401210 Health Variations 3: Chronic Systolic Heart Failure Report

This nursing report presents a case study of a patient diagnosed with atrial fibrillation and chronic systolic heart failure, detailing the patient's symptoms including severe breathlessness, high respiratory rate, and low oxygen saturation. The report analyzes the disease process, including the role of dyspnea, pulmonary edema, and the impact of high blood pressure on heart function. It also explores the nursing interventions, such as monitoring vital signs and patient education, that are crucial for managing the patient's condition. Furthermore, the report discusses the pharmacological treatments prescribed, specifically Furosemide and Glyceryl Trinitrate, explaining their mechanisms of action and importance in reducing the risk of heart failure. The report references relevant literature to support the analysis and recommendations for patient care.

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

1NURSING
Concept Map
Legend:
 Precipitating and predisposing factors
 Disease process
 Diagnostics
 Signs and Symptoms
 Management
 Aetiology
Severe breathlessness, heart
failure.
Arterial fibrillation
Chronic systol heart failure
Myocardial infarction
Dyspnoea
Restricted blood supply to the
myocardium
Low oxygen
saturation
and low
pulse rate.
High respiratory rate
Furosemide Glyceryl trinitrate
Crackels
bilaterally
Pulmonary oedema

2NURSING
Question 1
According to the case scenario, ECG monitor proved atrial fibrillation. She was also
diagnosed to have severe dyspnea, high respiratory rate (24 breaths/minute), low oxygen
saturation (85% on room temperature), high blood pressure (170/95mmHg), high pulse rate
(120 beats/minute) and bilateral basal crackles in her lungs. However, looking at all the
manifestations, the doctors concluded that Mrs. Brown was at risk of chronic systolic heart
failure.
Chronic systolic heart failure mainly occurs due to decrease in left ventricular ejection
fraction. Heart failure results due to decrease in the cardiac output which in turn activates the
sympathetic nervous system thereby increasing the heart rate of Mrs. Brown. Blood pressure
rises in chronic systolic heart failure as it pushes the blood against the walls of the arteries
with a huge force which leads to halting of the heart muscle. Due to this halt, the patient
suffers from heart failure. Mrs. Brown has a high blood pressure which can be referred to as
high systolic blood pressure. Due to this, the left ventricle deals with increase in the afterload.
Afterload is defined as that workload which pumps the blood against the risen vascular
resistance. After a period, this will result in hypertrophy of the cardiac myocardium. If patient
does long-term remodeling then it may result in various disorders. Due to Mrs. Brown’s high
blood pressure, she is suffering from chronic systole heart failure, as it is seen that 60-70%
patients suffering from high blood pressure or hypertension to be more precise, there is a risk
of heart failure (Textbookofcardiology.org, 2019). High respiratory rate favors pulmonary
edema. Pulmonary edema is often causes in cases of chronic systolic heart failure. This is
because in this condition, the heart fails to pump sufficient blood and it can hence back up
into the veins which consume blood from the lungs. Thus this reduces the normal movement
of oxygen through the lungs. Due to this, the person suffers from shortness of breath. As per

3NURSING
the case study, Mrs. Brown had a high respiration rate which might have favored pulmonary
edema and in turn increasing the risk of chronic systolic heart failure (Retamal et a., 2014).
According to Dubé, Agostoni & Laveneziana (2016), dyspnea is one of the main
symptoms that led to chronic systole heart failure. It impairs the functional capacity as well as
life quality which are generally independent from the severity of the disease. In case of Mrs.
Brown or patients suffering from Chronic systolic heart failure, dyspnea arise from the
pulmonary congestion due to the dysfunctionaning of the left ventricle which in turn results
in decrease in the cardiac output and rise in pulmonary venous pressure. Chronic systolic
heart failure results in reduction in urine output. Hence with kidney failure, the kidneys fail to
function, allowing the sodium to be deposited in the body resulting in water retention.
Mainly the chronic systolic heart failure occurs due to activation of the rennin –
angiotensin system and increase secretion of the catecholamine. It is mainly compensated
with the help of Frank-Starling mechanism. According to this mechanism, in case of a heart
failure a force is introduced in the muscle fiber which is dependent on such an extent that
results in stretching of that fiber. In situations like Mrs. Brown’s when the afterload
increases, the walls of heart also stretch. Increase level of catecholamine leads to an upward
shift of the Frank-Starling curve (Kobirumaki-Shimozawa et al., 2014). Hence it uses in
compensating the occurrence of chronic systolic heart failure. However, Mrs. Brown also
suffers from bilateral basal crackles in her lungs. This is mainly as small airways or alveoli
popping out due to lack of aeration during expiration. In case of chronic systolic heart failure,
excessive fluid secretion in the airways leads to the development of crackles (Bohadana,
Izbicki & Kraman, 2014). Doctors diagnosed the crackle in Mrs. Brown’s lungs by
auscultation. It is defined as a term where the internal sounds of the body are heard usually
with help of a stethoscope. It is mainly performed in order to examine the circulatory system.
Atrial fibrillation results to heart failure in 90% of cases. This is because in such patients the

