Assessment And Management Of Congestive Heart Failure In A 76-year-old Female: A Nursing Perspective

Evaluate principles and strategies to conduct an integrated and comprehensive assessment of the client at home and in the community

Apply the principles of evidence-based nursing to devise strategies to promote independence and wellbeing for individuals with chronic illness and/or disability

In your 2000 word essay outline the following (this assessment will need to be submitted via Turnitin):

• Describe the aetiology of CHF and discuss what the likely cause of the condition is in Mrs Carlos
• Your initial nursing care for Mrs Carlos on her admission to your ward, taking into consideration what has and has not been attended already
• What client education you will provide as this is her first admission for this condition, and what recommendations, or lifestyle changes, you would recommend for Mrs Carlos
• Describe the likely progression of Mrs Carlos’s probable condition, and the subsequent treatment options

Aetiology of Congestive Heart Failure

Congestive heart failure is a common chronic condition where the heart is not able to pump an adequate amount of blood. Heart failure is a common disease that is experienced by the majority of the individuals around the globe. The symptoms are including shortness of breathing, tiredness, an increase in urination, higher heart rate, dizziness and coughing (Ponikowski et al., 2016). Heart failure does not generally because by single cause instead it is a combination of other cause. Therefore, it requires proper medical assistance for curing and preventing the risk of the disease. Approximately 50% to 75% of individuals in the population of Australia die from congestive heart failure (Sahle, Owen, Mutowo, Krum & Reid, 2016). Therefore, the mortality rate is quite high in Australia. Recent researches suggested that approximately, 10% of the patient in this congestive heart failure is above the age of 75 years.  In the above scenario, a 76-year-old female admitted to the hospital in the medical ward. She was admitted to the hospital and diagnosed with congestive heart failure. Her medical report shows all the symptoms of developing congestive heart failure. Therefore, this essay will focus on the aetiology of the disease, primary care after admitting to the hospital, the lifestyle of the patient, progression towards illness and treatment of the disease in next paragraphs. The supporting papers are taken from CINAHL out of which 4 journals particularly focused on congestive heart failure and the rest are focused on nursing care. The key words used for this research are including aetiology of congestive heart failure, pathophysiology of congestive heart failure, initial care provided by nurse in congestive heart failure, clinical education provided by the nurses and treatment, exercise provided by nurse.

Congestive heart failure is a chronic disease that affects the blood pumping ability of the of the heart muscle. This phenomenon often referred to as heart failure. Generally observed when fluid around the heart abnormally increased and subsequently heart pump blood abnormally. Left-sided Congestive heart failure is the most predominant one in individuals. It occurs when the left ventricle of the heart unable to pump blood adequately out of the body (What is Heart Failure, 2018). As the situation progresses, fluid started accumulated in the centre, and eventually, the breathing becomes difficult. It is crucial to get checked by medical expertise at least in once in a year. There are few leading causes of Congestive heart failure. The first cause of Congestive heart failure is hypertension where blood pressure of the body becomes higher than normal blood pressure. This hypertension narrows down the arteries of the heart and makes it harder to maintain healthy blood flow in the body. Cholesterol or other fatty acids also acts as predominate cause of block in coronary arteries. The valve of the heart regulates the standard blood flow in the heart of every individual. In a few scenarios, the valve of the heart is not able to work correctly. Subsequently, an improper opening and closing phenomenon of valve give rise to Congestive heart failure ( Ter Maaten et al., 2015). Symptoms that immediately observed are irregular heartbeat, fatigue and excessively rapid breathing; skin appears blue, loss of appetite and sudden weight gain. Individuals might have increased urination and shortness of breath (Tham, Bernardo, Ooi, Weeks &McMullen, 2015). In the above scenario, Mrs Paulinea Carlos is a 76-year female who was admitted to the medical ward via direct admission. After an investigation, it was reported that her respiratory rate was 30, which is abnormal. In standard individual respiratory rate is 12 to 24 per minute, more than 24 consider as strange due to heaviness in heart and lungs.  She did not attend the blood test, but her full oxygen level indicated 97%, which is abnormal for healthy individuals. Her medical report suggested that increased urination at night, which is the first indication of Congestive heart failure. Moreover, her medical report also suggested bilateral oedema of valves. This oedema generally observed when it is difficult for vain to push blood into the heart and this subsequently leads to varicose veins and fluid accumulation in legs. This is a typical scenario for congestive heart disease, lungs, liver and thyroid disease. In the above situation, the Medical report of Mrs Carlos indicates all the causes of Congestive heart failure and need immediate medical assistance.

