Case Study 1: Comprehensive Analysis of Congestive Heart Failure

This case study analyzes a patient with congestive heart failure, focusing on the causes, symptoms, and treatment options. The patient's condition, stemming from sinus bradycardia and prior myocardial infarction, is examined in detail. The study explores risk factors like high blood pressure and coronary disorders, alongside the psychological impact on patients and their families. The case study further investigates symptoms such as shortness of breath, edema, and irregular heartbeats, which aided in the diagnosis. It then delves into pharmacological treatments, specifically beta-blockers and ACE inhibitors, explaining their mechanisms and benefits. Lastly, it discusses nursing care interventions, emphasizing prompt recognition in emergencies and the importance of patient triage and monitoring in acute and long-term management of the disorder. References from various research papers are also included.

Running head: CASE STUDY 1
CASE STUDY 1
Name of the student:
Name of the university:
Author note:

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Question 1:
Congestive heart failure mainly refers to the situation when blood moves through the
heart as well as the body in a much slower rate resulting in increase of pressure of the heart.
Heart becomes unable to pump sufficient amount of oxygen as well as nutrients for meeting the
needs of the body. Although the chambers of the heart tries its best to respond to the situations
by stretching to hold more blood and pumping through the body or by becoming stiff, the heart
muscle walls eventually gets weak and therefore they cannot continue the pumping efficiently.
Researchers state four different types of causes that may contribute to the disorders. The first one
may be coronary heart diseases where the arteries carry decreased amount of blood to the heart
muscles and therefore sufficient oxygen is not delivered (Mozaffarian et al., 2016). A heart
attack may be yet another cause where the arteries are blocked suddenly that stops blood flow to
the heart and heart muscles get damaged. Cardiomyopathy may be yet another cause where
damage of heart muscles takes place due to infections or alcohol use. Other causes that weaken
the heart are high blood pressure, diabetes, kidney disorders and others. However, the heart
disorder in the patient is mainly due to sinus bradycardia that had taken place due to inferior wall
myocardial infarction. She already had suffered from myocardial infarction in the past and her
heart muscles were already damaged due to lack of oxygen supply (January et al., 2014). Her
forgetting to take medications might have resulted in occurrence of the disorders. Therefore, the
risk factors of these disorders are high blood pressure, coronary heart disease, heart attack,
diabetes, and certain medications. Sleep apnea, congenital heart defects, viruses, alcohol and
tobacco use and many others. However, no such information is present in case of the patients.
Therefore, the risk factors for the patient may be her presence of high blood pressure as seen in
the case study as well as coronary disorders and sinus bradycardia. Patients who suffer from

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congestive heart failure have to maintain a highly restricted and disciplined life that might affect
them mentally (Lictman et al., 2014) . They often are seen to be anxious about their health
condition and gradually become depressed. They might not be able to conduct many activities
that they used to conduct earlier as the activities may put pressures on their heart. All such
obstruction in lives may make the patient feel sad and de-motivated. Caregivers and family
members may also get emotionally affected to see their patients suffer and may remain
concerned, tensed and fearful of the situations aggravating in any cases (Ford et al., 2015). They
also may be physically tired of taking care of the patients and heavy financial flow of
medications, healthcare costs and caregiver fees may may makes them tensed and depressed.
Question 2:
One of the most important symptoms of the disorder is congested lungs. Actually, fluid
backup in the lungs contribute to the occurrence of shortness of breath which results in difficulty
in breathing. Lung congestion also leads to the occurrence of dry cough development or even
wheezing. Another symptom is fluid and water retention. Less amount of blood flows to the
kidney that in turn results in swollen, ankles, legs as well as abdomen called the occurrence of
edema (Sin et al., 2015). The same phenomena results to the third symptom that increases the
need to urinate at night. The third symptom is loss of appetite and feeling of nausea by the
patient. This symptom mainly occurs due to the buildup of fluid around the liver and gut and
these interferes with digestion. As result of these, loss of appetite and nausea often accompanies
such patients. The fourth symptom is the occurrence of dizziness, fatigue and weakness. The
main reason for the occurrence of the disorder is less flow of blood to the major organs as well as
the muscles. These make the patient feel tired and weak. Very little flow of the blood to the brain
can result in occurrence of dizziness as well as confusion among the patients. The fifth symptom

