Nursing Case Study: Congestive Heart Failure - Patient Care Plan

This case study focuses on Sharon Mackenzie, a patient presenting with symptoms of congestive heart failure. The study details the causes, signs, symptoms, and pathophysiology of the condition, including shortness of breath, swollen ankles, fatigue, and irregular heart rate. It explores the patient's medical history, including prior myocardial infarction and sinus bradycardia, which contributed to the heart failure. The case study then examines the use of beta-blockers and diuretics as key medications in managing the condition, along with their mechanisms of action. Finally, it outlines an emergency care plan, prioritizing interventions for shortness of breath, high heart rate, hypertension, and nausea, with rationales for each intervention. The nursing care plan emphasizes monitoring vital signs, administering oxygen and medications, and providing a supportive environment to alleviate symptoms and improve patient outcomes.

Running head: NURSING CASE STUDY:
Nursing case study:
Name of the student:
Name of the university:
Author note:

1NURSING CASE STUDY:
Table of Contents
Question 1: 2
Question 2: 3
Question 3: 5
Question 4: 6
References: 10

2NURSING CASE STUDY:
Question 1:
Congestive heart failure is a very common cardiac disorder that mainly targets the middle
aged and above patient population. On a more elaborative note, it can be mentioned that this
disease is a chronic progressive condition that only alters the pumping capability of the heart due
to excess fluid build up facilitated by deficient oxygen rich blood supply (Tissot, da Cruz &
Miyamoto, 2014). Elaborating on the different causes of the disease it can be mentioned that
there are a variety of different health conditions that can lead to the occurrence congestive heart
failure such as coronary arterial diseases, hypertension, valve deterioration and damaged or
weakened heart. Exploring further, in case of the coronary arterial diseases, there is generally
cholesterol deposition that blocks the most vital arteries narrowing them down further (Bartunek
et al., 2016). This restricts the flow of blood and leads to deficiency of oxygen rich blood
reaching the heart. Another very common cause to congestive heart failure is the hypertension
which increases the vulnerability of any patient suffering from congestive heart failure as well. It
has to be mentioned in this context that for hypertensive patients, the blockages are much more
aggravated in vital arteries leading to more probability of the patient going through congestive
heart failure. Other causes include impaired valve condition that do not open or close correctly
and weakened o pre damaged heart due to past history of cardiovascular disorders. In this case
the patient had went through a past history of myocardial infarction which can have damaged her
cardiovascular apparatus, along with that Sharon had also went through a sinus bradycardia
which must have contributed to irreversible damage to the coronary muscles and arteries leading
to the congestive heart failure (Crowley et al., 2017).

3NURSING CASE STUDY:
Considering the incidence of congestive heart failure, it can be stated that this diseases
carries the burden of 30% of the total mortality in Australia and affects one Australian in every
12 minutes. There are various risk factors associated with the disease, first and foremost, tobacco
usage and alcohol addiction can be considered as one of the most common ones. Along with that,
a few health conditions can also increase the risk of congestive heart failure effectively such as
obesity, diabetes, insomnia, congenital coronary abnormalities, etc. Although, with respect to the
case study, the common risk factors to this scenario, can be the hypertension and previous
history of myocardial infarction and sinus bradycardia (Hall, Levant & DeFrances, 2012). The
impact of congestive heart failure is extreme and it imposes a significant set of restriction and it
can be a huge psychological burden on the patient; even the family members suffer to see their
loved one going through the complexities of this disease.
Question 2:
Signs and symptoms Patho-physiology
Shortness of breath It is one of the most frequently observed and reported signs of congestive
heart failure. The medical terminology for this symptom is Dyspnoea, and
it accompanies acute breathlessness occurring randomly and persistently.
The underlying pathophysilogy behind this symptom is associated with
the leakage of blood into the longs of the patient due to the excessive
blood back up in the pulmonary veins as the heart is unable to keep up
with the demand of oxygenated blood of the body (Martindale et al.,
2016).
Swollen ankles or
localized oedema
The direct reason behind the occurrence of swollen ankles in the cardiac
disorders or in congestive heart failures is the excess fluid back in the

