In-depth Case Study: Managing Congestive Heart Failure Patient

This nursing assignment presents a case study on congestive heart failure (CHF), exploring its causes, incidence, and risk factors, including heart attack, coronary artery disease, and cardiomyopathy. It details the impact on patients' quality of life, highlighting physical symptoms like fatigue and dyspnea, as well as psychological distress. The study identifies common signs and symptoms such as irregular heartbeat, swelling, shortness of breath, and hypertension, linking them to their underlying pathophysiology. It also describes two common classes of drugs used for CHF patients—angiotensin-converting enzyme inhibitors and beta-blockers—explaining their physiological effects on the body. The assignment outlines essential nursing assessments, including ABCDE assessment, monitoring vital signs, head-to-toe assessment, and focused assessments on respiratory, cardiovascular, and musculoskeletal systems, along with dietary modifications.

Running head: NURSING ASSIGNMENT
Case Study on congestive heart failure
Name of the Student
Name of the University
Author Note

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Answer 1
Congestive heart failure (CVF) refers to the medical condition when the cardiac output of
a person is unable to meet the requirements of the lungs and the entire body (Hall, Levant
&DeFrances, 2012). This occurs due to inefficiency of the heart to pump sufficient amount of
blood, thereby disrupting blood flow.
Cause- There is a variety of reasons that can be attributed for congestive heart failure.
 Heart attack- This results in sudden blockage of the coronary artery, thereby directly
reducing or stopping blood flow to the cardiac muscles. This result in formation of a
scarred area that fails to function appropriately (Authors/Task Force Members et al.,
2012).
 Coronary artery disease- This disease of the arteries that supply oxygen rich blood to the
heart involves a decrease in blood flow to the muscles. Narrowing or blockage of
arteries also results in deprivation of nutrients and oxygen, thereby leading to heart
failure (Heusch et al., 2014).
 Cardiomyopathy- This is a direct manifestation of damage to the cardiac muscles due to
infections or substance abuse (Summerfield et al., 2012).
All of the aforementioned conditions prevent the heart from pumping blood efficiently and
result in CHF.
Incidence- Prevalence of CHF in Australia has been found to range between 1-2%, with a
huge proportion of the cases going unreported or undiagnosed (Sahle et al., 2016). More than
5.7million adults in the United States are found to suffer from CHF. It accounted for 1 in 9

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deaths in the year 2009. Moreover, more than half of the people who develop CHF die within 5
years of getting diagnosed (Benjamin et al., 2017).
Risk factors- The risk factors are given below:
 High blood pressure
 Atherosclerosis
 Previous history of heart attacks
 Disorders of the heart rhythm (Bayes-Genis et al., 2014)
 Smoking
 Alcohol consumption (Calvillo–King et al., 2013)
 High blood glucose levels
 Obesity
 Genetic factors
 Valvular heart disease
Thus, history of myocardial infarction and signs of hypertension in the patient can be
regarded as the major risk factors that predispose her to CHF.
Impact- Congestive heart failure severely affects the quality of life of the patients by
limiting them in performing daily activities. Most common physical symptoms are related to
fatigue, oedema, dyspnoea, chest pain and sleeping difficulties that adverse effects their quality
of life (Evangelista et al., 2012). Such worsening symptoms increases risks of recurrent
hospitalization and creates a major financial burden on the patient along with the family
members. Poor psychological status, such as, bad mood and financial trouble add to emotional

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distress and limits social activities. Depression is also found to occur in such circumstances,
which in turn disrupts relationship with family members (Fry et al., 2016).
Answer 2
Signs and symptoms Pathophysiology
Irregular heartbeat Abnormal heart rhythm occurs when the heart
beats slow, or fast. Sharon demonstrated a
heart rate of 54 bpm, much lower than the
normal rate of 60-100 bpm. This condition
(bradychardia) can be linked to disruption of
the vital systems of the heart due to inadequate
blood supply to the cardiac muscles (Fox et al.,
2014). Less efficiency of the heart in pumping
blood makes the latter move at a slower rate
and results in low heartbeat, thereby increasing
risks of heart failure.
Swelling Ankles and legs are considered as common
sites of swelling due to gravitational effect of
the body fluids. Sharon reported swollen
ankles which can be linked to congestive heart
failure in that failure of the right ventricle to
pump blood results in accumulation of fluid in
the lower legs and feet in the patient. This
resulted in oedema (King, Kingery&Baretta

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Casey, 2012).
Shortness of breath Commonly referred to as pulmonary oedema
the condition results due to accumulation of
fluid in the lungs. Blood present in the body
have backed up in the blood vessels in the
patient, which return blood to the heart from
the lungs. Due to inefficiency of the heart, fluid
has leaked into the lungs of the patient and
resulted in shortness of breath (Kosmala et al.,
2013).
Hypertension Inability of the heart muscles to provide
adequate amount of blood to the body can
often result due to blocking on narrowing of
blood vessels due to hypertension. The patient
showed high blood pressure which indicates
that lesselasticity of the narrowed arteries has
made it difficult for blood to travel easily and
smoothly throughout the body, thereby
resulting in the heart to work hard
(Parati&Esler, 2012). Overtime this will lead
to thickening and enlargement of the heart to
meet demand for nutrients and oxygen.

