Analyzing Congestive Heart Failure Treatment: A Detailed Case Study

This case study delves into the treatment of congestive heart failure (CHF) through the detailed analysis of a patient case. It identifies the primary priorities in managing CHF exacerbation, focusing on impaired gas exchange and decreased cardiac output. Key interventions discussed include positioning the patient for optimal breathing (semi-Fowler's position), administering appropriate medications such as beta-blockers and morphine (with careful monitoring for side effects), and providing comprehensive health education to empower the patient for self-management and early symptom recognition. The study emphasizes a patient-centered approach to education, involving the patient in setting care management goals and connecting them with rehabilitation programs. Finally, it addresses discharge planning within a social justice framework, ensuring access to care and patient participation, particularly for vulnerable populations like the elderly. Desklib offers a wealth of resources, including past papers and solved assignments, to support students in their studies.

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Congestive Heart Failure Treatment
Student’s Name
University
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Congestive Heart Failure Treatment
Step 1: Introduction
Congestive heart failure is defined as a syndrome where patients have an abnormality of
cardiac structure that leads to worsening of symptoms and signs of heart failure thus requiring
urgent treatment. This means that the patient’s condition must be determined for the practitioner
to be able to determine the interventions that need to be taken to restore the condition of the
patient. Most patients with this condition report worsening of the clinical status leading to
hospitalization (Azad & Lemay 2014, p. 328). The role of the practitioner in this state is to
determine the nature of the exacerbation and putting clinical interventions in place to restore and
relief the patient. Thus the practitioner has to determine the preceptors of the condition and put
measures in place to address the causes of the problem. This entails determining the medical
priorities for the patient, developing interventions and monitoring the patient to ensure that
healing is achieved.
Step 2 Primary Priorities
To address the condition of Rob, the health professional needs to develop health priorities
that will inform the intervention that he will receive. The first priority of care in the treatment of
congestive exacerbation is to address the impaired gas exchange that may have led to congestion.
From the case of Rob, the impaired gas exchange can be a result of personal factors related to
mobility like fatigue from the three-hour walk. This fatigue is related to the cardiac problems of
Rob which may have been triggered thus leading to the congestion. This can also be related to
past illnesses like hypercholesterolemia, MI, angina, hypertension, Increased BMI which may
have worked with fatigue to cause an exacerbation. This means that the patient needs to assess
the patient from the general appearance that gives a clue to the respiratory status of the individual

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(Wayne 2017, pp. 8). The priorities for intervention should focus on fostering gas exchange to
the patient through positioning the patient in a position that allows the increased exchange. By
applying the ABCDE framework, the practitioner needs to assess the patient’s condition and
position the patient in a semi-fowler position to increase breathing.
The second priority is the provision of symptomatic relief to the patient through
decreasing the cardiac output. This process entails administering the required medication based
on the condition of the patient and the physical characteristics that he presents (Wayne 2017, pp.
9). This means that a combination of therapies need to be used to ensure that the patient is
restored to his normal condition. In the case of Rob, the therapeutic intervention needs to be
aligned to reducing chest congestion so that the patient can be discharged. The practitioner needs
to check certain conditions for the patient like assessing the heart and blood pressure, checking
for a pulse, heart sound, oxygen saturation, check for symptoms of pain assessing the
contributing factors that may have led to the problem. To address decreased cardiac output, the
practitioner needs to focus on two interventions: administering medications as prescribed while
at the same time noting the side effects and toxicity of the condition and education of the patient
and family about the disease, complications, personal care and seeking medical attention.
Step 3 Interventions
According to Fung, et al. (2018, p. 5) the first intervention is to assist the patient to
overcome the impaired gas exchange problem by positioning him with the head elevated off the
bed in a semi-fowler position to increase gas exchange. This means that the head should be
placed at 45 degrees allowing increased thoracic capacity, full descent of the diaphragm thus
increasing lung expansion which reduces abdominal crowding. When the patient is presented to
the facility, the first intervention that the practitioner needs to do is to relieve the patient of the

