed lower
lob infiltrate. Therefore, it is
appropriate to decrease
irregular heartbeat and
minimize the symptom such
as shortness of breath ( Van
et al., 2017).
3. Enalaprile used for
relaxing blood vessels and
controlling the hypertension

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in patient with congestive
heart failure (Ter Maaten et
al., 2017. Therefore, it is
suitable for the patient to
reduce the hypertension.
To increase
potassium level
1. Administration
of the
intravenous
2. Modification of
diet with the
potassium rich
food.
1. Low potassium level
is life threatening,
especially for the
patient with
congestive heart
failure. Therefore,
administration of
the intravenous
potassium would
be effective.
2. Modification of
diet elevates the
potassium level
of patient and
minimizes the