NRSG353 Case Study Analysis: Congestive Heart Failure Overview

This case study analysis focuses on Sharon McKenzie, a patient suffering from congestive heart failure (CHF). The analysis begins with an overview of CHF, including its causes, incidence, risk factors, and impact on both the patient and her family. The assignment then delves into three common signs and symptoms of CHF, detailing the underlying pathophysiology of each, such as edema, shortness of breath, and dizziness. Furthermore, the pharmacokinetics and pharmacodynamics of enalapril, a common ACE inhibitor used in CHF treatment, are discussed. Finally, the assignment outlines a comprehensive nursing care plan, including goals, interventions (pharmacological and otherwise), and rationales for managing the patient's condition, addressing symptoms like edema and shortness of breath, and preventing further deterioration.

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

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CASE STUDY ANALYSIS
Disorder, causes, incidence and risk factors and impact of the disorder on patient and
family:
Congestive heart failure mainly takes place when the muscles in the heart cannot pump
blood successfully. Koene et al. (2016) opine that conditions like narrowed arteries in the heart
or high blood pressure make the heart weak or stiff and for this reason they cannot be filled with
blood successfully and hence cannot undertake pumping action efficiently. In cases of heart
failure, the pumping chambers of the heart mainly the ventricles might become stiff and not fill
properly in between beats. In other cases, the heart muscles become damaged and weakened and
here, the ventricles are seen to get stretched to a particular point where they can no longer pump
blood efficiently throughout the body causing the disorder. The patient named Sharon Mckenzie
has also been found to be suffering from congestive heart failure because she was having the
same physiological issues that had been mentioned in the parapgraph.
The different signs and symptoms are shortness of breath, swelling in the legs ankles and
feet, rapid or irregular heartbeat are some of the symptoms. Others are increased urination at
night, persistent cough, and wheezing of white or pink phlegm, rapid weight gain from fluid
retention, lack of appetite and nausea are some other signs (Anderson et al., 2016). Sharon is
also seen to suffer many of these symptoms like swelling of ankles, shortness of breath, dizziness
and others and hence nurses can state that she is suffering from congestive heart failure
Cardiovascular disorder is one of the major causes of death in the nation of Australia with
around 43477 deaths attributed to cardiovascular disorders in 2017. This disorder is killing about
one Australian in every 12 minutes and is affecting one in six Australians of 4.2 million people.
Heart failure is present 1 to 2 % of the Australian population and is predominantly a disorder that

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CASE STUDY ANALYSIS
affects mainly the elderly with around 10% being present among the elderly (Messerli et al.,
2017).
Varieties of risks factors are seen to be intricately associated with the disorder. High
blood pressure and coronary artery disease are two such factors. Sharon suffers from high blood
pressure issues which might be a cause of her congestive heart disorder. Besides, heart attack,
diabetes and some diabetic medications, sleep apnea and congenital heart defects can also
increase the chances of an individual to suffer from congestive heart failure (Piepoli et al., 2016).
Valvular heart disorders, viruses, excessive use of alcohol, use of tobacco, irregular heartbeats,
and obesity are also believed to increase the chances of the disorder.
The patient suffering from congestive heart failure may suffer from a large
number of healthcare complications. They may suffer from kidney damage or failure. Heart
failure might reduce the flow of blood to the kidneys, which eventually leads to cases of kidney
failures when not treated. It may also result in heart valve problems. The valves of the heart,
which actually work by making the blood flow in one direction, might no more function properly
when heart is enlarged or when blood pressure is high due to heart failure (Mozaffarian et al.,
2016). Heart rhythm problems and liver damages are also other physical complications that the
patients may also suffer due to heart failure. Moreover, the patients might also suffer from stress
and anxiety because of the suffering they have to o through because of the symptoms of the
disorder. They have to lead restricted lives which might make them feel frustrated. The family
members can also suffer from stress and depression seeing their patients suffers. They may feel
guilty thinking that they might have not taken enough care of the patients. Moreover, financial
crisis might also impact the quality of lives of both patients and family members because of the

