Case Study: Diagnosis, Treatment, and Nursing of Left Heart Failure

This assignment presents a comprehensive case study on chronic left-sided heart failure, focusing on a patient named Mrs. Brown. It begins with a concept map illustrating the risk factors, etiology, pathophysiology, clinical manifestations, diagnosis, treatment, and prognosis of the condition. The case study then delves into the patient's clinical presentation, including tachycardia, tachypnea, dyspnea, and decreased oxygen saturation, leading to a diagnosis of chronic left-sided heart failure with arterial fibrillation. The pathogenesis of the condition is discussed, emphasizing systolic and diastolic dysfunction. Furthermore, the assignment explores evidence-based nursing strategies for managing Mrs. Brown's condition, including oxygen therapy and medication administration, such as Digoxine. Finally, it examines the mechanism of action and nursing implications of IV furosemide and sublingual glyceryl trinitrate, commonly used medications in treating heart failure, providing valuable insights into patient care and pharmacological interventions.

Running head: CONCEPT MAP AND GUIDED RESPONSE
Concept Map and Guided Question Response
Name of the Student:
Name of the University:
Author Note:

1CONCEPT MAP AND GUIDED RESPONSE
Concept Map on Left Heart Failure

2CONCEPT MAP AND GUIDED RESPONSE
Risk factors
Diabetes mellitus
Obesity (BM=31)
Sedentary lifestyle
Hypertension
Advanced age is the other common
risk factor (1)
Aetiology
Myocardial infarction
Pathophysiology (1)
Narrowing of arteries
Poor oxygen & blood
supply to heart
Impairment of pumping by left ventricle
Poor supply of oxygen rich blood
Accumulation of blood inside lungs and
shortness of breath- Stress on right heart
Impairment of left
ventricular function
Accumulation of fluid (1)
Left Heart Failure
Left Heart Failure
Diagnosis
Blood test to evaluate
thyroid, liver and kidney
function
Chest
e-ray,
electrocardiogram,
coronary angiography,
heart test and
echocardiogram (2)
Treatment
Prevention
Long term beta blocker
Aspirin therapy & satins
Weight management and lifestyle changes
managing blood pressure, having healthy diet,
quitting smoking and alcohol. Patient and family
education will also be crucial (5)
Treatment
high blood pressure medicines
cardiac catheterization
Beta-blockers, digitalis, digoxin
and ARBs, ACE, inhibitors (2)
Prevents
Arthrosclerosis
Progression of Disease
The major symptom of heart failure is
lack of dyspnea.
One also feel unusually exhausted.
The patient is subjected to medical
treatment and intervention, for
example, administering an IV.
Consistent chest x ray will enable
further diagnosis (3).
Prognosis
Left heart failure is a serious condition that
can result in early death. How long a person
live depends on the cause, age and exercise.
The chances of full recovery are also
limited. However, consistent medication can
stabilize the patient (3)
Prevents
causes
Course of disease
With palliative care- treat intractable
symptoms of chest pain, shortness of
breath, fatigue.
Without transplantation - heart failure
may not be reversible and cardiac
function typically deteriorates with
time (2)
Influences
Clinical manifestations
Dyspnoea
Orthopnoea, Cough,
Cyanosis,
Basal crackles, breathlessness
Fatigue,
Oliguria, Increased heart rate,
faint pulses
restlessness
confusion and anxiety (4)
References

3CONCEPT MAP AND GUIDED RESPONSE
1. Dupuis, J., & Guazzi, M. (2015). Pathophysiology and clinical relevance of
pulmonary remodelling in pulmonary hypertension due to left heart
diseases. Canadian Journal of Cardiology, 31(4), 416-429.
2. McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein,
K., ... & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute
and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.
3. Jamerson, K. & Byrd, J.B., (2017). Hypertension: Pre-Hypertension to Heart Failure,
an Issue of Cardiology Clinics, E-Book (Vol. 35, No. 1). Elsevier Health Sciences.
4. Alpert, M. A., Lavie, C. J., Agrawal, H., Aggarwal, K. B., & Kumar, S. A. (2014).
Obesity and heart failure: epidemiology, pathophysiology, clinical manifestations, and
management. Translational Research, 164(4), 345-356.
5. Schocken, D. D., Benjamin, E. J., Fonarow, G. C., Krumholz, H. M., Levy, D.,
Mensah, G. A., ... & Hong, Y. (2008). Prevention of heart
failure. Circulation, 117(19), 2544-2565.