4NURSING CASE STUDY:
body tissues. The reduced or slowed down blood flow through the heart
causes blood back up in the veins which in turn leads to fluid back up in
the tissues. The reduced blood flowing through the body also affects the
water retention capability of the body and leads to reduced water and
sodium disposal in the body. This is how fluid retention is aggravated in
different parts of the body including feet, ankles, legs, and abdomen
(Mathew et al., 2018).
Fatigue and dizziness Another very common symptom of congestive heart failure can be the
persistent feeling of tiredness or fatigue all throughout the day. The
pathophysiology behind this is the inability of the heart to pump enough
blood to meet the needs of the rest of the body. The lack of enough blood
flow to brain and vital organs of the body results into the blood being
diverted from the less vital organs of the body like the muscles in the limb
causing extreme muscular fatigue (Norhammar et al., 2017).
Rapid and irregular heart
rate
Heart palpitations can be defined as a very common consequence of
congestive heart disease and is a very common sign or symptom of such
disorders. In congestive heart failures, the loss of pumping capacity is
compensated by the heart by pumping faster (Cho et al., 2015).
Cold hands The last sign or symptom that congestive heart failure is associated with is
the cold hand and feet which is mainly facilitated by the de to the lack of
warm oxygenated blood flowing throughout the body. The end points or
peripheral regions of the body receive the least amount of warm blood and
hence the hands and feet remain cold for the most part of the day (Di
Biase et al., 2016).

5NURSING CASE STUDY:
Question 3:
For any cardiovascular disorders the most abundantly opted medication is the beta blockers.
This class of drugs are extremely potent and they provide immediate relief to the patients defying
the fatal consequences of the patient effectively. It has to be mentioned in this context that there
has been a time in the past when the beta blockers were not the first choice of medication for
congestive heart failures, however nowadays, a medication plan for the congestive heart failure
is not complete without beta blockers (Cho et al., 2015). The mechanism of action of the beta
blockers is complex, these agents can slow down the progression of systolic heart failure
effectively by slowing down the heart rate and allowing the left ventricle to access higher blood
flow and fill more completely. As the left ventricle is the main pumping chamber of the heart this
function has a significant impact on slowing down the heart rate and evading the mortality
dangers for the patient. Along with that it has to be mentioned as well that the beta blockers can
also widen the blood vessels allowing higher blood passage through the veins and arteries.
Hence, Beta blockers can be the first choice of medication for the patients, such as carvedilol,
extended-release metoprolol, and bisoprolol (Raimondi et al., 2016).
It has to be understood that the patient had been suffering from extreme breathing troubles or
shortness of breath. The most important reason behind the shortness of breath and breathing
troubles is the increased fluid back up in the body. The second class of drugs that can be
extremely beneficial for the patient can be the diuretics. The aldosterone receptor antagonists are
potent potassium sparring diuretics that can helps by stimulating the kidneys to dispose more
water and sodium which reduces the fluid back up completely and relieves the pulmonary burden
and swelling as well (Di Biase et al., 2016). Hence, medication ACE inhibitors like the amiloride
and triamterene can be used to manage the patient as well.

6NURSING CASE STUDY:
Question 4:
This case study represents the case of a Sharon Mackenzie who had been presented to the
emergency department with the symptoms of shortness of breath, swollen ankles, mild nausea
and dizziness. The patient had past patient history of myocardial infarction at the age of 65and
had been going thorough random and frequent episodes of shortness of breath for the last 7 days
as well. It has to be mentioned in this context that her signs and symptoms were aggravated
whenever she was undergoing any physical exertion. According to the diagnostic assessment that
the patient had been undergone the most possible health disorder diagnosed had been congestive
heart failure. The emergency care plan for her can be as follows:
Nursing care
priority
Nursing outcome Intervention Rationale
Shortness of
breath
The ineffective
breathing pattern
of the patient will
subside and the
patient will be
relieved from the
dyspnoea.
Monitoring and assessment
of the respiratory ratio of the
patient along with the vital
signs to assess the immediate
care priorities.
Critically analyse the
breathing pattern for
dyspnoea such as the nasal
flaring, pursed lip breathing
and prolonged expiration
involving excessive
respiratory muscle usage (Fry
et al., 2017).
The thorough assessment will
help reveal the exact breathing
troubles that Sharon was
dealing with and will be able to
design accurate and precise acre
plan.
The airway clearance and the
external oxygen therapy will be
beneficial to increase the
respiratory rate the oxygen
saturation.

