Case Study Of Congestive Heart Failure

Causes and Incidence of CHF

Discuss about the Case Study Of Congestive Heart Failure.

Causes

There are several causes of Congestive Cardiac Failure (CHF) or simply Heart Failure. These can be categorized as follows;

1. Coronary artery disease/heart attack: It encourages the buildup of plaque (fatty deposits) in the arteries that hinders the flow of blood and pave towards heart failure.
2. Hypertension: Hypertension is generally diagnosed with high blood pressure. It is an exaggeration to mention that if the blood pressure is high, the heart have to perform more and due to that exertion, the muscles might be afflicted with stiffness or fatigue, which can affect the efficiency of blood pumping.
3. Cardiomyopathy: Cardiomyopathy can referred as severe damage of the heart muscle. Excessive alcohol consumption coupled with toxic effect of drugs (Tham et al. 2015). It can be congenital. After going through the current conditioned, the evident impression is the congestive cardiac failure is not caused by that.
4. Myocarditis: In an empirical tone, any kind of inflammation of the heart muscles can be referred as Myocarditis. As the patient has a history of MI, Myocarditis can be a cause of congestive cardiac failure (Ter Maaten et al. 2015).
5. Heart arrhythmias: Arrhythmias can be referred to abnormal heart rhythms that indulge the heart to perform more. In the current case, the heart rate (HR) of the is 54bpm (beats per minute) [which is considerably less than the normal heart rhythms which is 72bpm]. Thus, it is evident that it might be also a potent cause.

Incidence and risk factors

In the current context, the risk factors are strongly dependent on the root causes that might pave the patient towards mortality. The incidences upon which the risk factors are framed can be categorized as

1. CHF affliction rates are higher in Afro-Americans as compared to the non-Hispanic whites
2. It is chiefly a disease in which the older adults are more prone to be afflicted with (6% to 10% who are of greater age than 65)
3. Major cause of the older peoples to be hospitalized

Risk factors are

1. High blood pressure or hypertension
2. Coronary artery diseases
3. Heart attack
4. Diabetes
5. Sleep apnoea

Impact

It has been observed that the patient who has been diagnosed with CHF and the family are prone to become traumatized. In this regard, it can be mentioned that, a little modification of regular lifestyle can cause considerable emancipation of the condition.

The 5 common symptoms of CHF can be categorized as follows;

Palpitations

In cases of CHF, in terms of a common consequence, an abnormal rate of sinus rhythm has been perceived which is due to the inability of the heart to pump blood and circulate it properly (impeded cardiac output) (Nichols et al. 2015). Thus, it is due to the considerable alteration of the cardiac rhythm that causes palpitations of a patient diagnosed with CHF.

Edema or swelling

This phenomenon especially occurs in concert with erratic Starling forces such as a considerable reduction in the plasma oncotic pressure or abrupt increase in venous capillary pressure. This Starling forces directly informs the interruption in blood circulation and subsequently promote fluid extravasations that subsequently informs edema formation (Mentz & O'connor, 2016).

Shortness of breath

It has been observed that this phenomenon has been accompanied with the senses of fatigue, internal strangulation and sterna compression. In the case of CHF (especially later stages), the pulmonary circulation has been hindered due to the left ventricular failure (Mehra et al. 2017). This is the main reason behind the formation of dyspnea accompanied by mild exertion. Furthermore, the patient develop a tendency to form paroxysmal nocturnal dyspnea (better known as orthopnea) (Mehra et al. 2017).

Wheezing (pink, foamy mucus)

The main cause of foamy mucus is late stages of pulmonary edema. However, the fluid in pulmonary edema can be considered as transuded, there are chances to have blood in them. In most of the cases, it has been observed that due to acute lung congestion, there are possibilities of micro-hemorrhages along with the presence of ‘heart failure cells’ (especially macrophages laden with hemosiderin). This is pathophysiological illustration of the mucus being pink and frothy (Kuvhenguhwa, Belgrave, Shah, Bayer & Miller, 2017).   