Initial Nursing Care for Patients

Congestive heart failure is one of the leading causes of a higher rate of morbidity worldwide. The heart is one of the vital organs which is responsible for balanced blood circulation in the body. Any malfunction of processes leads to drastic anatomical changes. If inappropriate blood circulation observed for more extended period then it gives rise to severe heart disease. Therefore, providing sufficient clinical nursing care to the patient with heart disease require sound knowledge about the disease and application of that knowledge for providing appropriate care. Thus, nursing intervention of nursing care in healthcare sectors for patient with heart failure should include priorities such as monitoring of vital signals, modification of diet plan of the patient, accurate administration of medicines prescribed by cardio experts, providing Oxygen therapy, monitoring the improvement because of revised diet, coordination between diagnosis and administration of specific medications (Atherton et al., 2018).As a clinical nurse of cardiovascular disease, primary care should be the identification of signs of congestion and refer the patient for X-ray. Identification of clinical stability of the patient is another critical factor nurses should take in to account. The blood test of the patient should be done and noted in paper or on any computer. The pulse rate of the patients should be monitored whether it is high or not. Peripheral perfusion, heart rate and rhythm of the patient should be monitored. Her blood pressure should be monitored, generally in case Congestive heart failure patient usually have high blood pressure (Vedel &Khanassov, 2015). Her body temperature should be measured since due to abnormal distribution of oxygen metabolism rate of the patient ceases rapidly. Therefore, nurses should encourage bed rest. Creatinine level, glucose level, urea level, full blood count, troponin and natriuretic peptide level should be measured. Nurses should monitor the urination frequency at night, her level of consciousness (Carthon, Lasater, Sloane & Kutney-Lee, 2015). The weight gain observed along with the sudden loss of appetite, in this case, suggestions for nurses is to monitor food habit of the patient along with the habit of smoking and addiction of alcohol consumptions.  After observing all the important vital signs, nurses should address the anxiety of the patient and patient family by promptly answering their query related to the disease. Nurses should be transparent about the signs and symptoms of the patient and the implementation plan of the patient. Nurses should communicate with a multidisciplinary team of the hospital for providing the excellent treatment.

Educating patient is an important part of health care system for managing patient with congestive heart failure. Therefore, the involvement of nurses for educating the patient and their family members is a crucial factor for providing the accurate treatment.  Patients require education for adapting with the symptoms of the disease and coming up with treatment procedure so that they can be more corporative with hospital authority and that education should be effective verbal communication followed by writing information. In the above scenario, Mrs. Carlos is a patient of congestive failure. After her admission in a hospital ward, as a nurse, it should be recommended to communicate effectively with patient family and provide history, symptoms and treatment of congestive heart failure. Nurses should introduce a new concept to the Family members of the patient to make it easier for them to understand the disease (Lewis et al., 2016). As a nurse, I would recommend to a few foods that should be included in the food diet. Fruits and vegetables should be included in the diet of the patient to reduce the risk of heart failure. Family members should ensure that the patient only consumes foods that contain low sodium. Too much consumption of sodium can cause the sudden increase in blood pressure and subsequently, the risk of developing heart disease increases (Mancia et al., 2017). The family should ensure that patient strictly avoid foods containing mayonnaise, pickles, marinades and food containing excess fat.  It should be recommended to monitor the weight of the patient on a daily basis. A slight increase of the weight requires adjustment diet to prevent further risk of the disease. Moderate exercise such as aerobic per week reduces the risk of heart failure and enhances the quality of life. Walking, bicycling and swimming also help to eliminate the risk of heart failure( Mancia et al. , 2017). However, heavy exercises are strictly prohibited. It is also suggested to quit smoking in order to reduce the risk of the congestive heart failure. It is also suggested to avoid the travelling in areas with high altitude and avoid lifting heavy materials, running fast for reducing the risk of heart failure (Sacks et al., 2017). Moreover, it is also recommended to the family members that family members should take into account the psychological state of the patient. Patients might be anxious, might has anger issues because of difficulty in coming up with the disease. Therefore, patience and empathy is the only key to handle patient with heart failure.