4CONCEPT MAP AND GUIDED RESPONSE
Case Study
Answer to Question 1
The case study provided informs that the clinical manifestation in Mrs. Brown was
tachycardia, tachypnoea, dyspnoea, hypertension, and decreased level of oxygen saturation.
The other things that caused concern in the patient were the lung auscultation reports that
showed bilateral basal crackles. By performing the electrocardiogram test, the patient’s
condition was diagnosed as chronic left-sided heart failure. Arterial fibrillation was evident
from the electrocardiogram tests performed.
Systolic and Diastolic dysfunction
The pathogenesis of this clinical condition can be explained on the basis of this
manifestation. According to Dupuis, and Guazzi (2015) systolic dysfunction is the main
cause of left-sided heart failure. It is known to be the main etiological factor. Systolic
dysfunction is the condition characterized by poor capacity to pump out blood. It relates to
the poor ventricular contraction. The causative factor underlying this phenomenon may be the
impaired functioning of myocytes or fibrosis. When the blood flow is resisted to a level
above the threshold, creating afterload and consequently systolic dysfunction. The cumulative
effect of this processes is the overstretching of the left ventricle and impaired myocardial
contractility. In short, systolic dysfunction is significantly responsible for the heart failure.
The onset of heart failure is also initiated by the Diastolic dysfunction to some extent.
The hindrance to the ventricular relaxation and filling causes diastolic dysfunction. It is
evident from the stiffness of the wall, during this condition. In the patients with the left-sided
heart failure, ventricular contractility is impaired. It give rises to the condition like

5CONCEPT MAP AND GUIDED RESPONSE
myocardial infarction or ischemic heart (Kraigher-Krainer et al., 2014). During systolic
dysfunction and impaired ventricular contractility, the patients also exhibit dilated
cardiomyopathy. It is the another feature of left-sided heart failure. The overload can also be
contributed by the aortic regurgitation. Overload in this patients causes uncontrolled Systemic
hypertension. This may occur together with the aortic stenosis (Craft et al., 2015).
Homeostasis
In addition to the systemic factors, the deleterious consequences of the left-sided heart
failure is also linked to the mechanism that maintains homeostasis in our body. Based on the
various clinical examinations it was found that the left-sided heart failure is the outcome of
the cascade of events (Adeniran et al., 2015). The factors that are involved in this process are-
 Continuous sympathetic activation
 accentuated heart rate
 increased circulating volume
 preload in conjunction with increased total peripheral resistance
 chronic elevation of angiotensin II enzyme
 aldosterone hormone
In the given vase study, the two main symptoms of the diagnosed left-sided heart
failure manifested will be focused for understanding the pathophysiology.
Shortness of breath
The shortness of breath experienced by Mrs. Brown may have occurred because of the
pulmonary oncotic pressure. left-sided regurgitation contributes to decreased pulmonary
compliance. It occurs because of the extravasation of fluid into the pulmonary interstitium.
The increased airway resistance also reflects it. The process leading to the bilateral basal

6CONCEPT MAP AND GUIDED RESPONSE
crackles ca ne explained by the worsening pulmonary edema. The lung bases have greater
hydrostatic forces and before inspiration, closure of small airways occurs due to interstitial
edema. If this condition is serious, crackles are represented by higher lung regions
(Rosenkranz et al., 2015).
Answer to Question 2
The prevailing condition of Mrs. Brown can be treated by evidence based nursing
strategies. The patient’s health condition is deteriorating with increased respiratory rate and
low level of oxygen saturation. In this situation, oxygen therapy is the effective way to
prevent the pulmonary congestion and hypoxia (Miguel-Montanes et al., 2015). It will
improve the oxygen saturation. Nurses must monitor the patent under this action plan to
ascertain the intervention. The nurse must ensure adequate ventilation by using the nasal
cannula. The oxygen mask may create temporary suffocation must be mitigated by the
nurses. Nurse actions under this strategy involves taking preventive steps fr probable
occurrence of emphysema and hyperinflation of the lungs (McMurray et al., 2012).
Mrs. Brown’s heart rate was elevated above the normal limit. It is necessary in this
stage to maintain the satisfactory cardiovascular functioning. Under the supervision of the
physician, nurse can administer Digoxine as prescribed. Thus medication improves the
contraction and rhythmicity of the heart. It improves the cardiac output by enhancing the
myocardial contractility. It will lead to stabilization of the heart rhythms (Ambrosy et al.,
2014). The role of the nurse is to monitor and report to the physician in case of
contraindications or adverse outcomes. In addition to the pharmacological intervention, the
non-pharmacological interventions for the nurses can be emphasizing on self-care programs
for the patient. The urinary output can be measured as part of the diuretic therapy (Lilley et
al., 2014).

