Case Study Analysis of Congestive Heart Failure in Nursing (NRSG353)

This case study analysis focuses on a 77-year-old patient, Mrs. McKenzie, diagnosed with Congestive Heart Failure (CHF). The analysis begins with an outline of CHF, including its causes, risk factors, and prevalence within the Australian context, emphasizing the impact on the patient and her family. The study then examines three common signs and symptoms of CHF observed in Mrs. McKenzie, such as shortness of breath and swollen ankles, along with their underlying pathophysiology. Furthermore, the analysis explores the rationale behind choosing Digoxin as a treatment, detailing its pharmacokinetics and pharmacodynamics. Finally, a comprehensive nursing care plan is presented, outlining nursing goals, interventions, and rationales aimed at managing the patient's condition, including monitoring vital signs, educating the patient, and providing emotional support.

Running head: CASE STUDY ANALYSIS
CASE STUDY ANALYSIS
Name of the Student:
Name of the University:
Author Note:

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Response 1:
Outline of the disease:
Congestive Heart Failure can be defined as the condition which is characterized by
the weakening of the cardiac muscles (Francois et al., 2015). The weakening of the cardiac
muscles interferes with the ability of the heart to effectively pump blood into other tissues
and organs. As stated by Guglielmini and Diana (2015), congestive heart failure affects the
systolic motion of the heart which caused an increase in the heart beat. The increased heart
beat subsequently leads to the elevation of the blood pressure and causes an abnormal heart
rate. Studies have indicated that congestive heart failure is related to the weakening as well as
improper functioning of the ventricular heart muscles (Kubota et al., 2015). It should be
noted here that the oxygenated blood in the body is pumped by the ventricles and is then
transported to the different organs of the body. In addition to this, studies further reveal that
constricted arteries or associated coronary artery diseases can lead to the reduced efficiency
of the heart to pump blood (Kubota et al., 2015; Francois et al., 2015). It is on account of the
lack of a smooth blood circulation that fluid starts accumulating within the major organs that
include kidney, liver or upper and lower limbs. The symptoms of the disease includes
increased shortness of breath as well as a pertinent feeling of discomfort which has been in
reported in case of the patient within the case study. In close association to the case study, it
should be noted that the 77 year old patient (Mrs, McKenzie), has a previous medical history
of MI and displays vivid symptoms of swollen ankle, cold feet as well as shortness of breath.
The symptoms collectively suggest that the patient is suffering from Congestive Heart
Failure.
Causes, risks and prevalence within Australian Context:

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Congestive Heart Failure is majorly caused due to a number of lifestyle factors. In
addition to this, studies have also indicated that the disease condition is heavily triggered in
patients who are affected with cardiac problems and have weak ventricular muscles. This
elicits extra pressure on the ventricles as well as the blood vessels and as a result the blood
supply does not sufficiently reach to other organs within the body. Further, because of the
physiological stress the cardiac muscles function irregularly and this subsequently increases
the heart rate as well as the blood pressure of the blood vessels (Lichtman et al., 2014).
Therefore, on account of deficiency of adequate blood supply within the vital organs of the
body, the disease condition occurs. In addition to this, research studies indicate that patient
with previous medical history of MI are susceptible to develop Congestive Heart Disease due
to the weakened cardiac muscles. In addition to this the probability of developing Congestive
Heart Disease is higher in patients with a previous medical history of MI or coronary heart
disease who perform strenuous activities such as extensive workout, swimming or indulge in
diving or other sport activities.
Research studies have indicated that the prevalence of Congestive Heart Failure is
considerably high in Australia. As stated by American Diabetes Association (2016), a total of
300,000 individuals suffer from the disease condition. In addition to this the disorder is
invariably found to manifest in individuals aged 45 and higher (Lichtman et al., 2014).
However, it should be critically noted in this context that the appropriate local or state
prevalence of the disorder is not recorded in the official directory of the Australian Institute
of Health and Welfare (Australian Institute of Health and Welfare, 2019).
The risk factors of developing the disorder, majorly comprise of previous medical
history of cardiac failures or associated disorders such as cardiac arrest or coronary artery
blockage (Mukherjee et al., 2015). In addition to this, hypertension also serves as a high risk
factor that increases the probability of developing the disorder. Lifestyle stressors such as

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erratic diet routine or extensive consumption of fat based diet increases the probability of
acquiring Congestive Heart Failure (Mukherjee et al., 2015). It should further be noted that
scholarly literatures reveal that increased susceptibility to acquire bacterial or viral infections
increases the probability of developing the disorder (Patel et al., 2016). The mentioned risk
factors can be mentioned to be aligned to the patient Mrs. McKenzie.
Response 2:
Symptoms and Pathophysiology observed in the Patient:
The case study suggests that Mrs. McKenzie experiences increased shortness of
breath. Increased shortness of breath is a characteristic symptom of Congestive Heart Failure.
Research studies suggest that fluid storage within the tissues and organs of the body causes
shortness of breath (Benotti et al., 2017). This can be explained by the condition of fluid
storage within the lungs. The fluid fill up within the lungs leads to feeling of heaviness in the
chest and interferes with the normal breathing pattern. Mrs. McKenzie experienced problem
with shortness of breath and also has a previous medical history of MI that had weakened the
cardiac muscles leading to problems with normal blood circulation.
In addition to this, the case study mentions that the patient had swollen ankle and foot
and experienced intense pain within the swollen areas. The inflammation within the ankle and
foot typically indicated fluid accumulation (Chatterjee et al., 2017). This can be aligned to the
research study findings which suggest due to the compromised blood circulation, fluid starts
accumulating within the tissues and the vital organs. In addition to this, the first organs where
fluid accumulation occurs include within the arm and leg region. In this case, fluid
accumulation was detected with the ankle and the foot. This suggests the patients was
suffering from Congestive Heart Failure.