Clinical Education for Patients

Congestive heart failure is chronic long-term diseases that get worse with time. it is a condition where the heart is not able to pump blood efficiently, and oxygen deficiency in body observed. Subsequently, it leads to the high blood pressure and other cardiac problems.   Shortness of breathing and the exponential increase of heartbeat, oedema, and lack of oedema leads to the development of congestive heart failure as observed in this case study. In this scenario, the medical report suggested that she had no appetite and gained weight a lot. The report also suggested the shortness of breathing and increased urination. Other symptoms such as coughing and wheezing also observed in the patient in during the time she was admitted to the hospital. Moreover, she had bilateral oedema of calves. All of these symptoms will give rise to the third stage congestive heart failure and require the assistance of medical expertise to handle the situation. With time she might exhibit the symptoms of memory loss and confusion if not prevent immediately. Treatment for stage three congestive heart failure is quite similar to the treatment that provided in stage one and two. Primarily, Angiotensin-converting enzyme inhibitor should be given if the patient has high blood pressure (Yu et al., 2014). Beta blockers are also given to the patient if the patient has high blood pressure because, in the majority of the cases, patients had a dysfunctional left ventricle of the heart. The beta blocker is specifically effective for the elderly patient. Beta blockers such as acebutolol, atenolol, bisoprolol generally prescribed in the hospital (Cadrin-Tourigny et al., 2017). However, the sides effects are also predominate because of usage of beta blocker. Cardiac resynchronisation and implantable defibrillators have shown the evitable result to obtain superior medical therapy. However, it is also suggested for the treatment of a patient with dysfunctional heart failure. Hydralazine and nitrate combinations are used if other treatments don't stop your symptoms (Sliwa et al., 2016). Diuretics also suggested in a few cases if symptoms continue even after treatments ( Pose et al., 2017). The advantage of using these medications is that these medications help to reduce the heartbeat of the patient if the heartbeat is faster than 70 beats per minute.  Here the patient’s ECG report shows that the heart rate is 99 which are abnormal for a normal patient. Therefore, these kinds of treatment help to reduce the risk of developing congestive heart failure and prevent the other possibilities of heart disease.

Conclusion:

Thus it can be concluded that congestive heart failure is a critical condition in individual worsen with the time. The prime reason behind the occurrence of congestive heart failure is an exponential decrease of the blood flow in the heart muscles. However, the first monitoring and family-centric care provided by healthcare practitioner can prevent this critical disease.  As a part of the healthcare practitioner, heart failure specialist nurses has enormous role to support the patient and provide quality care to the patient for curing the disease. Sometimes, nurses from the non-cardio specialist area also provide out reached service throughout the recovery from congestive heart failure for well being of the patient. However, Maintenance of lipid-free diet with regular exercise has an enormous role in enhancing the quality of life. Diverse medicinal drugs are used to cure the patient with congestive heart failure especially the beta blocker. However, these beta blockers have side effects in elder patient with weak heart muscles. Therefore, congestive heart failure can be prevented efficiently by enhancing lifestyle, the cooperation of medical practitioner and certain drugs.

Lifestyle Changes: Diet and Exercise

References:

 Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... & Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the management of heart failure 2018. The Medical Journal of Australia, 209(10), 1.Retrived from:  https://doi.org/ 10.1016/j.hlc.2018.06.1042.

