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Causes and symptoms of congestive cardiac failure

Question:

Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family.

Congestive cardiac failure occurs when the muscles of the heart are not able to pump sufficient blood as required. It is a chronic condition where the arteries of the heart are narrowed or the gradually high blood pressure results in weakening of the heart or become stiff and is not able to pump or fill efficiently (Ohuchi & Diller, 2014).  Mrs. Sharon McKenzie was suffering from hypertension that is of high risk which is also one of the condition which can cause the congestive cardiac failure (Ohuchi & Diller, 2014).  Beside this, the coronary arteries contraction is also one of the causes of congestive cardiac failure in the case of Mrs. Sharon McKenzie. Mrs. Sharon McKenzie was a 77 year old woman and was already taking the dose of 250mcg digoxin which was prescribed when she suffered from Myocardial infarction (MI) around 12 years before which was as a result of the heart muscle damage (Ohuchi & Diller, 2014). Such a heavy dose of the digoxin results in the higher level of the digitalis in the body. The human body receives the remedial effect sonner it accumlates around 8 to 12 mcg/kg with least risk of toxicity amongst patients having the threat of breathing rhythm, heart failure or normal sinus. In the case of Myocardial infarction (MI) patients are advised with the diuretics which results in removing the extra fluid form the body and results in the loss of potassium among the patients and increase the risk of the congestive cardiac failure. The low level of potassium that is 2.5mmol/l was observed in Mrs. Sharon McKenzie’s which can also be one of the causes of congestive cardiac failure in the case (Packer, 2018).

In the case of Mrs. Sharon McKenzie, congestive cardiac faliure is incident while selling in the feets and ankles also shortness in the breath was observed which are certain symptoms that are related to the congestive cardiac failure.

In the elderly age, there is turn down in the renal functioning and hence this results decrease in the volume of distributing blood. In the case, stage 2 hypertension was experienced which is the major risk factor as in the case the heart has to work harder (Packer, 2018).  The medications which Mrs. Sharon has also one of the major causes that increases the risk of the congestive cardiac failure. The inability of breathing in a proper way results in low levels of the oxygen in the blood with an increased risk of the irregular heart rhythms (Packer, 2018). 

Treatment options for congestive cardiac failure

Congestive cardiac failure is a condition that is life threatening and rigorously impacts the patient and the families. Many times the individual suffers from the cardiac failure lack the social support; increased social support increases the healing rate (Núñez, Núñez, Miñana, Bayés-Genis & Sanchis, 2016).  

The common signs and symptoms related to the congestive cardiac failure along with the pathophysiology are discussed below:

Signs and symptoms

pathophysiology

Congestive cardiac failure results in certain neurologic symptoms and signs such as the visual disturbances, disorientation, and confusion (Klapholz, 2003). In certain instances the bright spots are seen, having the blurry vision of experiencing blind spots.

In certain cases, the symptoms of more or less urination are observed as compared to normal with swelling in certain body parts (Klapholz, 2003).

Physiologies related to the neurological symptoms are very complex and identifying them at most of the time is incomplete them are mostly incomplete. From the perspective of evolutionary, it is easy to judge (Klapholz, 2003).

Severe ventricular arrhythmias:

Dizziness, light-headedness, fluttering, pounding, chest discomfort, quivering, fast heart beats with pain and breath shortness, is normally reported among the patients (Shavelle, 2016).  

Pathophysiology of the said symptoms is covered by two fundamental mechanisms.

Arrhythmogenesis is one of the common mechanism which results re entry (Shavelle, 2016).

This results in changes in the state of mind and mood too (Shavelle, 2016).

Activated action happens after depolarization and tardy following depolarization commence numerous depolarization, impulsive ventricular arrhythmias (Shavelle, 2016) 

Hyperkalemia

The elevated pace of potassium in blood influence the heart functioning. Hyperkalemia sign include

heart rate being slow

heart rhythm being Abnormal

Weakness (Shavelle, 2016)

Hyperkalemia consequence rise of potassium level in the body and  resulting in an imbalance of emission vs intake or misdistribution among the intra and extra cellular space (Shavelle, 2016)

Sinus Node Dysfunction:

comprises syncope, weakness, palpitations, effort intolerance and analysis through ECG

requirement of Pacemaker for the Symptomatic patients (McDonald, Conlon & Ledwidge, 2007)

SND grounds irregularity among the structure of Sinus node impulse and dissemination so as to causes malformation among the atrium and also among the conduction system of the heart (McDonald, Conlon & Ledwidge, 2007).