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Also, the patient in the case study has been reported to have an elevated blood
pressure and heart rate that required immediate medical attention. As has already been
discussed, Congestive Heart Failure in patients compromise the natural ability of the hearty to
pump blood and supply the blood to the different parts of the body. This leads to increased
pressure on the cardiac muscles which is reflected by the elevated blood pressure and heart
rate of the patient in the case study.
Response 3:
Choice of Drug:
While making the choice of an appropriate consider, it is essential to ensure two
outcome. The first would be to optimize the high blood pressure of the patient and the second
would be to ensure that the drug could potentially strengthen the cardiac muscles and
normalize the physiological functioning of the heart (American Diabetes Association, 2016).
In this regard, it should be mentioned that the drug chosen for the patient is Digoxin which is
also known as the ‘Cardiac Glycoside’ and belongs to the Glycoside family of drugs (Lopes
et al., 2018).
Pharmacokinetics:
The pharmacokinetics of a drug typically depends upon four important aspects that
include, metabolism, distribution, absorption and elimination. According to Lopes et al.
(2018), the absorption level of the drug, when administered orally was found to be equivalent
to 70%. On the other hand, while administering the drug intravenously, the absorption
average was reported to be 90% (Ettehad et al., 2016). Also, studies report that the drug
distribution occurs in the region surrounding the heart muscles that helps in strengthening the
cardiac muscles (Ettehad et al., 2016; Forsyth, 2017)). In addition to this, the activity of the
drug has been reported within the intestine and the kidney. On the other hand, the drug

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metabolism has been reported primarily within the intestine as well as the liver and the
elimination of the drug metabolites has been reported to be through the process of urination
(Forsyth, 2017). Therefore, the rationale for the choice of drug in case of Mrs. McKenzie can
be mentioned as the targeted properties of the drug.
Pharmacodynamics:
The drug has an inotropic mode of action that helps in stabilizing the rhythm of the
heart. The first line of the drug action is to stabilize the abnormal heartbeat. This is achieved
by the drug by regulating the SA node and eliciting a sympathetic effect directly over the
nodes. This results in a cholinergic effect and helps in optimizing the blood circulation within
the body (Forsyth, 2017). The drug action regulates the heart muscles to pump an increased
amount of blood and make the blood supply available to other body organs (Kubota et al.,
2015). This subsequently helps in restoring the cardiac output and also helps in stabilising the
heart beat and the cardiac output.
Response 4:
Care Plan:
The nursing care plan would specifically focus on the immediate care needs of the
patient. In order to address the care needs, appropriate interventions strategies would be
discussed along with appropriate rationale that would provide relief to the patient.
Nursing Goal 1:
 Assessment to monitor heart rate and cardiac output
 Diagnostic assessment would be conducted to evaluate the heart size and the presence
of any abnormalities
 Interventions:

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 The enlisted nursing goals would be achieved by conducting ECG and EKG
 Rationale:
 The rationale can be mentioned as the need to monitor the cardiac output and the heart
rate so as to ensure stability and in case of detecting an abnormality a consultation
with the physician would be arranged.
Nursing Goal 2:
 The high blood pressure of the patient would be stabilised
 The patient’s vital signs would be assessed
 Intervention:
 In order to monitor the blood pressure, the vital assessment would be conducted.
 The emotional or psychological stressors or insecurities of the patient would be
stabilized
 Rationale:
 Conduct a vital assessment offers an overview about the state of physiological
functioning of the body.
 Life stressors such as fear or pain directly impacts leads to the increase in blood
pressure (Patel et al., 2017). Therefore, the patient would be offered emotional
support and made to feel comfortable.
Nursing Goal 3:
 The patient would be educated about the health condition
 Intervention:
 The patient would be educated about the health condition and the medication routine
prescribed.
 Rationale:

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 The patient would be made aware about the risk factors that could increase the
intensity of the disorder and would be asked to observe precautionary measures
(Forsyth, 2017).

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References:
American Diabetes Association. (2016). 8. Cardiovascular disease and risk
management. Diabetes care, 39(Supplement 1), S60-S71.
Australian Institute of Health and Welfare (2019). Heart failure. . . what of the future?,
Summary - Australian Institute of Health and Welfare. [online] Australian Institute of
Health and Welfare. Available at: https://www.aihw.gov.au/reports/heart-stroke-
vascular-diseases/heart-failure-future/contents/summary [Accessed 23 Mar. 2019].
Benotti, P. N., Wood, G. C., Carey, D. J., Mehra, V. C., Mirshahi, T., Lent, M. R., ... &
Hirsch, A. G. (2017). Gastric bypass surgery produces a durable reduction in
cardiovascular disease risk factors and reduces the long‐term risks of congestive heart
failure. Journal of the American Heart Association, 6(5), e005126.
Chatterjee, N. A., Chae, C. U., Kim, E., Moorthy, M. V., Conen, D., Sandhu, R. K., ... &
Albert, C. M. (2017). Modifiable risk factors for incident heart failure in atrial
fibrillation. JACC: Heart Failure, 5(8), 552-560.
Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., ... &
Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease
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Forsyth, R. P. (2017). Mechanisms of the cardiovascular responses to environmental
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François, K., Ronco, C., & Bargman, J. M. (2015). Peritoneal dialysis for chronic congestive
heart failure. Blood purification, 40(1), 45-52.

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Guglielmini, C., & Diana, A. (2015). Thoracic radiography in the cat: identification of
cardiomegaly and congestive heart failure. Journal of Veterinary Cardiology, 17,
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