Impact of CHF on Patient and Family

Mild Nausea/dizziness

In an empirical tone, the dizziness is chiefly caused by impeded blood flow coupled with abnormal heartbeats. Furthermore, postural hypotension or a temporary decline in blood pressure can also be considered as the reason of dizziness.

The 2 common classes of drugs that has been used with the patients of the identified conditions can be empirically categorized as;

Beta Blockers

As one of major consequences of CHF is impeded blood flow with hypertension, this class of drugs has been used to cause a considerable decline in the heart rate and corresponding blood pressure. Apart from that, beta blockers are potent enough to protect the heart from the substances that can cause severe damage of the heart. The excessive use of Beta Blockers can cause several physiological side effects, which, in some cases, might lead towards several lethal consequences. The most controversial aspect is that it might worsen the complications prior to congestive heart failure. Apart from that, it can cause dizziness and fatigue. The popular medicines in this genre, which have been frequently used in the cases of CHF, is a low dose of metoprolol and carvedilol (Heslinga et al. 2015).

ACE is the acronym of Angiotensin Converting Enzyme, which is a very effective measure to combat with the hormones that can cause severe damage to the heart (Harada et al. 2016). Apart from that, it assists in the opening of blood vessels while helping to reduce the blood pressure in order to lessen the workload of the heart. One of the major side effects of using excessive ACE inhibitors is it might increase the potassium level from the critical physiological level. Apar from that, it can cause a significant impact on the functionalities of kidney. The popular ACE inhibitors that have been used in the course of recovering from CHF are captopril and lisinopril (Harada et al. 2016).    

The physiological effects of Beta Blockers can be categorized as;

1. Dizziness
2. Fatigue/Feeling tired
3. The typical symptoms might get worsen

The physiological effects of ACE inhibitors can be categorized as;

1. Increased potassium levels (Mrs McKenzie has been diagnosed with a Potassium level of 2.5mmol/L)
2. Considerable alterations in the kidney functions
3. Mild Nausea
4. Dizziness

In case of admission of a patient with the symptoms of CHF, the nurses have to act prudently in order to ensure the effectiveness of their strategies in terms of prioritization. For instance, the nurses are required to enable the admitted to go through a chronological serious of tests in order to procure the assurance regarding the current disease. In the incipient phase, they are required to send the patient for a test of blood pressure. In this course, the nurses are also required to run their eyes on the medicines on the foundation of which the patient have developed the current condition.

Common Signs and Symptoms of CHF

Afterwards, the nurses are required to enlist the Heart rate of the patient in their accounts while having a sincere look in the Respiratory rate as well. Furthermore, the nurses are also required to scrutinize the ECG report and Chest X-ray in order to identify the chances of Sinus Bradycardia and cardiac enlargement, which, in terms of priority, is considered as a cardinal step towards the diagnosis of the disease properly (Di Biase et al. 2016). In the cases like Mrs McKenzie who has a history of Myocardial Infarction, the report of the Full Blood Count (FBC), Liver Function Tests (LFT) and the examination of Urea-electrolytes and creatinine (UEC) are expected to be prepared (Fisher et al. 2014). In the cases of new admission, the nurses are required to send the patient and the family to have the report of the above-mentioned tests as early as possible.

In concluding the nursing care plan, the requisite steps can be categorized in a systematic fashion, which might look like; (These are only applicable for the patients who have immediate requirements)

This can be presented in a form of Congestive Heart Failure Nursing care plan

The Subjective data are

1. Impediments in terms of breathing
2. Wheezing with a pink frothy mucus
3. Heart pounding and palpatations

The Objective data

1. Edema (especially in legs or ankles)
2. Crackled lung bases
3. Wheezing upon exertion

The rationale of Nursing interventions can be posited as follows;

Monitoring heart rhythm

The nurses are obliged to get a 12 lead ECG in order to resolve the issues associated with peripheral edema.

