Nursing Case Study: Managing Systolic Heart Failure in Healthcare

This case study examines the case of Mrs. Brown, an elderly patient admitted with an acute exacerbation of chronic systolic heart failure. It delves into the patient's clinical manifestations, including severe dyspnea, high blood pressure, and atrial fibrillation, linking these to the underlying pathophysiology. The study explores the rationale behind nursing interventions, such as oxygen administration and patient positioning, to improve oxygen saturation and alleviate symptoms. Furthermore, it discusses the nursing role in monitoring vital signs and administering medications like Furosemide (Lasix) and sublingual Glyceryl Trinitrate, explaining their mechanisms of action and therapeutic effects. The case study emphasizes the importance of evidence-based practice, providing a comprehensive overview of the nursing management of systolic heart failure.

Running head: HEALTHCARE
Healthcare
Name of the Student
Name of University
Author’s note

1
HEALTHCARE
Case Study
Answer 1
According to the study conducted by Rosenberg, Brunt and Rossman (2017), heart attack
or cardiac complication is one of the leading causes of mortality, morbidity and increased rate of
hospitalization among the older adults who are above 65 years of age. The vulnerability of
witnessing heart-attack of both men and women who are 80 years old is 20%. The age of Mrs
Brown is 78 years and she also has a past history heart attack, diagnosed 2 years ago. Her age
and her past medical history has accounted for her current clinical manifestations. Upon
admission to the emergency department, Mrs Brown showed severe dyspnoea. According to
Zhou, Zhang, Song, Li and Wang (2018) dyspnoea is a debilitating symptom that is defined as
shortness of breath or difficulty in breathing. The pathophysiology of dyspnoea mainly involves
a complex interplay of both peripheral and central receptor and cognition. Breathing is an
involuntary process that helps the central nervous system from getting flooded with irrelevant yet
constant sensory impulses. However, when the oxygen saturation in the body falls below the
normal level (95%) the process of breathing becomes voluntary as central nervous system make
conscious effort (gate-in) to conduct the breathing process with the help of the bi-lateral muscles
of the lungs (Rogers & Bush, 2015). This results in the generation of shortness of breath or
severe dyspnea. The oxygen saturation of Mrs. Brown is 85% and thus indicating the chances of
severe dyspnea. As the oxygen saturation (amount of dissolved in the hemoglobin) decreases
below the normal range, the heart increases the effort to pump more oxygen (oxygenated blood)
to peripheral regions of the body. This increases the systolic blood pressure (the upper blood
pressure). The systolic blood pressure is defined as the pressure executed by the arteries by

2
HEALTHCARE
squeezing and pumping the blood. In case of Mrs. Brown, the blood pressure was 170/95 mm Hg
thus indicating she has higher systolic pressure (normal range: 120/80 mm Hg). The increase in
the systolic blood pressure further increases the pulse rate of Mrs Brown, 120 beats/ minute
(normal up to 100 beats per minute). The fall in the oxygen saturation and increased blood
pressure leads to lack of aeration during expiration. This leads to “popping open” of the small
airways. This popped open alveolus is filled by fluid resulting in collapsing of the alveoli and
formation of bi-basal crackles. The increase in the bi-basal crackles leads to poor inhalation of
oxygen from the atmosphere by the lungs and at the same time decreases the oxygen saturation
of the body further (Rogers & Bush, 2015). In order words, it can be said that, bi-basal crackles
or wheezes is known as adventitious lung sound. These are regarded as additional respiratory
sounds that are super-imposed over the normal breath sounds. Crackles to be specified is
discontinuous sound that is attributed to the passage of air through accumulated secretions. These
secretions block the opening and closing of the airways leading to blockage in the free
transportation of oxygen within the blood (Sarkar, Madabhavi, Niranjan &Dogra, 2015).Under
this condition, the overall cardiac output increases and hence Mrs. Brown’s systolic blood
pressure is high, it resulted in the formation of chronic systolic heart failure. Moreover, the ECG
report of Mrs. Brown had shown a valid evidence of atrial fibrillation. Atrial fibrillation is
defined as abnormal rhythm of the heart. It happens when the electrical impulses of the heart
triggers rom different places in the atria that is the top chambers of the heart. These atrial
fibrillations can be sited as another cause behind the clinical manifestations of the chronic
systolic heart failure (Kirchhof et al., 2016).

3
HEALTHCARE
Answer 2
Increasing the oxygen saturation within the body
At present the oxygen saturation of Mrs. Brown is low (SpO2 is 85% whereas the normal
limit is 95%) (Rogers & Bush, 2015). Thus immediate nursing intervention for Mrs. Brown will
be external supply of oxygen with the help of nasal cannula. Rogers and Bush (2015) stated that
external supply oxygen helps to increase the level of oxygen saturation within the body and
thereby helping to improve the overall breathing pattern. Increase in the oxygen saturation will
help to reduce the discomfort associated with shortness of breath along with a significant
reduction in the respiratory rate (at present Mrs. Brown’s respiratory rate is 24 breaths per
minute whereas the normal rate is 12 to 20 beats per minute). The supply of oxygen through
nasal cannula will help to reduce the loss of oxygen during the passage from the tube into the
body. The posture of the patient must be maintained at a 45 degree. This signifies that the head
must be aligned at 45 degree to 90 degree from the waistline. This specific posture is known as
Fowler’s position. Fowler’s position helps to increase the surface area of the diaphragm and thus
helping the lungs to inhale more oxygen and thereby aiding in fast increase of the oxygen
saturation within the body (Saraçoğlu et al., 2016). According to the Nursing and Midwifery
Board of Australia (2018) Professional Code of Conduct, a nurse must deliver safe care and
giving oxygen supply in Folwer’s position helps to increase the safety quotient of the patient.
Monitoring of the vital signs
The patients who have witnessed heat attack, one of the crucial aspect of the nursing
intervention in regular monitoring of the vital signs. Here the regular monitoring vital signs will
involve monitoring of the pulse rate, the cardiac impulses of the heart, pulse rate, respiratory
rate, blood pressure and the level of oxygen saturation within the body. The monitoring of the