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is the occurrence of rapid as well as irregular heartbeats. The heartbeats are mainly seen to beat
at a faster rate in order to pump more blood to the body. This results in occurrence of situations
that causes rapid heartbeat. In case of the patient also, all the symptoms had been visible which
helped in confirming to the disorder by the healthcare professional. The patient in the case study
had shortness of breath that mainly resulted from fluid backup in lungs causing shortness of
breath and difficulty in breathing. She also had swollen ankles that might be the result of fluid
retention in her body (Sin, Yaffet & Whooley, 2015). She is also suffering from dizziness,
fatigue and weakness due to restricted flow of blood to major organs like brain. Irregular
heartbeats are also present. She also had nausea that may be due to fluid accumulation
surrounding her gut region that is affecting her digestion. Such symptoms help in identification
of the disorder.
Question 3:
Beta-blockers are one of the classes of drugs that are used to control various types of
symptoms of heart failures. Some of the conditions of heart failures are made worse by certain
hormones called catecholamine. The body of human beings is seen to release these hormones as
a part of symptoms of heart failures. Therefore, researchers are of the opinion that beta-blockers
are indeed helpful for effectively treating heart failures. These classes of drugs mainly help by
controlling the heart rate in ways that allows the left ventricle to fill more completely.
Researchers have also stated that these medications also help in opening as well as widening the
blood vessels of the body (Cadrin et al., 2017). This class of drug is therefore useful for the
patients who have certain form of hear failures along with high blood sugar level. In case of the
patient in the case study, it is see that the patient is also suffering from high blood pressure and
therefore this class of drug would be highly helpful for the patient. Carvediol, metoprolol as well

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as bisoprolol are some of the beta-blockers that are already proven helpful for patients with
randomized controlled trial (Alabed et al, 2016). This class of medications helps in slowing
down the progression of systolic forms of heart failure. They are helpful in treating the systolic
dysfunction but may be also helpful to treat diastolic heart failures as well. Beta-blockers mainly
reduce the detrimental effects of catecholamine stimulation on myocardium that is harmful
largely.
Angiotensinogen-converting enzyme called the ACE inhibitors is another class of
enzymnes that are very important in managing heart failures. These mainly help in relaxing of
the blood vessels as well as lowering of the blood pressure resulting in improvement of blood
flow. The heart becomes successful in pumping more blood to the rest of the body without
working harder. Such class of drug mainly helps in blocking the activity of angiotensin in blood
that is responsible for narrowing the blood vessels of the heart. This makes the blood vessels
narrow and thereby makes it widen (Ouwerekerk et al., 2017). This helps in lowering of the
blood pressure and makes it easier for the heart to pump blood. They also help to releases salt
and water which also decreases the pressure of blood. Some of the examples of these classes of
drugs are enalapril, ramipril, quinapril, captopril and lisinipril.
Question 4:
In most of the cases of the patients, it has been witnessed that journey of the patients in
case of acute heart failure mainly starts with occurrence of shortness of breath that increases over
period. This remains associated with edema, fatigue, loss of appetite, weight change and nausea.
People take professional help when their self-care resources are seen to fail miserably (Mebaza et
al., 2015). Therefore, recent researches show that healthcare teams should provide more

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importance to optimizing better patient outcome by setting focus on the in-patient admission,
faster diagnosis of the acute as well as decompensated failure of heart, in patient management of
care in a proper healthcare environment followed by planned discharge. However, nursing care
interventions that would be taken on long-term management of the disorders need to be
considered secondary in the emergency and nurses should primarily provide more importance to
the patient in making the patient come out of emergency (Coffey et al., 2017). On arrival to the
emergency, prompt recognition of the condition of the patient from the symptoms are extremely
necessary. Proper management and transfer of the patient to the proper environment is necessary
for the alleviating both the physical and emotional symptoms of breathlessness and thereby
optimizing outcomes. Acute heart failure triage nurses are extremely important in the emergency
centers. A nurse practitioner can conduct the initial patient triage if triage nurse is not present.
She should be eliciting the patient history and then assess the severity of the clinical status.
Following this, the patient should be referred to the relevant team and thereby the nurse can
actively participate in completing the key role by helping the multidisciplinary team to
distinguish the cause of breathlessness and thereby initiating prompt symptom to relieving
therapy. The nurse practitioners of the emergency department usually have an expanded skill set
that enables them to perform proper clinical examination and therefore identify proper signs of
congestions thereby referring to electrocardiogram (ECG), Chest X-ray, sonograms and heart
scan are done (Feltner et al., 2014). This is then followed by enabling prompt transfer to
appropriate level of care. In short, the activities would be rapid triage to appropriate environment
for safe clinical care like general medical ward, coronary care unit and cardiology ward.
Objective monitoring for different modifications and changes in signs and symptoms of the
patient would help her to know if the patient is responsive to the interventions like medical

