NRSG353 Case Study: In-depth Analysis of Congestive Heart Failure

This case study provides a comprehensive analysis of congestive heart failure (CHF) based on a patient scenario. It outlines the disease, its causes, incidence, and risk factors, along with a discussion of the impact on the patient and their family. The analysis includes a detailed examination of common signs and symptoms, explaining the underlying pathophysiology of each. Furthermore, the study delves into the pharmacodynamics and pharmacokinetics of digitalis glycosides, a common class of drugs used in treating CHF. Finally, it presents a nursing care plan tailored to the patient's condition, outlining specific goals, interventions, and rationales for addressing the patient's shortness of breath, increased heart rate, elevated blood pressure, and fluid accumulation.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS ASSIGNMENT’
Name of the study
Name of the university
Author note

1CASE STUDY ANALYSIS
Answer 1
Outline of the disease
Congestive heart failure (CHF) is an acute and progressive heart condition which occurs
due to the fluid buildup around the heart muscles, making them contract ineffectively and
decrease their ability to pump blood (Pose et al., 2017). The heart anatomy is inclusive of two
atria and two ventricles, in which ventricular pump helps to provide oxygenated blood to the
organs and tissues and the atria receives all the deoxygenated blood. When the pumping ability
of the ventricle decreases, bodily organs are unable to receive enough blood (Maisel et al., 2016).
Due to this, several organs such as liver, abdomen, lungs and lower body organs starts
accumulating fluids, originating congestive heart condition (Vedel & Khanassov, 2015). In the
provided case study, it was seen that Mrs. Sharon McKenzie (77) suffered from myocardial
infarction at her 65 years of age and her current symptoms include shortness of breath, cold feet,
swollen ankle, dizziness and elevated heart rate, hence all the symptoms indicated towards the
congestive heart failure.
Causes, incidence and risk factors
While discussing incidence, it should be mentioned that as per the Australian bureau of
statistics, more than 300,000 people are affected with congestive heart failure, which is 4% of the
total Australian population. Majority of these people are above the age of 45 and the number of
patients diagnosed with this disorder are increasing by 30,000 every year, making it one of the
crucial health concern for Australia (Sahle et al., 2016).
The most common cause of CHF are damaged heart muscles due to which the heart
valves are unable to work properly and loses its ability to pump adequate blood to the bodily

2CASE STUDY ANALYSIS
organs. Besides this, viral infections, which is known as cardiomyopathy, aging and excessive
alcohol consumption could also increase the severity of this disease. In the case study, it is seen
that Mrs. Sharon McKenzie suffered from an severe myocardial infarction 12 years ago and
hence, as per Ponikowski et al. (2016), patients suffered from myocardial infarction in their past
could develop the risk of CHF. Besides these, due to build up of fatty deposits or plaque in the
walls of heart, congestive heart failure could be observed in older adults.
The risk factors associated to the coronary heart failure are previous episodes of
myocardial infarction, increased blood pressure due to hypertension condition; rheumatic fever
as well as pulmonary embolism could lead to congestive heart failure (Maisel et al., 2016).
Besides these, due to viral or bacterial infection, anemic condition, increase in the salt
consumption and as well as spending time in the humid or heat condition could lead to onset of
this condition (EUGenMed et al., 2015). Excessive cardiac workout and over exercise is another
important risk factor associated with CHF as in the case study it was seen that Mrs. Sharon
McKenzie used to walk with her husband in spite of her history of myocardial infarction
(Ponikowski et al., 2016).
Answer 2
Signs and symptoms Associated pathophysiology
Swelling of ankles and cold feet Due to external or internal stressors involved
in the congestive heart failure, the lower chamber of
heart or ventricles loses their ability to pump adequate
amount of blood in the organs and tissues of body
(EUGenMed et al., 2015). This further causes the heart
to pump blood under pressure, due to which the bodily
tissues starts accumulating fluid around them so that
they could be provided with nutrients for their growth
and development. Majority of the smooth muscle

3CASE STUDY ANALYSIS
tissues present in the arms, legs, ankles in the bodily
organs such as liver, kidney, heart and abdomen starts
accumulating water hence, edema in these organs and
body parts could be observed in the congestive heart
failure condition (Xu & Xue, 2016).
Shortness of breath increasing while walking
or any action
Shortness of breath is termed as one of the
primary symptoms of congestive heart failure in which
the amount of fluid accumulated in the smooth muscles
of lungs and surrounding area increases and hence, due
to this condition, people feel shortness of breath
(EUGenMed et al., 2015). Further, due to this
excessive accumulation of fluid people become unable
to walk or move within their house, which could be
observed in case of Mrs. Sharon McKenzie. Hence, in
such situation, people, who perform excessive
activities, overlook their heart conditions and perform
over exercise, could develop the sign associated to
shortness of breath (McCance & Huether et al., 2018).
Increased heart rate and blood pressure While undergoing congestive heart associated
symptom, heart muscles loses its ability to pump
oxygenated blood from the ventricles to different
organs, and tissues of the body. However, in such
condition, the heart functions to meet the oxygen need
of different tissues and cells (Xu & Xue, 2016).
Therefore, it puts extra pressure on the heart muscles,
that makes it pump more blood by increasing the heart
rate, whereas, the blood pressure also increases as less
amount of blood flows through the ventricles, increases
the pressure of the ventricle cavity. Hence, it is one of
the most crucial symptoms of the congestive heart
disease (Monticone et al., 2017).
Answer 3
The drug
The common class of drug which is included in such patient condition is known as
‘digitalis glycosides’, which helps to increase the strength of the heart muscles and increases the
efficiency of human heart to pump more blood to the bodily organs (Morsy, 2017). Further, the

