NRSG353 Nursing Case Study: Comprehensive Analysis of CHF Patient

This nursing assignment presents a case study of Mrs. McKenzie, a patient diagnosed with Congestive Cardiac Failure (CCF). The assignment outlines the disease, its causes, incidence, and risk factors, discussing its impact on the patient and their family. It identifies and explains common signs and symptoms, including shortness of breath, high blood pressure, and cold extremities, detailing their underlying pathophysiology. The assignment also explores the pharmacodynamics and pharmacokinetics of Frusemide (Lasix), a common diuretic used in CHF treatment. Finally, it develops a nursing care plan for the patient's first 8 hours post-admission, focusing on relieving symptoms, providing comfort, and educating the patient about their condition and medication.

Running head: NURSING ASSIGNMENT
NURSING ASSIGNMENT
Name of the Student:
Name of the University:
Author Note:

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Outline the diseases, causes, incidence and risk factors. Discuss the impact of the selected
disease on the patient and their family.
In close association to the case study, it can be mentioned that the patient Mrs.
McKenzie is diagnosed with the Congestive Cardiac Failure. According to SymanHorduna et
al. (2013), Congestive Cardiac Failure (CCF) is characterized by the reduction of the
efficiency of the heart to pump blood. This interferes with the normal blood circulation
mechanism and reduced the pace of the blood flow. As a result of reduced blood flow, the
blood pressure substantially increases. As stated by SumanHorduna et al. (2013), decreased
blood flow interferes with the normal functioning of the kidney and as a result an increased
fluid build-up occurs within the arms, legs, feet and ankle.
As mentioned by Schultz et al. (2013), CCF manifests itself after other disease
conditions have substantially deteriorated the normal physiology of the heart. Studies suggest
that the disease condition occurs when the major areas within the heart concerned with
pumping blood become stiff and are not able to refill the blood in adequate amount between
the heartbeats. The condition also arises when the ventricles dilate to a maximum extent and
the heart is not able to pump blood effectively. This means that the heart loses its ability to
pump blood effectively so that it reaches appropriately to other parts of the body.
The condition of CCF is primarily triggered by a number of lifestyle factors such as
consumption of a diet rich in fats and poor in fibres (Verbruggeet al.2013). In addition to this,
patients with a previous medical history of cardiac disorder or cardiac failure are more
vulnerable to suffer from CCF as their heart muscles are considerably weakened. It should
also be noted here that individuals with a weakened heart who involve tremendously in
sporting activities are at at an increased risk of developing CCF.

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The prevalence of CCF has been documented to be roughly around 300,000 in
Australia with individuals above the age of 42 to 45 years being placed at a high risk (Roger,
2013). The prevalence of Congestive Heart Failure in Australia as reported by overseas
finding is equivalent to 4% among adults aged 45 years and above. In this regard, it should be
mentioned that there is no Australian findings on the incidence rate of CHF (Australian
Institute of Health and Welfare, 2019). The identified barriers in the process of determining
the statistical prevalence has been attributed due to the lack of a universally agreed definition
and complexities in diagnosing the condition at the initial stage (Australian Institute of Health
and Welfare, 2019).
It should be critically noted in this context that individuals who have a previous
medical history of cardiac failure or other cardiac issues are at a high risk of developing
Congestive Heart Failure. Also, patients who have higher blood pressure levels are also at a
significant high risk of developing the disorder. Other life style factors that increase the
probability of developing the disorder comprise of excessive consumption of alcohol,
consuming a high fat based diet and excessive smoking. Studies also mention that individuals
who are prone to infections such as bacterial or viral infections can also develop Congestive
Heart Disorder.
Discuss three (3) common signs and symptoms of the selected disease and explain the
underlying pathophysiology of each
The case study critically mentions about three symptoms that the patient has been
experiencing. The three symptoms along with their associated pathophysiology would be
discussed underneath in the form of a table.

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Signs and symptoms evident in the patient (Mrs.
McKenzie)
Pathophysiology of the symptoms
The case study mentions that upon presenting to
the emergency department (EU), Mrs. Mckenzie
was experiencing increased shortness of breath. It
was further mentioned by Mrs. McKenzie that
her shortness of breath worsened when she went
for a walk with her husband or indulged in
gardening activities.
CHF is characterized by the poor ability of the
heart to supply blood to the vital organs of the
body. As a result of which, there is a fluid build
up within the vital organs. Studies suggest that
accumulation of fluid within the lungs and leads
to increased shortness of breath and a feeling of
congestion within the chest (Sahle et al., 2016).
Mrs. McKenzie has been experiencing the similar
symptom.
The second symptom would essentially include
the assessment findings that revealed a high
blood pressure (170/110) and Heart rate (54BPM)
As suggested by Savarese & Lund (2017), CHF
weakens the heart’s ability to pump blood and
supply it to the vital organs within the body.
However, it is important to note here that in order
to maintain the normal physiological body
functions, it is essential that the heart pumps
blood and makes it available to the different parts
of the body. This is achieved by the heart by
putting extra pressure on the ventricular muscles
of the heart and as a result the pressure increases
greatly in the blood vessels. Therefore, CHF in
patients is marked by higher blood pressure and
heart beat.
The third symptom can be identified as Mrs.
McKenzie’s complain about her cold feet and
fingers
Studies mention that patients suffering from CHF
most commonly experience coldness in their
hands and feet (Sippel et al., 2015; Tabloski,
2014). The pathophysiology for this symptom
can be explained as the lack of adequate blood
supply in these regions of the body and on
account of the same these parts are unable to
sustain warmth (Tabloskli, 2014). This causes
coldness in these regions.
Discuss the pharmacodynamics & pharmacokinetics of one (1) common class of drug
relevant to the chosen patient
The chosen drug relevant to the patient in the case study can be stated as Frusemide
(Lasix). The drug is used as a diuretic and belongs to the group of sulphamoyl benzene which
resembles the group of thiazides (Ter Maaten et al., 2015). The prescribed dose to the patient
can be states as 40 mg BD. The chosen dug belongs to the pharamacotherapeutic group of
High-Ceiling diuretic sulphonamides or loop diuretics. The drug is denoted by the cose