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CASE STUDY ANALYSIS
healthcare expenditures. Sharon has developed symptoms of congestive heart failure and she and
her family is highly vulnerable of experiencing the same issues because of her disorder.
Three common signs, symptoms, and pathophysiology underlying them:
Symptoms pathophysiology
Edema that occurred in
the patient named
Sharon is one symptom
of congestive heart
failure.
When an individual suffer from congestive heart failure, one or both sides of
the lower chambers of the heart lose their capability in pumping blood
sufficiently. Because of this factor, blood can get backed up in the legs, feet
and ankle and this results in causing edema (Iwagami et al, . 2018) Congestive
heart failure can also cause swelling in the abdomen. Therefore, Sharon is also
seen have swollen ankles.
When pulmonary
edema occurs, the body
is seen to struggle in
order to get enough
oxygen and this causes
shortness of breath.
Sharon is also suffering
from shortness odd
breath
Pulmonary edema is a condition where the lungs get filled up with fluid.
During the times of heart failure, heart can no longer pump blood throughout
body thereby creating a backup of pressure in the small blood vessels of the
lungs. These cause the vessels in leaking fluid (Ter Maaten et al., 2015). When
the fluid fills up the lungs, they cannot put oxygen into the blood system and
thus causes deprivation of oxygen to the rest of the body. This causes shortness
of breath. Sharon has been found to be suffering from such symptoms.
Dizziness especially
when standing up too
Many of the studies opine that these might be due to abnormal heart function
or rhythm or due to narrowing of the valves. Blood flow to the brain might get

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CASE STUDY ANALYSIS
quickly of feeling of
fainting are also found
to be common
symptoms in people
suffering from
congestive heart failure.
Sharon is also seen to
feel dizzy.
reduced when the heart rate or rhythm becomes abnormal or when the heart
cannot pump blood sufficiently because blood flow gets blocked like because
of narrowing of the valve due to heart failure. Feeling dizzy, light-headed and
fainting might be mainly because of reduction of the blood flow to the brain.
Studies opine that sudden loss of consciousness usually means that supply of
blood to the brain is seriously reduced (Buck et al., 2015).
Pharmacokinetics and pharmaco-dynamics of one common class of drugs:
One of medicine that had been used for treating congestive heart failure of Sharon is
enalapril. This drug belongs to the class of Angiotensin-converting enzyme inhibitors or the ACE
inhibitors.
This class of drugs is seen to inhibit the activity of ACE competitively for prevention of
the formation of active octapeptide, angiotensin II, from that of the inactive decapeptide
angiotensin I. This occurs in blood as well as different tissues that include kidney, heart, blood
vessels as well as adrenal glands and brain. Studies have shown that Angiotensin II is a potent
vasoconstrictor and is successful in promoting aldosterone release. It also helps in facilitating
sympathetic activities and has many harmful effects on the cardiovascular systems
(Rickenbacher et al., 2017). It has been found that the reduction in the blood pressure secondary
to that of the process of vasodilatation following that of ACE inhibition in the greatest when the
rennin-angiotensin system gets stimulated like during the times following salt-restriction, renal

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CASE STUDY ANALYSIS
artery stenosis and diuretic therapy. However, Ace inhibitors also lower the blood pressure when
there is normal or low activity of that of the renin-angiotensin system.
This drug is absorbed by 55 to 75% where absorption remains unaffected by food. All
ACE inhibitors are found to bind with that of the tissue and plasma proteins and free drug is
eliminated rapidly mainly by the kidney predominantly by the glomerular filtration. It has been
found that they bind with the tissues sites and the plasma concentration time profile shows a long
lasting terminal elimination phase (Inamdar et al., 2016). Enalapril is an inactive pro drug. It is
found to require hydrolysis during or active absorption to general the active acid form called
enalaprilat.
Nursing care plan goals, interventions, and rationales:
Goals Interventions with rationale
Nursing goal: management of edema, blood
pressure
Pharmacological management is one of the most
important nursing interventions that need to be
taken. The nurses should provide diuretics to
Sharon. It helps in relieving congestive symptoms
as well as fluid retention and this will help
managing the symptoms of edema and fluid
accumulation in lungs as well. Another set of
intervention that should be given to Sharon would
be the beta-blockers, which mainly act by
countering the effects of the sympathetic nervous
system. These are the medications that help in
reduction of the blood pressure. They mainly work

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CASE STUDY ANALYSIS
by blocking the effects of the hormone epinephrine.
When beta blocker would be provided to Sharon,
her heart would beat slowly and with less force and
this would help in reduction of her blood pressure
which is found to be quite high above the normal
level (Ouwerkerk et al., 2017). Beta blockers also
help the blood vessels in opening up and improving
the blood flow. Another group of drug that should
be also provided to Sharon is the Angiotensin
Converting Enzyme inhibitors. These drugs mainly
help in relaxing the blood vessels. These drugs help
on preventing the enzyme in the body that produces
angiotensin II. This substance in the body narrows
the blood vessels and it releases hormones that can
raise the blood pressure. This narrowing causes the
occurrence of high blood pressure and force the
heart to work harder. Hence, this drug helps in
preventing the action of the enzyme and hence
blood pressure comes under control.
Nursing goal: management of shortness of
breath
Oxygen therapy is an important nursing
intervention that can also prove to be helpful for
Sharon. During heart failure, the heart muscles
might become weaker and may not pump enough
blood the way they normally would. In such
conditions, the body does not get oxygen it

