Nursing Case Study: Diagnosing Systolic Heart Failure Patient

This case study focuses on a patient, Mrs. Brown, presenting with symptoms of systolic heart failure. The analysis begins with an overview of her medical history, including a previous cardiac complication and age-related factors, leading to her reported dyspnea and low oxygen saturation. The pathophysiology of dyspnea, high blood pressure, and atrial fibrillation are explored, along with the use of external oxygen administration, patient positioning, and vital sign monitoring as immediate interventions. The case then addresses the pharmacological management, specifically the use of Furosemide (Lasix) as a diuretic and Sublingual Glyceryl Trinitrate for vasodilation. The case study incorporates relevant research and guidelines to support the diagnosis and treatment strategies, including the NMBA Professional Code of Conduct, emphasizing the importance of nurses' role in patient care and safety. This case study provides a comprehensive understanding of the assessment, diagnosis, and management of systolic heart failure in an elderly patient.

Running head: SYSTOLIC HEART FAILURE 1
SYSTOLIC HEART FAILURE
Name of Student:
Name of University:
Author’s Note:

SYSTOLIC HEART FAILURE 10
Table of Contents
Concept map....................................................................................................................................3
Answer 1:.........................................................................................................................................4
Answer 2:.........................................................................................................................................6
Answer 3:.........................................................................................................................................7
Reference list...................................................................................................................................9

Running head: SYSTOLIC HEART FAILURE 3
Concept map

SYSTOLIC HEART FAILURE 4
Answer 1:
As per the study conducted by Adams and Urban (2015), cardiac complication emerges
out to be one of the leading reason of death among the older adults. The susceptibility of
observing a cardiac arrest among people above 80 years is equal irrespective of gender. Mrs.
Brown is an older adult with previous history of heart complications 2 years ago. On the basis of
her past medical history and even age, her clinical manifestation can be well understood. Mrs.
Brown reported immense level of dyspnoea that made her lose her sleep. As stated by Kirchhoff
et al. (2016), dyspnoea is often termed as a debilitating symptom characterised by shortness of
breath. The pathophysiology of dyspnoea is often caused due to complicated interplay of central
and peripheral receptors. It would be fair enough to state that breathing is an involuntary process
that often helps CNS to from being subjected to irrelevant and constant sensory impulses.
However, if the level of O2 saturation drops below 95% that CNS exerts conscious effort making
the process of breathing a voluntary action. The voluntary mode of breathing is often carried out
with the help of bi-lateral muscles present in lungs, resulting in shortness of breath (dyspnoea)
(Galbraith et al. 2015). The level of O2 saturation of Mrs. Brown is 85% indication shortness of
breath. Additionally, level of oxygen saturation if falls below 95% the heart exerts more effort
for pumping oxygen rich blood that increases upper blood pressure (systolic). Based on research
study, it can be stated systolic blood pressure is pressure exerted by the arteries during the course
of pumping blood.
Mrs. Brown is diagnosed with high blood pressure (BP) 170/95 mm Hg hinting higher
systolic pressure. Increase in systolic blood pressure is linked with increase in pulse rate in Mrs.
Brown 120 beats/ minute. The fall in level of oxygen coupled with increase in blood pressure
results in negligible aeration during the expiration leading to cleaning up of intricate airways.

SYSTOLIC HEART FAILURE 10
The new airways get filled with fluid leading to formation of bi-basal crackles. Thus, it can be
stated the crackles or wheezes are accidental lung sounds that are super imposed n normal
breathing. The secretions collected are often responsible for blockage of airways, limiting the
transportation of oxygen rich blood (Heartfoundation.org.au, 2018). The systolic blood pressure
is an outcome of chronic systolic heart failure that further leads to increase in cardiac output. The
other reports provide strong evidence of atrial fibrillation leading to abnormal heart beat rhythm.
Thus, it would be fair enough to state that the atrial fibrillation (AF) can be termed as one of the
prime cause behind the clinical manifestation of chronic heart problem (Keteyian et al. 2016)
The valvar defects in human heart can be termed as constant cause of AF. Familial AF
although rare is well described in the present condition. A study conducted by Køber et al.
(2016), stated 10th chromosome is responsible for AF as autosomal dominant trait. The
pathogenesis of AF is often known to commence through ectopic foci present within the
pulmonary veins. The structural cardiac problems are seen to underline various causes related to
AF.
Heart failure is often an outcome of dual compensatory mechanism, RAAS and
Sympathetic nervous system (SNS) (Sahle et al. 2016). The function of RAAS is stimulated in
poor heart function. Activated RAAS is seen to stimulate the kidneys responding with release of
renin producing in angiotensin II. Ponikowski et al. (2016), reported, high level of both
aldosterone and angiotensin II leads to vasoconstriction and high BP. They increase the blood
volume and cardiac output and damages the myocyte, thus resulting in fibrosis and systolic heart
failure. Together, they both increase cardiac output, volume of blood and even damages the
myocyte, leading to systolic heart failure. Hypovolemia is often suspected as a result of renal