4CASE STUDY ANALYSIS
primary aim of including these drugs in the intervention for patients affected with congestive
heart disease is its ability to control the irregular heart rate, heart beat and rhythm.
Pharmacodynamics
While discussing the pharmacodynamics of digitalis glycosides, the antiarrythmic action
as well as inotropic action should be discussed. While inducing the heart rate reduction action by
antiarrythmic action, it affects the SA nodes by putting sympatholytic effect in combination with
the cholinergic effect (Diederich, Muller & Cerella, 2017). However, toxic dose of this drug
could lead to automation of depression of SA node that directly affects the decrease of the blood
pressure, leading to harmful conditions (Botelho et al., 2018). On the other hand, while exerting
inotropic action on the patient, this class of drug increases the force and velocity of the
myocardial contraction of the heart muscles, increases its total peripheral resistance ability and
increases the AV node refractory period (Morsy, 2017). Hence, helps to increase the cardiac
output and balances the systole and diastole imbalance due to the congestive heart failure.
Pharmacokinetics
On the other hand, the pharmacokinetics of this drug revolves around four aspects such as
metabolism, absorption, distribution and excretion (Roberts et al., 2016). The absorption of the
dose, depends on the type of medication such as in form of tablet, the absorption is 60 to 80%, in
a form of capsule, it is 90 to 100%, whereas, through intra-muscular administration, it is 80%
(Jelliffe, 2016). The distribution of this drug depends on the site of action and due to this higher
distribution is witnessed in heart, intestine, kidneys, and liver as well as skeletal muscles,
whereas brain is the lowest distributed organ (Roberts et al., 2016). The metabolism of this drug
is done by bacteria in the gut and liver of humans, whereas the primary path of drug excretion is

5CASE STUDY ANALYSIS
through urination. The half life of this drug inside the human body is 300 to 40 hours, which
increases its efficiency as a drug (Jelliffe, 2016). Due to these positive signs, this drug was
included in the care process of Mrs. Sharon McKenzie.
Answer 4
Nursing care plan for Mrs. Sharon McKenzie
Nursing care plan goals Interventions Rationale
The primary goal would be
addressing the shortness of
breath associated situation of
patient as this may cause
severe discomfort in her health
condition
To maintain the respiratory
functions, the patient would be
provided with corticosteroids to
relieve the smooth muscles and
provide the lungs with adequate
air to meet the need of oxygen of
the body. Further, the patient
would also be provided with
anticoagulant drugs so that if any
blood clot is present within the
ventricular or atrial veins, it
could be eliminated and blood
could flow from the cavity
properly (Vedel & Khanassov,
2015).
As per Barbic et al. (2018),
providing patients suffering from
CHF with anticoagulant helps to
thin the blood and hence, blood
could flow from the ventricles
properly. This ultimately
decreases the fluid intake of
organs decreasing the edema
condition and thereby decreases
the shortness of breath associated
situation.
The second goal would be
lowering the increased heart
rate and elevated blood
pressure as in such situation; it
could increase the severity of
patient condition.
The first intervention to achieve
this goal would be monitoring
heart rhythm of the patient.
Further, the BNP or the Brain
natriuretic peptide production of
the patient would also be
assessed. Besides this, to
maintain the balance of the heart
rhythm and heart rate, the sodium
intake of the patient would be
assessed (Hasanpour-Dehkordi et
al., 2016).
BNP is the heart hormone, which
is released by the heart muscles
while undergoing pressure and
hence, monitoring this hormone
could provide details about the
stress or pressure the heart
muscles are facing to pump the
blood throughout the body.
Further, decreasing the sodium
intake control could help to
reduce the blood pressure of this
situation (Maisel et al., 2016).
Decreasing the fluid from the
smooth muscles and internal
organs of the patient as it
would decrease the edema
associated condition and
provide the patient with relief
To achieve this goal, the edema
would be monitored and the input
and output of the patient’s fluid
intake would be conducted.
Further, in the light of these
observations if increased
complication arises, diuretic
Diuretic medication is included
on the intervention because it
helps to excrete the excessive
fluid out of the body of the
patients (Pose et al., 2017). with
application of this, bathroom
plan for the patient would also be

6CASE STUDY ANALYSIS
medication would be included.
Further with this medication
administration, the bathroom
plan of the patient would also be
developed so that the fluid output
could be assessed and resulting
dehydration could be avoided
(Jonkman et al., 2016).
developed so that the fluid intake
and output could be assessed for
further care process of the patient
(Poole, Kerlin & Wynne, 2017).

7CASE STUDY ANALYSIS
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