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CASE STUDY ANALYSIS
requires. In such cases, nurses need to initiate
oxygen therapy. This therapy helps the patients to
breathe in extra oxygen for making sure that the
whole body is getting oxygen. It can help in
prevention of failures of organs that might take
place due to inability of oxygen to reach the other
organs. This would help in preventing damages to
kidney, brain and even heart itself (Shen et al.,
2017). This would be very helpful for the
symptoms of shortness of breath and swelling of
ankles. Sharon would be benefitted from this
intervention as well. To manage her breathing
problems in the night, nurse should use more
pillows, allow her to sleep in a recliner chair and
provide her a cushion for support so that Sharon
might rest upright.
Nursing goal: to prevent any further
deterioration of the condition of the patient and
relapse into severe phases again.
Nurses need to monitor the vital signs of Sharon in
regular intervals to monitor the condition of the
patient. Studies have stated that monitoring the
vital signs at regular intervals can help in acting as
important strategy for not only early detection but
also treatment of the alteration in the vital signs
that denote the deteriorating situations of the
patient or their relapse into severe stages of heart
failure. The basic sets of vital parameters that need

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CASE STUDY ANALYSIS
to be conducted would mainly comprise of ECG,
SpO2, Blood Pressure and Weight, respiration rate,
and others. All these should be documented from
time to time in order to study the trend and
understand whether the person is responding to the
treatment and whether she is coming out of danger
(Bnagalore et al., 2016)

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CASE STUDY ANALYSIS
References:
Anderson, L., Oldridge, N., Thompson, D. R., Zwisler, A. D., Rees, K., Martin, N., & Taylor, R.
S. (2016). Exercise-based cardiac rehabilitation for coronary heart disease: Cochrane
systematic review and meta-analysis. Journal of the American College of
Cardiology, 67(1), 1-12.
Bangalore, S., Fakheri, R., Toklu, B., Ogedegbe, G., Weintraub, H., & Messerli, F. H. (2016,
January). Angiotensin-converting enzyme inhibitors or angiotensin receptor blockers in
patients without heart failure? Insights from 254,301 patients from randomized trials.
In Mayo Clinic Proceedings(Vol. 91, No. 1, pp. 51-60). Elsevier.
Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., ... & Strachan,
P. H. (2015). Caregivers’ contributions to heart failure self-care: a systematic
review. European Journal of Cardiovascular Nursing, 14(1), 79-89.
Inamdar, A., & Inamdar, A. (2016). Heart failure: diagnosis, management and
utilization. Journal of clinical medicine, 5(7), 62.
Iwagami, M., Tomlinson, L. A., Mansfield, K. E., Douglas, I. J., Smeeth, L., & Nitsch, D.
(2018). Clinical codelist-Read codes for congestive heart failure.

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CASE STUDY ANALYSIS
Koene, R. J., Prizment, A. E., Blaes, A., & Konety, S. H. (2016). Shared risk factors in
cardiovascular disease and cancer. Circulation, 133(11), 1104-1114.
Messerli, F. H., Rimoldi, S. F., & Bangalore, S. (2017). The transition from hypertension to heart
failure: contemporary update. JACC: Heart Failure, 5(8), 543-551.
Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M., ... &
Howard, V. J. (2016). Heart disease and stroke statistics-2016 update a report from the
American Heart Association. Circulation, 133(4), e38-e48.
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.
Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., ... & Graham,
I. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical
practice: The Sixth Joint Task Force of the European Society of Cardiology and Other
Societies on Cardiovascular Disease Prevention in Clinical Practice. European heart
journal, 37(29), 2315-2381.
Rickenbacher, P., Kaufmann, B. A., Maeder, M. T., Bernheim, A., Goetschalckx, K., Pfister,
O., ... & TIME‐CHF Investigators. (2017). Heart failure with mid‐range ejection fraction:
a distinct clinical entity? Insights from the Trial of Intensified versus standard Medical
therapy in Elderly patients with Congestive Heart Failure (TIME‐CHF). European
journal of heart failure, 19(12), 1586-1596.

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Shen, L., Jhund, P. S., Petrie, M. C., Claggett, B. L., Barlera, S., Cleland, J. G., ... & Latini, R.
(2017). Declining risk of sudden death in heart failure. New England Journal of
Medicine, 377(1), 41-51.
Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A.
(2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and
therapy. Nature Reviews Cardiology, 12(3), 184.