SYSTOLIC HEART FAILURE 10
perfusion that can retain high level of sodium through RAAS leading to rise in blood pressure
(Kirchhof e al. 2016)
Answer 2:
Increasing the level of oxygen saturation
At present the level of oxygen is low in case of Mrs. Brown, 85% whereas the normal
level is 95% (Galbraith et al. 2015). Thus, it would be fair enough to state, Mrs. Brown should be
subjected to external oxygen administration, through the use of nasal cannula. The external
oxygen supply can be termed useful as it can work in reducing the level of discomfort faced
during breathing. The pulse rate would normalise as the cardiac muscles would not be subjected
to stress to pump more blood (Jankowska et al. 2016). The administration of oxygen through
cannula can work on reducing the loss of oxygen. In addition to that, the patient should be made
to sit using Fowler position. The mentioned position makes the bed aligned at 45 degrees to a
perpendicular to waist. The prime use of the mentioned position is to increase the surface area of
diaphragm. As pointed out by Keteyian et al. (2016), increase in surface area of diaphragm
providing larger area for the oxygen to be absorbed. As per the NMBA 2018 Professional Code
of Conduct, nurses must work as per the standards that meets the safety requirements of the
patient. The Fowler position increase safety of patient
Keeping a check on the vital signs
Patients with previous history of poor cardiac condition need to get their vital signs
checked. The continuous monitoring of vital sign includes monitoring the rate of pulse,
respiration and even heartbeat. The level of oxygen saturation within the blood and even BP is
monitored. As per Fisher (2017), keeping a check on vital signs happens with a specialized

SYSTOLIC HEART FAILURE 10
device (pulse oximetry). It becomes the duty of nurse to monitor the vital signs as per Nursing
and Midwifery Board of Australia (2018) Professional Code of Conduct. The vital signs can
work on evading errors during the course of medication and even care plan (Fisher, 2017).
Special care must be undertaken for checking the BP and cardiac impulse; change in the signs
must be reported immediately to avoid cardiac complication. The increase in body weight,
coupled with distended abdomen hints towards the accumulation of fluid in lower parts of the
body. Heart attack is often followed by renal malfunction causing retention of fluid. The
symptom of fluid retention is high and evident through the prescription of Lasix
Answer 3:
Furosemide (Lasix)
Lasix acts as strong diuretic often prescribed to treat edema linked with cardiac arrest.
The mentioned drug works by blocking sodium and chloride receptors, limiting their absorption.
The medicine is responsible for increase in excretion of dilute urine. The act of reducing the
water level within the blood often leads to decrease in pressure on arteries and veins to pump
blood that immediately results in reduction of blood pressure. Finally, the right level of
electrolyte balance by reabsorption of sodium and chloride. As per the study conducted by
Hodson et al. (2017), a normal level of electrolyte balance can maintain normal cardiac rhythm
as facilitated by neurotransmitter
Sublingual Glyceryl Trinitrate
The mechanism of the mentioned medication is mediated by relaxing the smooth muscle
cell in the heart causing vasodilation. As pointed out by Farag et al. (2015), vasodilation is
responsible for reducing preload and even the after load. The combined effect works on reducing

SYSTOLIC HEART FAILURE 10
three things, arterial pressure, systolic and even the diastolic blood pressure. The reduction of the
blood pressure is the medical intervention required by Mrs. Brown. Hence, it can be conclusively
stated use of the mentioned medication can help in reducing the blood pressure in case of Mrs.
Brown.

SYSTOLIC HEART FAILURE 10
Reference list
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Farag, M., Mabote, T., Shoaib, A., Zhang, J., Nabhan, A. F., Clark, A. L., & Cleland, J. G.
(2015). Hydralazine and nitrates alone or combined for the management of chronic heart
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Fisher, M. (2017). Professional standards for nursing practice: How do they shape contemporary
rehabilitation nursing practice?. Journal of the Australasian Rehabilitation Nurses
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Galbraith, A., Bullock, S., Manias, E., Hunt, B., & Richards, A. (2015). Fundamentals of
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Heartfoundation.org.au (2018) Improving diagnosis and care for heart failure patients Retrieved
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failure [Retrieved on: 18 Aug. 2019]
Hodson, D., Jackson, K., Chunara, Z., Rao, V., Mahoney, D., Thomas, D., ... & Ahmad, T.
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Keteyian, S. J., Patel, M., Kraus, W. E., Brawner, C. A., McConnell, T. R., Piña, I. L., ... &
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