7CONCEPT MAP AND GUIDED RESPONSE
Answer to Question 3
Mechanism of action of IV furosemide and sublingual glyceryl trinitrate
This section deals with the mechanism of the drugs and relation to the acute
exacerbation of the chronic condition.
IV furosemide:
This drug is diuretic and functions to block the reabsorption of sodium, chloride, and
water from kidney. It is effective to treat oedema as it eliminated fluid from the body by
increasing urine output. Oedema is decreased by diuresis and pleural effusions, thereby
lowering the blood pressure. It is usually administered for the management of left-sided heart
failure (davisplus.fadavis.com., 2017).
Sublingual glyceryl trinitrate:
Thus drug is used for prophylactic management of angina pectoris. It is also used in acute
conditions. It is known as adjunct therapy to treat heart failure. This drug acts to dilate the
coronary arteries. It improves the collateral flow to ischemic regions. Upon administration of
this drug the coronary blood flow increases. This drug decreases the myocardial oxygen
consumption. Thus, it is administered to relive the symptoms of heart failure by reducing the
blood pressure and increasing cardiac output (davisplus.fadavis.com., 2017).
Nursing implication of the drugs administered
Nurse must report the physician in case of adverse outcomes. Timely assessment of
fluid status is necessary in addition to regular check of vital signs and location of edema, lung
sounds, skin turgor, and mucous membrane. Fall risk assessment should be conducted as Mrs
Brown is an elderly patient. The patient must be educated about the fall prevention strategies,
and the side effects of IV furosemide. It includes dzziness, nausea, muscle cramps, and

8CONCEPT MAP AND GUIDED RESPONSE
abdominal pain. Increased heartbeat, allergic reactions and tongue ulcers are the side effects
of sublingual glyceryl trinitrate. Nurses must carry out evaluation of the contributing factors
of angina pain in Mrs Brown. The patient must be checked for three level of consciousness
(Aitken et al., 2016).

9CONCEPT MAP AND GUIDED RESPONSE
References
Adeniran, I., MacIver, D. H., Hancox, J. C., & Zhang, H. (2015). Abnormal calcium
homeostasis in heart failure with preserved ejection fraction is related to both reduced
contractile function and incomplete relaxation: an electromechanically detailed
biophysical modeling study. Frontiers in physiology, 6.
Aitken, L., Marshall, A., & Chaboyer, W. (2016). Acccn's Critical Care Nursing. Elsevier
Health Sciences.
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L.
(2015). Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences.
Dupuis, J., & Guazzi, M. (2015). Pathophysiology and clinical relevance of pulmonary
remodelling in pulmonary hypertension due to left heart diseases. Canadian Journal
of Cardiology, 31(4), 416-429.
Furosemide. (2017). davisplus.fadavis.com. Retrieved 12 August 2017, from
https://davisplus.fadavis.com/3976/meddeck/pdf/furosemide.pdf.
Kraigher-Krainer, E., Shah, A. M., Gupta, D. K., Santos, A., Claggett, B., Pieske, B., ... &
McMurray, J. J. (2014). Impaired systolic function by strain imaging in heart failure
with preserved ejection fraction. Journal of the American College of
Cardiology, 63(5), 447-456.
Lilley, L. L., Collins, S. R., & Snyder, J. S. (2014). Pharmacology and the Nursing Process-
E-Book. Elsevier Health Sciences.
McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ...
& Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and
chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.

10CONCEPT MAP AND GUIDED RESPONSE
Rosenkranz, S., Gibbs, J. S. R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., &
Vachiéry, J. L. (2015). Left ventricular heart failure and pulmonary
hypertension. European heart journal, 37(12), 942-954.