Restriction of Sodium intake

Fixing the salt limit to 300-600 mg/serve as the patient is in a situation when he/she needs to get rid of the overboard of fluid

Monitor BNP (Normal range will be <100 pg/mL)

BNP is the acronym of Brain Natriuretic Peptide, which the heart is prone to release during its adherence to any stress (Bardy, 2016). The nurses are required to keep it less than 100pg/mL

Administration of diuretics (with a pee plan)

After the preparation of a pee plan, the nurses are obliged to administer diuretics such as Furosemide, Bumetanide, Hydrochlorothiazide and Spironolactone etc

Monitor swelling or edema

The edema can be consistently monitored through bony prominence in order to discern the nature of the edema (whether it is pitting edema or not). This has been popularly measured by judging the indentation of the skin.

References

Bardy, G. (2016). U.S. Patent No. 9,232,900. Washington, DC: U.S. Patent and Trademark Office.

Di Biase, L., Mohanty, P., Mohanty, S., Santangeli, P., Trivedi, C., Lakkireddy, D., ... & Casella, M. (2016). Ablation vs. amiodarone for treatment of persistent atrial fibrillation in patients with congestive heart failure and an implanted device: results from the AATAC multicenter randomized trial. Circulation, CIRCULATIONAHA-115.

Fisher, S. A., Brunskill, S. J., Doree, C., Mathur, A., Taggart, D. P., & Martin-Rendon, E. (2014). Stem cell therapy for chronic ischaemic heart disease and congestive heart failure. Cochrane Database Syst Rev, 4(4).

Harada, M., Hojo, M., Kamiya, K., Kadomatsu, K., Murohara, T., Kodama, I., & Horiba, M. (2016). Exogenous midkine administration prevents cardiac remodeling in pacing-induced congestive heart failure of rabbits. Heart and vessels, 31(1), 96-104.

Heslinga, S. C., Sijl, A. M. V., De Boer, K., Van Halm, V. P., & Nurmohamed, M. T. (2015). Tumor necrosis factor blocking therapy and congestive heart failure in patients with inflammatory rheumatic disorders: a systematic review. Current medicinal chemistry, 22(16), 1892-1902.

Kuvhenguhwa, M. S., Belgrave, K. O., Shah, S. U., Bayer, A. S., & Miller, L. G. (2017). A Case of Early Prosthetic Valve Endocarditis Caused by Staphylococcus warneri in a Patient Presenting With Congestive Heart Failure. Cardiology research, 8(5), 236.

Mehra, P., Mehta, V., Sukhija, R., Sinha, A. K., Gupta, M., Girish, M. P., & Aronow, W. S. (2017). Pulmonary hypertension in left heart disease. Archives of Medical Science, 13(1).

Mentz, R. J., & O'connor, C. M. (2016). Pathophysiology and clinical evaluation of acute heart failure. Nature Reviews Cardiology, 13(1), 28.

Nichols, G. A., Reynolds, K., Kimes, T. M., Rosales, A. G., & Chan, W. W. (2015). Comparison of risk of re-hospitalization, all-cause mortality, and medical care resource utilization in patients with heart failure and preserved versus reduced ejection fraction. American Journal of Cardiology, 116(7), 1088-1092.

Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A. (2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Nature Reviews Cardiology, 12(3), 184.

Tham, Y. K., Bernardo, B. C., Ooi, J. Y., Weeks, K. L., & McMullen, J. R. (2015). Pathophysiology of cardiac hypertrophy and heart failure: signaling pathways and novel therapeutic targets. Archives of toxicology, 89(9), 1401-1438.

Volpe, M., Carnovali, M., & Mastromarino, V. (2016). The natriuretic peptides system in the pathophysiology of heart failure: from molecular basis to treatment. Clinical Science, 130(2), 57-77.