The two classes of the drug that is to be used while treating the elderly patients suffering from the congestive heart failure are discussed below:

The first class of the drug class that is meant to be helpful while treating the congestive cardiac failure patients is the (ACE) angiotensin-converting enzyme inhibitors that broaden the blood vessels and additional decreases the work load of the heart. ACE drug resutts in reducing the angiotensin II production and applies the biologic consequence so as to improve symptoms, slash hospitalizations, and extend survival (Jeon, Kraus, Jowsey & Glasgow, 2010).

The ACE inhibitors acquire the enhanced outcome between the patients with systolic dysfunction, quite a few patients with hypertension practice congestive heart collapse as a consequence of the diastolic dysfunction which is connected to the left ventricular hypertrophy. The ACE inhibitors end result in diverting or reversing the left ventricular hypertrophy between the patients who all are suffering from hypertension (Jeon, Kraus, Jowsey & Glasgow, 2010).  The meta-analysis consequence of assured antihypertensive agent recommends that ACE inhibitors be the mainly effectual agent in reducing the left ventricular hypertrophy. The erstwhile class of the medicine that is to be recommended is the Beta-blockers that reduces the heart tempo and block the needless blockage which is there in the heart. This classification of the medicine is also helpful in the heart syndromeplus it is mostly taken into use with the ACE inhibitors for providing an extra advantage. Beta blockers might also for the time being aggravate indicators but it on the other hand also in the long-term marks a development in the implementation of the heart (Jeon, Kraus, Jowsey & Glasgow, 2010).

The Beta blocker set of drugs are helpful to the purpose of the worsening LV plus it also requires preventing and the reversing progressive LV chamber, dilation, hypertrophy, and sphericity. The drug Beta stops and also reduces the rate of the heart beat and the anxiety between the LV walls (Walthall, Jenkinson & Boulton, 2017). The current research in the labs also proves that the beta blockers please the cardiomyocyte apoptosis refer the heart breakdowns. Discussed are the essential profits and beneficial for a beta blocker for the refer the patients at any of the advanced stages (Walthall, Jenkinson & Boulton, 2017).

Role of ACE inhibitors and beta-blockers in patient management

Mrs. Sharon was an aged patient aged 77 years; she wants a due concern and soft dealing. She is moreover having the precedent record of the MI that is also to be kept in mind as suggesting her medication and cure related to the congestive cardiac collapse (Seah, Tan & Wang, 2015). In case of the congestive cardiac stoppage will have a habitual monitoring of the continuous renal working with this the edema and the auscultator of the lungs (Seah, Tan & Wang, 2015). The main aim of the cure is declining of the level of the cardiac collapse plus comforting the instant remedial help while confronting the inhalation shortness that includes the wide-ranging accommodating care; discontinue of the digoxin and averting of extra exposure; organization of the definite antibody fragments like digoxin immune Fab; treatment of the specific complications like dysrhythmias and electrolyte abnormalities (Tsujii, 2013).

Supportive care

The compassionate care comprises to connect patients to the cardiac test, providing IV fluid to the tolerant with volume reduction or hypotension, supplemental oxygen, or the repletion of the electrolytes in the middle of the patients having the electrolyte abnormalities (Mittal, Katta & Alpert, 2016).