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congestion by adopting relevant therapeutic processes. This means that the practitioner focusses
on assisting the patient to overcome chest congestion by placing him in a position that allows
easy breathing through reduced abdominal content crowding. According to NajafI, Dehkord,
Abdav & Memarbash (2018, p. 34) argue the best way for assisting the patient to recover is
regulating the cardiovascular position with the head tilted and down to influence the nervous
system. This means that sympathetic nerve activity will be increased and at the same time vagus
nerve activity will be reduced to achieve the required cardiovascular response.
The semi-fowler position is achieved by inclining the patient with backrest to necessitate
breathing. This is a clinical intervention for promoting oxidation through maximum chest
expansion in respiratory distress. Breathing is achieved through relaxed tension of abdominal
muscles thus improved breathing. When the patient is seated in this position, the diaphragm is
pulled downwards through gravity allowing expansion and ventilation. El-Moaty, EL-Mokadem,
Abd-Elhy (2017, p. 229) suggest that therapeutic positioning of the patient is important in
increasing ventilation and perfusion to promote gas exchange. One of the factors that lead to
congestive heart failure is impaired gas exchange due to poor circulation of blood and expansion
of lungs thus causing the patient to be unable to breathe well. For example, patients with cardiac
diseases and fatigue can have chest congestion or heaviness. This means that despite the fact that
the patient may have been admitted in the facility, there is a need to ensure that basic breathing
therapy is induced before any other form of advanced therapy can be applied. The fact that Rob
has been taking his regular medication well and the congestion may be as a result of fatigue, the
practitioner needs to start by natural therapy methods like the semi-fowler positioning before
moving to the next stage of intervention. Therefore, this intervention seeks to ensure that the

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patient achieves and maintains the optimal gas exchange. Further, the semi-fowler position is
used to ensure that clear lung fields are maintained free from any regular distress.
The second intervention is the administration of medications while noting the side
effects. The first thing to do is to ensure that Rob has taken his regular medication. To resolve
heart congestion, Rob needs to be administered with beta blockers which will assist in slowing
down the heart rate. This type of drugs are good for patients with irregular heartbeat, angina and
high blood pressure. Oliveira, Feitosa-Filho & Ritt (2012, 679) suggests that this will slow down
the heart beat to treat through blocking the hormones adrenaline and noradrenaline, thus reducing
the rate of heartbeat which in turn decreases the amount of oxygen needed thus reducing the
amount of angiotensin which relaxes and widens the blood vessels easing the flow of blood
through the vessels. Since Rob has been reported with hypertension in the past, it is important for
practitioners to be cautious in the administration of morphine to reduce its side effects.
Dokainish (2018, 943) suggests that in patients who are presented with chest pain and
congestion, it is important for practitioners to test the troponin level as a way of assessing the
risk of heart failure thus presenting different care priorities for the patient. This should also be
related to the previous history of the patient to ensure that the practitioner understands the nature
of the cardiac problem that the patient presents. Thus 2.5-5mg of morphine can be administered
to the patient and repeated if necessary with care. The fact that Rob reported negative troponin of
TNI to show that there is an unlikely of a heart attack. This means that the case of the patient
does not raise an alarm and thus the practitioner needs to monitor him as he responds to the
medication. The fact that semi-fowler therapy has already been applied means that the patient
should be monitored to determine how he is responding to the medication.

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For monitoring the patient it is important to look out for signs like any shortness of
breath, blood pressure and even changes in the troponin level. This means that the patient is
supposed to respond to the medication and the therapy that has been induced in the first
intervention. Further, morphine use can have some side effects to patients with hypertension
which calls for the need to adequately monitor the vital signs presented by the patient and how
relief to the patient can be attained. Naito, Kohno & Fukuda (2017, p. 134) argue that morphine
use has been disputed in some studies thus the need for the practitioner to ensure that vital signs
of the patient are monitored to determine how he is responding to the medication. This means
that tracking the cardiac changes in the patient is important in determining the progress of the
patient and discharge decisions.
The last intervention is health education that seeks to empower the patient with skills for
monitoring the condition and when to seek medical advice. Vaillant-Roussel, Hélène; Laporte,
Pereira, Tanguy, Cassagnes, Ruivard, Clément, Reste & Vorilhon, Philippe. (2014) state that,
congestive heart failure is common in the aging population due to poor heart disease detection
management strategies. This calls for the need to reduce the poor quality of life for such patients
through reduced complications and hospitalization. The European Society of Cardiology
recommends the need for proper patient and family education to improve the quality of life and
non-pharmacological management which reduces cases of cardiac failure. Patient education
focusses on improving the knowledge and skills to increase attitudes and behaviors required to
improve health. This implies that once discharged from the healthcare facility, Rob needs to
understand how to manage the condition through leading a healthy lifestyle and at the same time
having the ability to monitor and respond to the vital signs. Since education improves
knowledge, then there is a need to ensure that the patient learns how to respond to the early signs