7NURSING CASE STUDY:
Administer airway clearance
and external oxygen therapy
to the patient.
Administration of potassium
sparring diuretics such as the
ACE inhibitors to relieve the
patient from the pulmonary
burden due to fluid back up
(Yu et al., 2015)
Increased renal functions will
revive the swelling and
breathing troubles of the patient
(Yu et al., 2015).
High heart rate
and decreased
cardiac output
The heart rate of
the patient will
return to normal
levels and the
cardiac output of
the patient will
also increase.
Auscultation of the apical
pulse and assessment of heart
rate and rhythm.
Administration of beta
blockers to dilate the blood
vessels and slow down the
heart rate (Norhammar et al.,
2014).
Palpating peripheral pulse to
revive diminished radial,
popliteal, dorsalis pedis, and
post tibial pulses.
It will provide insight regarding
the exact cardiac function will
help in customizing the care
plan according to the
emergency care needs.
Slowing down the heart rate and
vasodilatation will be helpful in
avoiding fatalities due to
decreased cardiac output (Di
Biase et al., 2016).
As the impact of decreased
cardiac output can be reflected
upon the peripheral pulses,
palpating will help revive them

8NURSING CASE STUDY:
(Martindale et al., 2016)
hypertension The blood
pressure of the
patient will revert
back to normal
Monitor the blood pressure of
the patient and assessment of
the systolic pressure
imbalance.
Administration of medication
like the thiazide diuretics and
the calcium channel blockers
as well (Martindale et al.,
2016).
Diligently monitoring the
blood pressure of the patient
in the hands and thighs.
This monitoring will be
beneficial for the patient so that
any minute change in the vital
sign can be addressed properly.
This medication will help in
reducing the systolic pressure of
Sharon.
The progress of the patients and
response to the medication will
be helpful to carry forward the
nursing care planning (Mathew
et al;., 2018).
Nausea and
dizziness
The patient will
be relieved from
the nausea and
dizziness and
fatigue.
Provide the patient with the
opportunity to be comfortable
in a calm environment.
Increase the fluid uptake of
the patient and put her in a
high energy high antioxidant
It will relax the patient and will
help in reviving the energy of
the patient (Mathew et al;.,
2018).
It will help the patient find the
necessary nutrition to remain

9NURSING CASE STUDY:
diet.
Encourage a therapeutic
relationship with the patient
and ask her take the recovery
position (Norhammar et al.,
2017)
energized (Crowley et al.,
2017).
This intervention will relax her
and will help in reducing the
anxiety and fatigue
(Vijayakrishnan et al., 2014).

10NURSING CASE STUDY:
References:
Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C.
(2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART‐1)
trial design. European journal of heart failure, 18(2), 160-168.
Cho, M. J., Lim, R. K., Jung, M. K., Park, K. H., Kim, H. Y., Kim, Y. M., & Lee, H. D.
(2015). Effects of beta-blockers for congestive heart failure in pediatric and
congenital heart disease patients: a meta-analysis of published studies.
Crowley, M. J., Diamantidis, C. J., McDuffie, J. R., Cameron, C. B., Stanifer, J. W., Mock,
C. K., ... & Williams, J. W. (2017). Clinical outcomes of metformin use in
populations with chronic kidney disease, congestive heart failure, or chronic liver
disease: a systematic review. Annals of internal medicine, 166(3), 191-200.
Di Biase, L., Mohanty, P., Mohanty, S., Santangeli, P., Trivedi, C., Lakkireddy, D., ... &
Casella, M. (2016). Ablation vs. amiodarone for treatment of persistent atrial
fibrillation in patients with congestive heart failure and an implanted device: results
from the AATAC multicenter randomized trial. Circulation, CIRCULATIONAHA-
115.
Fry, N., Liu, C., Garcia, A., Galougahi, G. K., Hamilton, E., Harris, J., ... & Rasmussen, H.
(2017). From Bench-Based PhD Project to First-in-Man Use of β3 Adrenergic
Agonist in Patients with Treatment-Resistant Decompensated Congestive Heart
Failure. Heart, Lung and Circulation, 26, S134.