NRSG353 - Acute Care Nursing: Case Study Analysis of Heart Failure

This case study provides a detailed analysis of acute care nursing for a patient, Mrs. Sharon, suffering from congestive heart failure. It explores the causes, incidence, and risk factors associated with the condition, including coronary artery disease, heart muscle failure, and lifestyle factors, emphasizing their emotional impact on both the patient and her family. The study identifies five key signs and symptoms of congestive heart failure—irregular heartbeat, swollen ankles, nausea, shortness of breath, and difficulty using flat beds—linking them to the underlying pathophysiology. It also discusses two common classes of drugs used in treating congestive heart failure, Furosemide and Digoxin, detailing their physiological effects and potential side effects. Finally, it outlines the responsibilities of a nursing professional in creating a priority care plan, including thorough checkups, fluid evaluation, and nutritional planning, highlighting the importance of a multidisciplinary team approach and the application of supplements to ensure optimal patient care. The solution emphasizes the critical nature of the first 24 hours in managing congestive heart failure and the importance of collaborative decision-making to minimize clinical errors.

Running head: ACUTE CARE NURSING
ACUTE CARE NURSING USING CASE STUDY 1
Name of the Student
Name of the university
Author note

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Answer 1
Congestive heart failure is a disease that is related to the weakening of the heart muscles,
leading to decreasing the power of the heart to pump blood to the entire body organs. This
condition primarily causes the blood to accumulate around the heart and prohibits it to pump
blood efficiently (Calvillo–King et al., 2013). The actual function of the heart and its four
chambers two ventricles and two atria is to collect oxygenated blood from lung (both ventricles)
and after the blood transportation, collect all the deoxygenated blood in the atria. However, in
this disease condition, the hearts ventricles are unable to transport blood to the entire body due to
its inability to pump blood and hence, the body stats accumulating blood in organs such as
kidney, liver, lungs, lower body, abdomen and nearby tissues (Roger, 2013). While talking about
the incidents related to congestive cardiac disease, it should be mentioned that currently there are
more than 22.5 million people in the entire world are affected with this disorder and maximum
number of affected people are observed in developing countries with lower socio-economic
status (Verbrugge et al., 2013).
There are several risk factors associated with congestive heart failure, within which, the
following three are most important. Coronary artery disease is one of the major risk factor that
enhances the plaque formation within the artery and decreases the flow of blood within the atrial
canal (Gheorghiade et al., 2013). Further due to this condition, the second risk factor associated
with congestive heart disorder emerges, which is heart muscle failure. As the heart is unable to
pump blood in enough amount within the body due to narrow oxygen concentrated blood, it
causes the heart muscle to put more stress to pump blood to the entire body and in the course the
blood pressure increases and the heart muscles becomes weaker (Verbrugge et al., 2013).

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Furthermore, another risk factors associated with it includes, excessive consumption of alcohol,
presence of viral infection, irregular heartbeats and respiratory rates and increased blood sugar
are risk factors that leads to congestive heart failure (Roger, 2013).
This disorder impacts the patient and their family emotionally. The body of the patient
becomes scary due to the scar formation in the heart muscles and due to the accumulation of
blood around bodily organs, the patient looks swollen. This is the way the disease impacts the
patient (Packer et al., 2013). Further, emotional impact is also important as the patient and his or
her family develops depressive syndrome. In the given case study, Mrs. Sharon and her husband
both has the chances to develop depression as her husband takes care of her congestive heart
failure and he might not be that string to see scars and discomfort of his wife. Hence, these are
the way, congestive heart failure may impact the patient and her family (Gheorghiade et al.,
2013).
Answer 2
There are several signs and symptoms that are developed by the patient affected with
congestive heart failure, however, the five important signs and symptoms that help to identify the
disease are irregular heartbeat and pulse rate, swollen ankle, nausea, shortness of breath and
difficulty in using flat beds.
1. Irregular heart beat and pulse rate: as the heart becomes inefficient in pumping more
blood in the entire body, the heart rate become unstable and lost the rhythm to which it generally
beats. Further due to the less availability of blood in veins, and the inability of blood to reach
from veins to lungs, the pulse rate also affected and becomes irregular (Yancy et al., 2013).