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Dizziness Dizziness often occurs due to inability of the
heart to pump blood in enough amounts.The
patient complaints of dizziness or feeling
lightheaded which can be related to reduction
of blood flow to the brain due to weakened
heart (Conraads et al., 2012). This directly
resulted in sudden loss of consciousness and
dizziness in the patient.
Answer 3
Angiotensin converting enzyme inhibitors referred to pharmaceutical drugs that are
primarily used for treatment of congestive heart failure and hypertension. The basic property of
these drugs lie in the fact that they help in relaxation of the blood vessels and result in a decrease
in the overall blood, there thereby lowering blood pressure and bringing about a reduction in
oxygen demand from the heart. These classes of drugs are found to inhibit angiotensin
converting enzyme, which forms an essential component of rennin-angiotensin-aldosterone
system (van Vark et al., 2012). The aforementioned system primarily regulates mechanism of
blood pressure. They generally block conversion of angiotensin Ito angiotensin II, thereby
lowering arteriolar resistance and increasing venous capacity. Subsequently, the cardiac output
gets decreased, and lower resistance are faced in the blood vessels.The drugs also result in
bringing about a decrease in blood volume, which in turn brings back the blood pressure to
normal level (Cheng et al., 2014). Most common drugs that belong to this class include enalapril
that has been administered to Sharon.

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Beta blockers form another class of medications particularly administered for managing
abnormal heart rhythm and protecting the heart from myocardial infarction, after previous
history of attack. They are also used for treatment of hypertension. These drugs act as
competitive antagonist and block receptor sites, specific for catecholamine, such as, nor-
epinephrine and epinephrine, located on adrenergic beta receptors of sympathetic nervous
system. These beta receptors are primarily found in cardiac muscle, arteries, smooth muscle, and
kidney (Rienstra et al., 2013). The beta blocker drugs are found to interfere with binding of
epinephrine to the receptor, thereby weakening effects of stress hormones.In addition, they are
also found to influence the rennin-angiotensin system by decreasing secretion of renin, which in
turn results in a reduction in oxygen demand of the heart, thereby lowering the capacity of the
blood to carry oxygen (Swedberg et al., 2012).Catecholamine is responsible for several
deleterious effects, such as, increasing the oxygen demand and reducing efficiency of cardiac
contraction. Thus, these beta blockers are found to counteract high sympathetic activity, and
result in an improved ejection fraction, thereby reducing absolute risks of death due to
congestive heart failure (Lymperopoulos, Rengo & Koch, 2013).
Answer 4
 ABCDE assessment- This assessment will contain evaluation or investigation of airway,
breathing,circulation, disability and exposure of the patient. This is the first assessment to
be conducted on Mrs. McKenzie, following her admission to the emergency care
department. This examination will help in checking if her airway is compromised, or
there is danger of choking. Assessing the breathing patterns will help in evaluating
effectiveness of oxygen delivery and ease of breathing (Munroe et al., 2013). The
presence of intact oxygen flow will also be investigated. The patient will also be assessed

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for presence of radial pulse, moisture, skin colour, and temperature. The level of
consciousness will determine if she is drowsy, restless, disoriented, unconscious, or
agitated.
 Monitoring vital signs of the patient- Low cardiac output is found to affect the vital
signs adversely. The pulse rate likely to be high that acts as a compensatory mechanism
to hypoxia and low cardiac output. Disproportionately elevated blood pressure levels will
also indicate circulatory congestion that can be associated to poor venous return by the
heart. Shallow respiration due to lack of energy and low body temperature metabolism
and likely to be seen (Feltner et al., 2014). Hence, it is essential to monitor them and note
any likely abnormal changes.
 Head-to-toe assessment- Head to toe assessment will encompass all the body systems
and the observations will help in providing a clear information on the overall condition of
the patient (Uchida et al., 2014).
 Focused assessment – Focused assessments will follow any kind of unusual or abnormal
findings and the examination will involve collection of objective data using the medical
techniques of palpation, inspection, auscultation, and percussion. Focused assessment for
Sharon would be respiratory, cardiovascular, and musculoskeletal.
a) Respiratory assessment will involve examination of presence of shortness of breath and
will determine presence of crackling sound from the lungs, which would signify
increasing breathing effort in the patient.
b) Cardiovascular assessment will involve examination of the jugular distinction, the chest
wall, and chest pain, as reported by Mrs. McKenzie. This will help to recognize
cardiovascular pathology. The electrocardiograph is the most common test used for

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investigating condition of the heart. An ECG will be conducted upon Sharon for detecting
probable signs of cardiac abnormalities. Heart beat recordings will be taken at times
when the patient reports symptoms of chest pain, black outs, or palpitations (Ponikowski
et al., 2014).
c) Musculoskeletal assessments will be conducted to determine if oedema in her ankles have
created impairment in mobility. This will be followed by a fall risk assessment that will
determine her postural control and balance.
 Medication administration - Therapeutic and side effects of all prescribed medication
should be taken into account before administering them to the patient, in order to ensure
her progress, and prevent further treatment related adverse outcomes.
 Formulating dietary modification pattern- Owing to the fact that diet plays a significant
role in maintenance for healthy heart. Modifying diets will minimise risk of fluid
retention and subsequent ischemic heart diseases. Efforts will be taken to recommend
small servings of meal to reduce workload of the heart (Nieuwenhuis et al., 2012).


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