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of the condition which in turn reduce hospitalization. The focus should be to assist the patient in
early recognition of symptoms and prompt treatment which reduces hospitalization.
Taylor, Lynn & Bartlett (2018, p. 6) suggest that patient-centered approaches on
congestive heart failure view the condition as more related to the elderly people which calls for
the need to determine the needs and wants of such patients by involving them in the development
of models for managing the condition. This means that the practitioners need to review the
personal life of Rob and assist him to set care management goals that can lead to the
achievement of the appropriate care and management of the condition. Santana, Manalili, Jolley,
Zelinsky, Quan & Lu (2018, p. 431) suggest that the first step in the patient-centered approach is
to assess the previous knowledge of the patient through analyzing attitudes, misconceptions and
even motivation to stay healthy. Then from here the learning needs and barriers can be identified
to allow the practitioner to plan for the education of the patient. Continuous evaluation of the
patient is also important in ensuring that he follows the appropriate goals. To ensure that the
patient responds well to medication and education, referral to rehabilitation programs can be
effective for education, evaluation and even guided support to increase rebuild of life (Delaney
2018, p. 121). This will lead a thorough response to programs that increase functional capacity
and the left ventricular function.
Step 4 Discharge Planning
After treatment, the practitioner needs to have a discharge plan that is informed by the
social justice framework. This framework focusses meeting the rights of the patient by
specifically targeting the people who are marginalized and disadvantaged in society (Díez-
Villanueva & Alfonso 2016, p. 115). Rob falls under this category since old age presents
disadvantages that require special consideration. Thus the discharge plan needs to focus on the

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two principles of access and participation. Access means that the practitioner needs to develop a
plan that allows Rob to access the required care while at the same time the plan needs to be
participative so that it can be tailored to his needs.
Since the patient has been used to being cared for by the practitioner, the practitioner
needs to transition the patient from hospital care to home care. Azad NA. & Mielniczuk (2016,
1045) argue that tis is a collaborative process with increased involvement of the patient in
personal care and the need for understanding the vital signs of the problem. This means that Rob
needs to look for assistance after discharge since his energy will return slowly. This help will be
focused on reducing the straining of the body to increase recovery.
The next step is self-checking and assessment at home where the patient is required to
follow the care plans put in place in the third intervention. Chaves & Park (2016, p. 1730) call
for the need to have positive behaviour change in the patient to achieve the requird change. This
entails monitoring, assessing, analyzing and understanding vital signs and any changes in the
body. This should be based on ensuring that proper actions are followed like taking the required
exercise, adequate exercise and avoiding congestion triggers.
The last step is to follow up where the practitioner ensures that the progress of the patient
is monitored through linking him to the nearest caregivers that can assist in monitoring progress.
This includes linking him to rehabilitation groups and other aged care groups to assist him to
recover quickly.
Thus the role of the discharge plan is to put measures in place for ensuring that the
patient is able to transition easily from the hospital to home-based care and recovery. This should
be tailored to the needs of the patient to reduce readmission and hospitalization.
Step 5 Conclusion

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Therefore, congestion heart failure is a condition that can be managed at home to reduce
adverse effects and hospitalization. Patient-centered approaches need to ensure that the patient
understands his condition and learns how to monitor and respond early to the signs and
symptoms to reduce adverse effects. This means managing the condition is a key element in
reducing its effects and ensuring that the number of people admitted with the condition is
reduced. This means patient-centered education should focus on ensuring that such patients’
needs are met so that care plans can be developed based on their needs to reduce the adverse
effects of the condition.

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References
Azad NA. & Mielniczuk, L., 2016. A call for collaboration: improving cardiogeriatric care.
Canadian Journal of Cardiology, Volume 32, pp. 1041-1044.
Azad, N. & Lemay, G., 2014. Management of chronic heart failure in the older population.
Journal of Geriatric Cardiology, 11(4), pp. 329-337.
Chaves, C. & Park, c., 2016. Differential pathways of positive and negative health behaviour
change in congestive heart failure patients. Journal of Health Psychology, Volume 21, p. 1728–
1738.
Delaney, L. J., 2018. Patient-Centered care as an approach to improving health care in Australia.
The Australian Journal of Nursing Oractice, Scholarship & Research, 25(1), pp. 119-123.
Díez-Villanueva, P. & Alfonso, F., 2016. Heart failure in the elderly. Revista Latino-Americana
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Oliveira, F. C. d., Feitosa-Filho, G. S. & FontelesRitt, L. E., 2012. Use of beta-blockers for the
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Wayne, G., 2017. Decreased Cardiac Output. [Online]
Available at: https://nurseslabs.com/decreased-cardiac-output/
[Accessed March 2019].
Wayne, G., 2017. Impaired Gas Exchange. [Online]
Available at: https://nurseslabs.com/impaired-gas-exchange/
[Accessed March 2029].