University Case Study: Congestive Heart Failure (DNP-815)

This case study analyzes congestive heart failure (CHF), a prevalent condition among the elderly, examining its causes, symptoms (shortness of breath, irregular heartbeat, chest pain), and management strategies. The study reviews relevant literature, highlighting the increasing prevalence of CHF and the need for effective management. It discusses risk factors like hypertension and coronary artery disease, and proposes solutions based on the self-care deficit theory and cognitive behavioral therapy to improve patient education, reduce hospital admissions, and address inefficiencies in device therapies. The case study emphasizes the importance of patient education on symptom management and lifestyle modifications to mitigate the impact of CHF, advocating for improved patient knowledge and early intervention to enhance outcomes. The study proposes the application of self-care theory by the practitioner in assisting the patient while the cognitive behavior therapy will be used in health education of the patient to develop new approaches to controlling the condition and early response to the signs and symptoms.

Running head: CONGESTIVE HEART FAILURE CASE
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Congestive Heart Failure Case
Student’s Name
University

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Congestive Heart Failure Case
Introduction
Congestive heart failure is one of the common conditions among the aged population in
the US. According to Vigen, Maddox, & Allen (2012) suggest that as the aged population in the
US continues to expand, the development of heart failure risk factors like hypertension and
coronary heart attack also increases as seen in the recent statistics which indicate that 80% of
heart failure patients are 65 years and above. This means that the threat is real which calls for the
need to have proper management processes. This condition is characterized shortness of breath,
irregular heartbeat, chest pain, coughing and sneezing and sometimes even fainting.
Brief literature review.
Congestive heart failure is a syndrome where patients have an abnormality of their
cardiac structure that increases symptoms of heart failure requiring urgent treatment. Despite the
fact that this condition can be managed at home sometimes patients get exposed to triggers that
make it difficult for them to manage the condition thus leading to hospitalization.
Description of the conditions
Congestive heart failure is a condition where the patient experiences abnormality of the
cardiac structure leading to symptoms and signs of heart failure that require urgent treatment.
This is a chronic progressive condition that affects the pumping of blood to the heart muscles
(Díez-Villanueva & Alfonso, 2016). This is commonly referred to heart failure but it happens as
a result of the buildup of fluids around the heart causing the heart to pump inefficiently. This
means that the problem develops when the heart ventricles are unable to pump enough blood to
the body which becomes life-threatening. This means that left-sided heart failure is the common
types which occur in two conditions: systolic heart failure and diastolic failure. In the former, the

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left ventricle fails to contract normally reducing the available fore for pushing blood into
circulation. This means that the condition makes the heart fail to pump properly. On the other
hand, the latter happens when the left ventricle muscles become making it difficult for the heart
to relax thus making it difficult for filling of blood for circulation. Not all the conditions that lead
to heart failure can be reversed but rather treatments are used to improve the signs and symptoms
of heart failure making one live longer. This means that the condition is more of managing rather
than treatments since it requires stabilizing medications and lifestyle changes like exercise, diet,
losing weight and managing stress.
There are several causes or factors that can lead to congestive heart failure: hypertension,
coronary artery disease, valve conditions, and faulty heart valves. Hypertension happens when
the blood pressure is higher than normal due to narrowed arteries making it harder for blood to
flow through them. Coronary artery disease is caused by cholesterol or any other fatty substances
that block the coronary arteries making them narrows thus difficult to supply enough blood to the
heart. Valve conditions regulate blood flow through opening and closing to let blood in and out
of the chambers. The means that when they fail to open and close correctly the ventricles have to
work harder to achieve the necessary blood flow. Lastly, faulty heart valves make it difficult for
the heart to pump enough blood thus leading to difficulties in the flow of blood. This means that
congestive heart failure is a condition that relates to working of the heart where there are changes
in the working of the heart which affects blood flow. This means that the condition cannot be
treated but rather requires management to keep the required blood flow and circulation in the
body.
Discussion and synthesized literature findings

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According to Diez-Villanueva & Alfonso (2016), heart failure is a public problem with
80% of the patients suffering from the condition being the elderly. This means that the number of
patients with the condition keeps on increasing as the older population keeps in increasing with
time. As the majority of American hit the 65 age bracket, the challenge of heart failure becomes
eminent and a threat to the national healthcare costs. This means that there is a need to
understand the condition and the factors that lead to the condition.
Different studies have been carried out to identify trends in congestive heart failure
among the aged. In one Vigen, Maddox, & Allen (2012) reviewed the epidemiology of heart
failure among the aged population to understand the phenotype, management complications and
the implication of these challenges to the country. The study analyzed the impact of heart failure
from pharmacotherapies, device-initiated therapies, comorbidities, and fratility. All these factors
are related to the response towards the treatment of congestive heart failure thus calling for the
need to develop shared decision making and new approaches to therapies. This is because the
fatalities related to heart failure are still increasing despite the availability of mechanisms to curb
the condition. Further, some researchers have questioned the validity of the randomized control
trials and the nature of data that is used on them. This means that since the nature of the patients
keeps on increasing and changing then there is need to understand the changes in the population
and how they affect the way patients respond to therapies.
In another study, Komanduri, Jadhao, Guduru, Cheriyath, & Wert (2017) did a multistage
probability sampling design with the CDC revealed that the primary factors for the advent of
congestive heart failure are hypertension, diabetes mellitus, and obesity. Thus this study revealed
that the risks of congestive heart failure still remain the same despite the fact that there is
improved population awareness and advancement in both diagnostic and therapeutic processes.