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2. Swollen ankle: congestive heart disorder is associated with swollen legs, hands, and
ankles in excessive amounts due to the presence of accumulated fluids in these sections of the
body. As in this condition, the heart becomes unable to pump blood in the entire body, the
deoxygenated blood cannot reach out to the heart to be pumped into the lungs for purification.
Therefore, it starts accumulating in different portions of the body, making the ankles, legs, hands
and abdomen more swollen. All the veins in these region becomes swollen that leads to swollen
ankle (Verbrugge et al., 2013).
3. Nausea: The symptom of nausea is witnessed in the patient as due to congestive heart
disease, entire body organs accumulates blood and body fluids which are not transported to the
entire body organs. Therefore, signs and symptoms of nausea and appetite loss is witnessed.
Further, due to blood storage in several organs and around the chest, mild to severe chest pain is
also observed along with nausea and appetite loss (Gheorghiade et al., 2013).
4. Shortness of breath: Congestive heart failure is associated with improper cardiac
structure, cardiac rhythm and functionality. As this disorder makes the heart muscles weaker, it
becomes unable to pump blood to all the bodily organs. Further, due to inadequate oxygen
transportation of blood inside the body, the body fluids and bloods starts accumulating around
the heart that emerges as the shortness of breath in patients affected with the syndrome (Packer et
al., 2013).
5. Flatbed related issues: the patient is unable to comfortable use a flatbed as the entre
bodily organs have blood and other fluids around them. Moreover, as this condition increases
fatigue, bloated body and abdomen, patient feel uncomfortable using flatbed (Yancy et al.,
2013).

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Answer 3
In the given case of Mrs. Sharon, there are two common classes of drugs that have been
used for the symptoms of congestive heart failure of the patient. These common drugs are
Furosemide and digoxin that have been applied on Mrs. Sharon. These drug has a longer history
of usability in congestive heart failure syndrome and is proven to be effective in enhance health
of the patient.
The first drug class, furosemide is a diuretic medicine that decreases the level of salt and
water absorption within the human body. Further, it enhances the excretion of excessive water
and salt present in the human body, to pass through the urine. The prime symptom of the
congestive heart syndrome is the accumulation of blood and bodily fluids around the organs and
this drug targets this edema of the body (Carta & Supuran, 2013). As per the given case study,
Mrs. Sharon is also suffering from the congestive heart failure and has symptoms such as
shortness of breath and irregular heart and respiratory rates. Therefore, the healthcare expert
included this class of drug in her medication list. Further, while the consumption of this drug, the
dosage and the strength of each dose should be managed accurately, so that excessive fluid
cannot be drained from the body. Further, overdose should also be prohibited due to its drastic
consequences related to permanent hearing loss (Felker, 2012).
Another class of drug that has been mentioned in the case study is one of the primitive
class of drug used in congestive heart failure, the digoxin. This drug is created from the flower of
foxglove plant, hence it leads to minimal side effects (Russo et al., 2014). This drug is used in
congestive heart failure as it provides power to the heart muscles to make it pump excessive
blood throughout the body. On the other hand, it improves the arterial fibrillation condition.

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Therefore, this drug is used in congestive heart failure. This drug should be prohibited in the
ventricular fibrillation related condition as this is the disorder in which, the ventricles or the
lower portion of the heart pumps blood from heart to the entire body, becomes ineffective to
pump blood (Greene & Gheorghiade, 2014).
Answer 4
The primary responsibility of a nursing professional caring for a critically ill patient to
create a plan of care, depending on which the medical, pharmacological interventions and
surgical management will be carried out. The care plan should be prepared on the basis of
priority and the nursing professional should target the symptom that has the ability to harm the
patient with greater extent (Feltner et al., 2014). Therefore, in the case of Mrs. Sharon, priority
care plan should be prepared and the congestive heart failure should be managed using those
priority care plan as the level of blood accumulation has been increased in her body, mentioned
in her medical reports. Therefore, in this case the nursing professional should first conduct a
thorough checkups of signs and symptoms including cardiac output and distress of respiration
(Schultz et al., 2013). After that, the nursing professional should carry out fluid evaluation, to
assess viral infection, and check allergies so that the medicines that to be administered should
help in improvement of patient condition. Finally, the nursing professionals should prepare the
diet and nutritional plan of Mrs. Sharon and maintain low sodium ingestion, so that fluid
accumulation can be minimized and optimal health development can be achieved (Russo et al.,
2014).
As the RN of Mrs. Sharon, I will choose the multidisciplinary team for the first 24 hours
of care, as the multidisciplinary team will target the prime aspects of care such as assessment,