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administrations given to her in emergency conditions. Proper monitoring from time to time
should be conducted after immediate interventions of medicines. This would assess the objective
measurement of dyspnoea severity, hemodynamic status, heart rhythm, cardiac output and others
(Rai et al., 2017). Moreover, clinical examinations for signs of congestion from time to time,
analyzing the laboratory blood tests and management of the anxiety levels of the patients are
important. Following this, when results are satisfactory, nurses can shift them to further
treatment in the rehabilitation ward.

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References:
Alabed, S., Sabouni, A., Al Dakhoul, S., Bdaiwi, Y., & Frobel‐Mercier, A. K. (2016). Beta‐
blockers for congestive heart failure in children. The Cochrane Library.
Cadrin-Tourigny, J., Shohoudi, A., Roy, D., Talajic, M., Tadros, R., Mondésert, B., ... & Guerra,
P. G. (2017). Decreased mortality with beta-blockers in patients with heart failure and
coexisting atrial fibrillation: an AF-CHF substudy. JACC: Heart Failure, 5(2), 99-106.
Coffey, C. E., Carter, V., Wei, E., Hutcheon, D., Gruen, J. P., Anonas-Ternate, A., ... &
Spellberg, B. (2017). No More “Code Black”: Intervention to Improve Inpatient Flow at a
Large Public Hospital. The American journal of medicine.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., ... &
Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons
with heart failure: a systematic review and meta-analysis. Annals of internal
medicine, 160(11), 774-784.
Ford, I., Robertson, M., Komajda, M., Böhm, M., Borer, J. S., Tavazzi, L., & Swedberg, K.
(2015). Top ten risk factors for morbidity and mortality in patients with chronic systolic
heart failure and elevated heart rate: the SHIFT Risk Model. International journal of
cardiology, 184, 163-169.
January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Conti, J. B., ... & Sacco, R.
L. (2014). 2014 AHA/ACC/HRS guideline for the management of patients with atrial
fibrillation: a report of the American College of Cardiology/American Heart Association

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Task Force on Practice Guidelines and the Heart Rhythm Society. Journal of the
American College of Cardiology, 64(21), e1-e76.
Lichtman, J. H., Froelicher, E. S., Blumenthal, J. A., Carney, R. M., Doering, L. V., Frasure-
Smith, N., ... & Vaccarino, V. (2014). Depression as a risk factor for poor prognosis
among patients with acute coronary syndrome: systematic review and recommendations:
a scientific statement from the American Heart Association. Circulation, CIR-
0000000000000019.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S., ... &
McDonagh, T. (2015). Recommendations on pre‐hospital & early hospital management
of acute heart failure: a consensus paper from the Heart Failure Association of the
European Society of Cardiology, the European Society of Emergency Medicine and the
Society of Academic Emergency Medicine. European journal of heart failure, 17(6),
544-558.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., ... &
Howard, V. J. (2016). Executive summary: heart disease and stroke statistics—2016
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Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., ... &
Ng, L. L. (2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and
beta-blockers in patients with heart failure: a prospective European study. European
heart journal, 38(24), 1883-1890.

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Rai, M., Sharma, K. K., Seth, S., & Pathak, P. (2017). A randomized controlled trial to assess
effectiveness of a nurse-led home-based heart failure management program. Journal of
the Practice of Cardiovascular Sciences, 3(1), 28.
Sin, N. L., Kumar, A. D., Gehi, A. K., & Whooley, M. A. (2016). Direction of association
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disease: the Heart and Soul Study. Annals of Behavioral Medicine, 50(4), 523-532.
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soul study. Journal of the American Geriatrics Society, 63(1), 8-15.