4
HEALTHCARE
vital signs will take place with the help of special devise known as pulse oxymetry (Rogers &
Bush, 2015). It will be a duty of the nurse to document the patients’ information in an hourly
basis and brief the healthcare physician accordingly. According to the Nursing and Midwifery
Board of Australia (2018) Professional Code of Conduct, it is the duty of a nursing professional
to document the patients’ vital parameters in order to avoid errors in the process of medicine
administration and change in the therapy plan. The special attention must be given to the blood
pressure and cardiac impulses of the heart. Any deviation from the normal should be addressed
through medical emergency team (MET) call in order to avoid any future chances of further
cardiac complications (Lujak, Billhardt & Ossowski, 2016). The body weight along with the
signs of the abdominal distention and fluid accumulation in the lower part of the body must also
be monitored as heart attack is followed by renal malfunction leading to fluid retention (Adams
& Urban, 2015). The symptoms of fluid retention are evident as Mrs. Brown as administered
with Lasix that helps to fight against edema.
Answer 3
Furosemide (Lasix)
Furosemide (Lasix) is a potent diuretic. It is prescribed for the treatment of edema
associated with heart failure. Since Mrs. Brown has encountered a heart failure she has been
prescribed Lasix. It is also used in the treatment of hyper-tension and this can also be the case
with Mrs. Brown. It works by blocking the adsorption of sodium (Na+), chloride (Cl-) and water
from the filtered fluid in from the kidneys. The medicine mainly increases the rate of excretion
of the dilute urine (Adams & Urban, 2015). Thus reducing the water retention within the body
and reducing the tension on the veins and arteries. This in turn helps to reduce the blood

5
HEALTHCARE
pressure. The reabsorption of Na+ and Cl- from the kidneys helps to restore the electrolyte
balance of the body and thereby helping to ensure the normal cardiac rhythm as operated by the
neurotransmitter (Adams & Urban, 2015).
Sublingual Glyceryl Trinitrate
This medication is nitroglycerine in nature it works by relaxation of the smooth muscle
cells and thus leading to vasodilation. Vasodilation reduces the ventricular filling pressure
(preload) and systemic vascular resistance (afterload). This combined effect helps in reducing
both systolic and diastolic blood pressure along with mean arterial pressure. Mrs. Brown's blood
pressure is high and thus administration of Nitroglyceine will help in proper regulation of the
blood pressure (Adams & Urban, 2015).
.

6
HEALTHCARE
References
Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson Education.
Kirchhof, P., Benussi, S., Kotecha, D., Ahlsson, A., Atar, D., Casadei, B., ... & Hindricks, G.
(2016). 2016 ESC Guidelines for the management of atrial fibrillation developed in
collaboration with EACTS. European journal of cardio-thoracic surgery, 50(5), e1-e88.
https://doi.org/10.1093/ejcts/ezw313
Lujak, M., Billhardt, H., & Ossowski, S. (2016). Distributed coordination of emergency medical
service for angioplasty patients. Annals of Mathematics and Artificial Intelligence, 78(1),
73-100.
Nursing and Midwifery Board of Australia (2018). Professional Code of Conduct. Access date:
13th August. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards.aspx
Rogers, C., & Bush, N. (2015). Heart failure: pathophysiology, diagnosis, medical treatment
guidelines, and nursing management. Nursing Clinics, 50(4), 787-799.
DOI: https://doi.org/10.1016/j.cnur.2015.07.012
Rosenberg, H. L., Brunt, V. E., &Rossman, M. J. (2017). Diastolic dysfunction and older adults:
heating up the conversation. The Journal of physiology, 595(15),
5011.doi: 10.1113/JP274695
Saraçoğlu, A., Altun, D., Yavru, A., Aksakal, N., Sormaz, İ. C., & Camcı, E. (2016). Effects of
head position on cerebral oxygenation and blood flow velocity during
thyroidectomy. Turkish journal of anaesthesiology and reanimation, 44(5), 241.
doi: 10.5152/TJAR.2016.77598
Sarkar, M., Madabhavi, I., Niranjan, N., &Dogra, M. (2015).Auscultation of the respiratory
system. Annals of thoracic medicine, 10(3), 158.doi: 10.4103/1817-1737.160831
Zhou, S. L., Zhang, J., Song, T. T., Li, X., & Wang, H. X. (2018). Diagnostic accuracy of
natriuretic peptides for acute heart failure: a review. European review for medical and

7
HEALTHCARE
pharmacological sciences, 22(8), 2415-2420. Retrieved from:
https://www.europeanreview.org/wp/wp-content/uploads/2415-2420.pdf