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medication and prevention which will help to patient by protecting her from associated diseases
that occur while suffering from congestive heart failure (Feltner et al., 2014). Further I will try to
maintain the fluid intake and output, as it will help to assess the fluid that is accumulating in the
organs of the patient. Further I will be applying the two drug classes on the patient so that the
cardiac activity can be pushed so that increase amount of blood can be pumped in the body.
According to Schultz et al., (2014), the primary 24 hours of congestive cardiac failure is
important and hence, I will discuss all these interventions with the multidisciplinary team prior to
the application of medication and pharmacological interventions. Further discussing all these
interventions will provide an opportunity to eliminate all the manual errors present ion the
clinical process as the entire team will be focusing on the intervention applied on Mrs. Sharon.
Finally, as the patient is suffering from multiple syndromes that limits her diet and mineral
intake, I will be applying supplements in her diet so that she can consume exact amount of diet
and nutritional components without any side effect or allergic emergence (Ayalasomayajula et
al., 2015).

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References
Ayalasomayajula, S., Jordaan, P., Pal, P., Chandra, P., Albrecht, D., Langenickel, T., ... &
Sunkara, G. (2015). Assessment of drug interaction potential between LCZ696, an
angiotensin receptor neprilysin inhibitor, and digoxin or warfarin. Clin Pharmacol
Biopharm, 4(147), 2.
Calvillo–King, L., Arnold, D., Eubank, K. J., Lo, M., Yunyongying, P., Stieglitz, H., & Halm, E.
A. (2013). Impact of social factors on risk of readmission or mortality in pneumonia and
heart failure: systematic review. Journal of general internal medicine, 28(2), 269-282.
Carta, F., & Supuran, C. T. (2013). Diuretics with carbonic anhydrase inhibitory action: a patent
and literature review (2005–2013). Expert opinion on therapeutic patents, 23(6), 681-
691.
Felker, G. M. (2012). Loop diuretics in heart failure. Heart failure reviews, 17(2), 305-
311.
Feltner, C., Jones, C. D., Cené, C. W., Zheng, Z. J., Sueta, C. A., Coker-Schwimmer, E. J., ... &
Jonas, D. E. (2014). Transitional care interventions to prevent readmissions for persons
with heart failure: a systematic review and meta-analysis. Annals of internal
medicine, 160(11), 774-784.
Gheorghiade, M., Vaduganathan, M., Fonarow, G. C., & Bonow, R. O. (2013). Rehospitalization
for heart failure: problems and perspectives. Journal of the American College of
Cardiology, 61(4), 391-403.

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Greene, S. J., & Gheorghiade, M. (2014). Matching mechanism of death with mechanism of
action: considerations for drug development for hospitalized heart failure. Volume 64,
Issue 15, October 2014, DOI: 10.1016/j.jacc.2014.06.1199, Journal Of The American
College Of Cardiology
Packer, M., Colucci, W., Fisher, L., Massie, B. M., Teerlink, J. R., Young, J., ... & Garratt, C.
(2013). Effect of levosimendan on the short-term clinical course of patients with acutely
decompensated heart failure. JACC: Heart Failure, 1(2), 103-111.
Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.
Russo, E., Scicchitano, F., Whalley, B. J., Mazzitello, C., Ciriaco, M., Esposito, S., ... & Mammì,
M. (2014). Hypericum perforatum: pharmacokinetic, mechanism of action, tolerability,
and clinical drug–drug interactions. Phytotherapy research, 28(5), 643-655.
Schultz, S. E., Rothwell, D. M., Chen, Z., & Tu, K. (2013). Identifying cases of congestive heart
failure from administrative data: a validation study using primary care patient
records. Chronic diseases and injuries in Canada, 33(3).
Verbrugge, F. H., Dupont, M., Steels, P., Grieten, L., Malbrain, M., Tang, W. W., & Mullens, W.
(2013). Abdominal contributions to cardiorenal dysfunction in congestive heart
failure. Journal of the American College of Cardiology, 62(6), 485-495.
Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & Johnson,
M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure: executive
summary. Circulation, 128(16), 1810-1852.

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