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CO3C A01 (Medicines.org.uk, 2019). The mechanism of drug action can be explained as the
property of the drug to inhibit active chloride transport within the ascending loop of Henle
(Ter Maaten et al., 2015). The drug further facilitates sodium chloride reabsorption and
subsequently an isotonic or hypotonic urine is formed. Studies suggest that lasix acts along
the complete nephron and does not restrict its effect at the distal exchange site (Verbrugge et
al., 2013). The main effect of the drug can be explained as the diversion of the blood flow
from the juxta-medullary region into the outer cortex. Studies have further mentioned that the
administration of Furosemide could potentially alter the permeability of the glomerulas to the
serum proteins (Verbrugge et al., 2013).
The pharmacokinetic property can be explained under the following broad properties
(Medicines.org.uk, 2019):
Absorption: After oral absorption 65% of the drug is absorbed and the plasma half life is
biphasic with the terminal elimination phase lasting for 1.5 hour. Upon oral administration
the drug is 60% absorbed but the effect is over within 4 hours (Medicines.org.uk, 2019). The
ideal site of absorption in the upper region of the duodenum at pH 5.0.
Distribution: The drug is 99% attached to the plasma proteins (Medicines.org.uk, 2019)
Biotransformation: The drug is attached to plasma albumin and there is no sign of
biotransformation
Elimination: 90% of the drug is eliminated from the kidneys and is excreted in the form of
urine, a small amount is also eliminated through faeces
In order of priority, develop a nursing care plan for your chosen patient who has just
arrived on the ward from ED. Nursing care plan goals, interventions and rationales must
relate to the first 8 hours’ post ward admission

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In the words of Dykes et al. (2014), a nursing care plan essentially focuses on the care
needs of the patient and accordingly devises care goals in order to render holistic wellness.
After 8 hours of Mrs. McKenzie’s admission the following nursing plan would be followed:
Nursing care plan Goals Interventions Rationales
To relieve the patient of
shortness of breath and ensure
comfort
 Administration of
mild breathing
exercises and
ensuring adequate
rest can help in
relieving the patient
of her shortness of
breath
Research studies indicate that
administration of mild breathing
exercises and deep breathing
exercises can help in clearing
chest congestion and improve
the symptoms of shortness of
breath (Savarese & Lund,
2017).
To relieve the patient of cold
feet or pain
 Conduct pain
assessment to detect
the presence of pain
 Conduct vital sign
assessment to detect
any physiological
abnormalities
 Provide compressive
stockings to facilitate
easier mobility and
keep the patient warm
Conducting pain assessment
would help in determining the
pain score that would help in
the implementation of further
intervention
Conducting vital assessment
would help in monitoring the
physiological abnormalities
Compressive stockings would
keep the patient’s feet warn and
reduce the risk of developing
pressure ulcer (Sippel etal.,
2015).
To educate the patient about her
physical health condition and
ensure that she is aware of CFH
 Impart education
about the disease
condition and the
pathophysiology of
the symptoms in lucid
language
 Educate the patient
about the medication
routine and create a
note to remind the
patient about the
timings of the
medication
Educating the patient about the
disease would help in being
cautious and avoiding further
risk factors
Creation of a post it note or
routine would help the patient
in remembering her medication
dose and timings (Tabloskli,
2014).

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References:
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 25 Mar. 2019].
Dykes, P. C., Samal, L., Donahue, M., Greenberg, J. O., Hurley, A. C., Hasan, O., ... & Bates,
D. W. (2014). A patient-centered longitudinal care plan: vision versus reality. Journal
of the American Medical Informatics Association, 21(6), 1082-1090.
Medicines.org.uk (2019). Furosemide Tablets 40mg - Summary of Product Characteristics
(SmPC) - (eMC). [online] Medicines.org.uk. Available at:
https://www.medicines.org.uk/emc/product/5665/smpc [Accessed 25 Mar. 2019].
Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.
Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of
heart failure in Australia: a systematic review. BMC cardiovascular disorders, 16(1),
32.
Savarese, G., & Lund, L. H. (2017). Global public health burden of heart failure. Cardiac
failure review, 3(1), 7.
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).
Sippel, K., Seifert, B., & Hafner, J. (2015). Donning devices (foot slips and frames) enable
elderly people with severe chronic venous insufficiency to put on compression
stockings. European Journal of Vascular and Endovascular Surgery, 49(2), 221-229.

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Suman-Horduna, I., Roy, D., Frasure-Smith, N., Talajic, M., Lespérance, F., Blondeau,
L., ...& AF-CHF Trial Investigators. (2013). Quality of life and functional capacity in
patients with atrial fibrillation and congestive heart failure. Journal of the American
College of Cardiology, 61(4), 455-460.
Tabloski, P. A. (2014). Gerontological nursing. New York, NY, USA: Pearson.pp.111-114
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.
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.