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This means that there is a need to tackle the risk factors associated with the condition to have
fewer cases in the future. Practitioners and researchers need to understand the risk factors
associated with the condition and how to deal with the problem of patient education on
management of the condition and lifestyle issues that contribute to the condition. this points out
the inefficiencies in the application of self-care theory where patients are not able to mitigate the
challenges that they face since they have other factors that affect them.
From the three articles, four issues are seen from condition: the need for patient education
on management of symptoms to reduce admission; focus on lifestyle issues of the younger
generation to prevent cases of aged heart failure; the need to address the relevance of device
therapies and the need for new therapies to treat the adult population. These four issues related to
the gaps that have been identified and thus remedies will be proposed on how the challenges can
be solved. This calls for the application of the self-care theory and cognitive behavior therapy.
The self-care deficit theory focusses on improving the quality of nursing through working
towards the goal of improving the quality of patient care (Riegel, Carlson, Moser & Roland
2014). On the other hand, the cognitive behavior theory focusses on changing the way the patient
thinks, feels and behaves in different situations that they engage in and interact with when out of
the facility. Thus the former will focus on improved outcomes in the facility and the latter will
focus on improved behavioral outcomes which will lead to reduced hospital admission and risks
associated with the problem.
Summary of the case
Congestive heart failure occurs when the heart fails to pump blood as usual due to certain
conditions like narrowed arteries, high blood pressure and sometimes a weakened heart. The
symptoms of the condition include shortness of breath occurs due to the fall in levels of oxygen

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in the blood, the difficulty of lungs expanding and sometimes increased carbon dioxide in the
blood. This means that the patient feels sensation or difficulty breathing which can be frightening
and distressing to the patient. This problem sometimes occurs in conjunction with chest pain,
cough, and fever which is due to the heart problem and reduced circulation. In most cases, this is
related to the failure of the heart to pump enough blood to supply enough oxygen to the body
which will lead to the pooling of fluids in the lungs thus limiting gas exchange in the lungs thus
leading to the shortness of breath. Other signs include fatigue, swelling, irregular heartbeat, chest
pain, and sometimes persistent cough or wheezing with white or pink blood-tinged phlegm. In
most cases, patients with this problem live on medication which they take regularly and can be
managed at home. This means that the patient only needs to see the practitioner if the signs and
symptoms of the disease become worse. This is through increased chest pain, severe weakness,
an irregular heartbeat that is accompanied with shortness of breath, chest pain or fainting. In
some cases, some patients show sudden shortness of breath and coughing up pink or foamy
mucus. This means that the patient needs to see the practitioner to understand the challenges that
the patient may be facing and other risk factors like heart attack which may be more fatal. This
means that the patient should diagnose the condition but rather needs to seek medication
attention when the above signs start manifesting themselves. Thus to address the problem the
self-care deficit theory will be applied by the practitioner in assisting the patient while the
cognitive behavior therapy will be used in health education of the patient to develop new
approaches to controlling the condition and early response to the signs and symptoms.
Proposed solutions to remedy gaps, inefficiencies, or other issues from a theoretical
approach

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One way to address the inefficiencies and gaps in the management and treatment of
congestive heart failure is the need for patient education on management of symptoms to reduce
admission. , patient education is important is exploring the social situation/career burden causes
of the problem. This calls for health education that focusses on avoiding the triggers of the
condition, complications, and hospitalization (Leong, Rasnah, & Chong, 2017). Proper patient
and family education are important in ensuring that the quality of life and non-pharmacological
management applied by the patient to reduce cardiac failure. Attaallah, Klymko, & Hopp (2016)
proposes the use of self-care theory to empower the patients with skills that can assist them to
address the challenges related to the condition at home and reduce hospital admissions. This
should focus on increased knowledge and skills, increased attitudes and behaviors and overall
knowledge which will lead to improved health. RunDell & Todd (2010) suggests that through
the principles of cognitive behavior therapy like active pacing, goal setting, problem-solving,
cognitive restructuring and maintenance strategies, the patient can be taught how to react to
congestive heart failure signs and symptoms through following a behavioral step by step guide
that will lead to the recovery thus avoiding the need for hospital admission. This leads to the
need to improve patient knowledge thus the ability to respond to early signs of the condition to
avoid hospitalization and even severe outcomes of the condition. This means that after
admission, patient education needs to be adequately administered to the patient. however, the
fact that admission incidents are still high calls for the need to focus on understanding patient-
centered education as a way of ensuring that patients stay off triggers and can easily identify
early signs and mitigate the condition before it escalates and requires the need for admission.
Another issue that has been identified is the need to address the relevance of device
therapies that are used on these patients. Munir, Bogaeve, SobashGondi & Ahmed (2008)