4NURSING
sympathetic nerve activity increases which are responsible for occurrence of cardiac failure
(Zakeri, Chamberlain, Roger & Redfield, 2013).
Question 2
Nurses provide an important role in the cardiovascular unit. Cardiovascular diseases
have increased over the last years and it is also the leading cause of increase of deaths in
Australia. Hence, nurses are trained in such a way so that they can provide the best treatment
to their patients. For patients like Mrs. Brown the first and important care plan will be
monitoring her blood pressure after every definite interval. Hence the first strategy that
should be used by the nurses is to constant monitor all the vital signs of Mrs. Brown in order
to lower the risk of occurrence of the disease. All the records should be documented well as it
will help in the process of diagnosis. Monitoring the blood pressure, respiratory rate, oxygen
saturation will help the nurse as well in their interaction with the physician regarding
patient’s health (Kakria, Tripathi, & Kitipawang, 2015).
Another strategy that might be used by the nurses in order to improve the condition of
Mrs. Brown is by using the communication skills in order to support patient education.
Patient education is must for any kind of improvement in the condition of the patient. All
patients should know about their health conditions and what treatment they are going
through. Patient teach-back is found to be effective strategy in educating the patients about
their health and medicines. This strategy is used basically in order to judge patient’s
understanding and this will in turn be helpful to the nurses to determine where they have to
work more in order to provide the best treatment to Mrs. Brown. Communication is the best
way to read patient’s thoughts. Nurses can be use basic language in order to explain the
medical terminologies and should speak at a measured pace. This is because speaking quickly
sometimes results in issues regarding the understanding process of the patients. The nurse

5NURSING
should also ask a lot of question to Mrs. Brown regarding her health as well as outside
environment. It will help them in gaining trust from her which will be required for her future
care (Hjelmfors, Strömberg, Friedrichsen, Mårtensson & Jaarsma, 2014). These two
strategies will be the basics for the nursing practice in case of treating Mrs. Brown.
Question 3
Mrs. Brown was advised to take Furosemide (Lasix) and Glyceryl Trinitrate
sublingually. Furosemide is a diuretic which inhibits the Na-K-2Cl cotransporter in the
ascending loop of Henle. Hence, the inhibit reabsorption of sodium and water. Due to this it
is helpful for the kidneys to eliminated unwanted water as well as salt from the body (Malha
& Mann, 2016). These in turns help in the pumping of the blood. Furosemide is advised by
the doctors in order to treat high blood pressure, as in case of Mrs. Brown, which will reduce
the risk of heart failure. Glyceryl trinitrate is an antianginal drug which is mainly a
vasodilating agent. It helps in the dilation of blood vessels and reduces preload in small
doses. If taken in high doses it can also reduce the afterload (Giuseppe, Paul & Hans-Ulrich,
2015). As Mrs. Brown has been diagnosed with atrial fibrillation, hence she had an increase
in preload. In order to reduce it, doctor must have prescribed Glyceryl Trinitrate to Mrs.
Brown. Therefore, both these drugs are very important in order to reduce the risk of chronic
systolic heart failure.

6NURSING
References
Bohadana, A., Izbicki, G., & Kraman, S. S. (2014). Fundamentals of lung auscultation. New
England Journal of Medicine, 370(8), 744-751. DOI: 10.1056/NEJMra1302901
Dubé, B. P., Agostoni, P., & Laveneziana, P. (2016). Exertional dyspnoea in chronic heart
failure: the role of the lung and respiratory mechanical factors. European Respiratory
Review, 25(141), 317-332. DOI: 10.1183/16000617.0048-2016
Giuseppe, C., Paul, J., & Hans-Ulrich, I. (2015). Use of nitrates in ischemic heart disease.
https://doi.org/10.1517/14656566.2015.1052742
Hjelmfors, L., Strömberg, A., Friedrichsen, M., Mårtensson, J., & Jaarsma, T. (2014).
Communicating prognosis and end-of-life care to heart failure patients: a survey of
heart failure nurses’ perspectives. European journal of cardiovascular nursing, 13(2),
152-161. https://doi.org/10.1177/1474515114521746
Kakria, P., Tripathi, N. K., & Kitipawang, P. (2015). A real-time health monitoring system
for remote cardiac patients using smartphone and wearable sensors. International
journal of telemedicine and applications, 2015, 8. doi>10.1155/2015/373474
Kobirumaki-Shimozawa, F., Inoue, T., Shintani, S. A., Oyama, K., Terui, T., Minamisawa,
S., ... & Fukuda, N. (2014). Cardiac thin filament regulation and the Frank–Starling
mechanism. The Journal of Physiological Sciences, 64(4), 221-232.
https://doi.org/10.1007/s12576-014-0314-y
Malha, L., & Mann, S. J. (2016). Loop diuretics in the treatment of hypertension. Current
hypertension reports, 18(4), 27. https://doi.org/10.1007/s1190

7NURSING
Retamal, J., Borges, J. B., Suarez-Sipmann, F., Bruhn, A., Hedenstierna, G., & Larsson, A.
(2014). 0893. High respiratory rate favors pulmonary edema in an experimental
model of acute lung injury. Intensive care medicine experimental, 2(S1), O19. doi:
10.1186/2197-425X-2-S1-O19
Textbookofcardiology.org. (2019). Heart Failure - Textbook of Cardiology. Retrieved 5
August 2019, from https://www.textbookofcardiology.org/wiki/Heart_Failure
Zakeri, R., Chamberlain, A. M., Roger, V. L., & Redfield, M. M. (2013). Temporal
relationship and prognostic significance of atrial fibrillation in heart failure patients
with preserved ejection fraction: a community-based study. Circulation, 128(10),
1085-1093. https://doi.org/10.1161/CIRCULATIONAHA.113.001475