In case of Mrs. Sharon McKenzie, the hyperkalemia is rectified or corrected with glucose/ insulin in the case calculated as life-threatening, like the consequence of risk constructing hypokalemia, as the level of potassium in Mrs. Sharon McKenzie case is low down i.e. 2.5 mmol/l . In a learning, it is clear that the insulin acts mutually straight with Na(+)/K(+)(Bergamini, Cicoira, Rossi & Vassanelli, 2009) ATPase energy and adapt the consequence of digoxin (Bergamini, Cicoira, Rossi & Vassanelli, 2009). This chains the conclusion that patients suffering from the problem of diabetes, insulin prove to contain the cardio defensive effects subsequent to digoxin intoxication (Bergamini, Cicoira, Rossi & Vassanelli, 2009) .Calcium is not functional for treating the hyperkalemia tolerant with understood digoxin toxicity plus may encourage the cardiac catch (Betihavas et al., 2011).

Bradycardia management

Mrs. Sharon McKenzie’s ECG description reveals sinus bradycardia, that’s to be treated all the way through atropine. Atropine is advisable after each 3 to 5 minutes till there is an answer or utmost dose 3mg is achieved or reached (Betihavas et al., 2011).

Hemodynamic compromise management

Refer case of Mrs. Sharon McKenzie, it is shown that the hemodynamic deficiency or the hypotension, distorted consciousness symbols, dizziness, digoxin resistant Fab is provided as the most important administration (Ohuchi & Diller, 2014).

The monitoring of the patient along with the alteration in medication is also considered as one among the main nursing strategies on the occasion of congestive cardiac collapse (Otsu & Moriyama, 2010). If at all possible, digoxin is to be stopped and an untouched medicine for proper command of rate or the unlike inotrope is to be approved for arterial tremble or respectively

References

Bergamini, C., Cicoira, M., Rossi, A., & Vassanelli, C. (2009). Oxidative stress and hyperuricaemia: pathophysiology, clinical relevance, and therapeutic implications in chronic heart failure. European Journal Of Heart Failure, 11(5), 444-452.

Betihavas, V., Newton, P., Du, H., Macdonald, P., Frost, S., Stewart, S., & Davidson, P. (2011). Australia's health care reform agenda: Implications for the nurses’ role in chronic heart failure management. Australian Critical Care, 24(3), 189-197.

Jeon, Y., Kraus, S., Jowsey, T., & Glasgow, N. (2010). The experience of living with chronic heart failure: a narrative review of qualitative studies. BMC Health Services Research, 10(1).

Klapholz, M. (2003). Heart Failure in the Elderly. Heart Disease, 5(4), 241-243.

McDonald, K., Conlon, C., & Ledwidge, M. (2007). Disease management programs for heart failure: Not just for the ‘sick’ heart failure population. European Journal Of Heart Failure, 9(2), 113-117.

MITTAL, M., KATTA, N., & ALPERT, M. (2016). Role of isolated ultrafiltration in the management of chronic refractory and acute decompensated heart failure. Hemodialysis International, 20, S30-S39.

Núñez, J., Núñez, E., Miñana, G., Bayés-Genis, A., & Sanchis, J. (2016). Worsening Renal Function in Acute Decompensated Heart Failure. JACC: Heart Failure, 4(3), 232-233.

Ohuchi, H., & Diller, G. (2014). Biomarkers in Adult Congenital Heart Disease Heart Failure. Heart Failure Clinics, 10(1), 43-56.

OTSU, H., & MORIYAMA, M. (2010). Effectiveness of an educational self-management program for outpatients with chronic heart failure. Japan Journal Of Nursing Science, 8(2), 140-152.

Packer, M. (2018). Acute Heart Failure Is an Event Rather Than a Disease. JACC: Heart Failure, 6(1), 73-75.

Seah, A., Tan, K., & Wang, W. (2015). A Narrative Literature Review of the Experiences of Patients Living With Heart Failure. Holistic Nursing Practice, 29(5), 280-302.

Shavelle, D. (2016). Coronary Artery Disease. Heart Failure Clinics, 12(1), i.

Tsujii, Y. (2013). Management of the Patients with Chronic Heart Failure; the Role for Nurses and Team Management. Journal Of Cardiac Failure, 19(10), S112.

Walthall, H., Jenkinson, C., & Boulton, M. (2017). Living with breathlessness in chronic heart failure: a qualitative study. Journal Of Clinical Nursing, 26(13-14), 2036-2044.

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