 Bartunek, J., Davison, B., Sherman, W., Povsic, T., Henry, T. D., Gersh, B., ... & Homsy, C. (2016). Congestive Heart Failure Cardiopoietic Regenerative Therapy (CHART?1) trial design. European journal of heart failure, 18(2), 160-168. doi:10.1002/ejhf.434

Cadrin-Tourigny, J., Shohoudi, A., Roy, D., Talajic, M., Tadros, R., Mondésert, B., ... & Guerra, P. G. (2017). Decreased mortality with beta-blockers in patients with heart failure and coexisting atrial fibrillation: an AF-CHF substudy. JACC: Heart Failure, 5(2), 99-106. Retrive from: https://doi.org/10.1016/j.jchf.2016.10.015

 Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of hospital work environments and missed nursing care is linked to heart failure readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, 24(4), 255-263. Retrived from : https://dx.doi.org/10.1136/bmjqs-2014-003346

 Lewis, S. L., Bucher, L., Heitkemper, M. M., Harding, M. M., Kwong, J., & Roberts, D. (2016). Medical-Surgical Nursing-E-Book: Assessment and Management of Clinical Problems, Single Volume. Elsevier Health Sciences. Retrived from : https://books.google.co.in/books?hl=en&lr=&id=f-MCDQAAQBAJ&oi=fnd&pg=PP1&dq=education+provided+by+nurses+in+congestive+heart+failure&ots=KKSBwWFkGN&sig=LmpMpAfAykixPnycswYVPKw3oy8#v=onepage&q=education%20provided%20by%20nurses%20in%20congestive%20heart%20failure&f=false

 Mancia, G., Oparil, S., Whelton, P. K., McKee, M., Dominiczak, A., Luft, F. C., ... & La Torre, G. (2017). The technical report on sodium intake and cardiovascular disease in low-and middle-income countries by the joint working group of the World Heart Federation, the European Society of Hypertension and the European Public Health Association. European heart journal, 38(10), 712-719.doi:10.1093/eurheartj/ehw549

Ponikowski, P., Voors, A. A., Anker, S. D., Bueno, H., Cleland, J. G., Coats, A. J., ... & Jessup, M. (2016). 2016 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC). Developed with the special contribution of the Heart Failure Association (HFA) of the ESC. European journal of heart failure, 18(8), 891-975. Retrieve from: (https://creativecommons.org/licenses/by-nc-nd/4.0/ ) .

 Pose, A., Almenar, L., Gavira, J. J., López?Granados, A., Blasco, T., Delgado, J., ... & Manito, N. (2017). Benefit of tolvaptan in the management of hyponatraemia in patients with diuretic?refractory congestive heart failure: the SEMI?SEC project. ESC heart failure, 4(2), 130-137. DOI: 10.1002/ehf2.12124

 Sacks, F. M., Lichtenstein, A. H., Wu, J. H., Appel, L. J., Creager, M. A., Kris-Etherton, P. M., ... & Stone, N. J. (2017). Dietary fats and cardiovascular disease: a presidential advisory from the American Heart Association. Circulation, 136(3), e1-e23. DOI: 10.1161/CIR.0000000000000510

Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of heart failure in Australia: a systematic review. BMC cardiovascular disorders, 16(1), 32. Doi: 10.1186/s12872-016-0208-4

 Sliwa, K., Damasceno, A., Davison, B. A., Mayosi, B. M., Sani, M. U., Ogah, O., ... & Yonga, G. (2016). Bi treatment with hydralazine/nitrates vs. placebo in Africans admitted with acute HEart Failure (BA?HEF). European journal of heart failure, 18(10), 1248-1258. doi:10.1002/ejhf.581

 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. Retrived from : https://www.rug.nl/research/portal/files/32723592/Chapter_2.pdf

 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. DOI: 10.1007/s00204-015-1477

 Vedel, I., & Khanassov, V. (2015). Transitional care for patients with congestive heart failure: a systematic review and meta-analysis. The Annals of Family Medicine, 13(6), 562-571. Rertrived from: https://www.annfammed.org/content/13/6/562.full.pdf

What is Heart Failure. (2018). Retrieved from https://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/About-Heart-Failure_UCM_002044_Article.jsp#.W3D6Es4zbIV

 Yu, O. H. Y., Filion, K. B., Azoulay, L., Patenaude, V., Majdan, A., & Suissa, S. (2014). Incretin-based drugs and the risk of congestive heart failure. Diabetes Care, DC_141459