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suggest that there are still challenges in the use of device therapies like implantable cardioverter-
defibrillators (ICDs) which are designed to assist in regulating the heartbeat thus controlling the
fatality of the congestive heart failure. There also need to focus on improving clinical practice
skills like monitoring and diagnostic to improve the outcomes of the device therapy. This means
that the focus of the practitioner should be on understanding how the device functions and
putting proper measures in place to address the challenges. Despite the fact that the devices have
been helpful, research in these areas is minimal to carry out randomized control trials that can
seek to understand the impact and effect of such therapies. For example, the fact that heart failure
is not a disease but rather a condition, thus the reason why different devices have been used like
the pacemaker, implantable cardioverter defibrillators, cardiac resynchronization therapy, and the
left ventricle assist devices have been used to improve and control the irregular heartbeat and
functioning that can lead to congestive. This means that there is a need to understand how these
devices function and the impact that they have on treating the condition. This also calls for the
need to address cost-related factors to make the devices accessible to everyone since they are too
expensive for everyone to afford. Further, Griffin (2019) argues that the devices need to be
researched more so that breakthroughs can be achieved especially for the development of devices
that can be used to physically restrain the heart from enlarging thus curbing heart failure and
leaking heart valves.
Another gap that has been identified is the growing number of heart failure patients in old
age and the need to focus on lifestyle issues to the younger generation to reduce the cases aged
heart failure. Rajat, Mostafave, Sharifirad, Sadeghi, Tavakol & Pashaei (2013) propose the use of
cognitive behavior therapy in heart rehabilitation and training of the younger generation to lead a
better lifestyle that can avoid the development of the problem. Since the majority of the aged

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people have been reported to have this problem, then there is a need to research and find out the
factors for heart failure and develop preventive strategies towards the problem. This calls for
research on the topic to develop remedies that can be applied by the younger generation to avoid
the cases of heart failure in elderly age. This means that cognitive behavior approaches can be
applied to the younger generation to develop better lifestyle issues that will lead to improved
health outcomes in old age. This means that the focus should be on lifestyle issues that relate to
heart failure and how such issues can be identified and addressed.
Lastly, Vigen, Maddox, & Allen (2012) calls for new therapies to treat older patients due
to the increased proportion of patients left-ventricular failure. Since a study by Bhuiyan &
Maurer, (2011) showed that the use of beta blockers, ARBs and ACEI have not shown any
mortality benefits or improvements to these patients since the rates of hospitalization are still
high which means that there is the need for additional research to improve the quality of life of
sich patients. Most patients who are admitted with this condition report proper use of the
prescribed medications but the congestion does not stop thus the reason they always seek
medical assistance. Further, with the increased number of patientss admitted in facilities, it may
be challenging to determine if the results of clinical trials that have been carried are effective or
they fail to cover the specific number of patients due to increased cases of admitted patients.
Identification of a research instrument to evaluate the proposed solution along with a
description of how the instrument could be evaluated
The best way to evaluate the proposed solutions is the use of a tool for evaluating
research implementation challenges (TECH) which is normally developed through the process of
interaction between team members who are engaged in the study that is developed through the
use of purposive scientific studies (Simpson, Porter, McConnell, Daily & Anderson, 2013). Thus

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the researcher is the one who will develop the tool for the research by using the TECH approach
as a way of developing the measures for the study.
Conclusion
Congestive heart failure is a common problem among the elderly in many developed
countries. As the aged population continues to increase, the risks of people with the condition
and the associated costs tend to become a problem for many governments. This calls for the need
to ensure that proper mechanisms are put in place to empower patients with education that can
enable them manage the condition while at the same time there is need to carry out adequate
research to understand the viability of the available treatment options. Lastly, there is need to
focus on the younger generation through cognitive behaviour approaches that seek to reduce the
risk factors associated with heart failure as a way of ensuring that the burden is reduced.

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References
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Failure. Gerontology Geriatric Medicine, 3(4).
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Díez-Villanueva, P., & Alfonso, F. (2016). (2016). Heart failure in the elderly. Revista Latino-
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Griffin, M. (2019). Heart-Failure Treatment by Device. Retrieved from WebMD:
https://www.webmd.com/heart-disease/heart-failure/features/heart-failure-treatment-by-
device#1
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