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Mr Paul Carson is a 76 year old Polish Male, with poor English language skills, who has just been admitted to your medical ward as a direct admission via GP (no admission to ED). He has been admitted for investigation, following provisional diagnosis of congestive heart failure by the GP.

He has no previous admissions for this condition. Paul has no known allergies.

You are the primary Registered Nurse providing care for Mr Carson.


Social History:

Medical Findings


Coronary Heart Disease  


GP didn’t have an ECHO machine  

Coversyl 2.5mg Daily


One son – lives in Melbourne, sees Mr Cason x 3 times per year. Was due to visit this week but had to cancel due to work commitments

CXR – not attended. Direct admission

Colecalciferol 800 IU daily


Currently living in own home utilising community nursing services x 2 times per week. Assistance with washing and dressings to leg ulcer

Blood tests – not attended. Direct admission

Fosamax 70mg weekly

L total hip replacement 1997

Strong ties to the local Polish community who check on Carson daily. Coach of local soccer club

RR – 30 – laboured breathing. Has been getting worse last month

Panadol Osteo 1330mg TDS

Gall stones 2005

2 glasses of red wine per day

HR – 99 – no ECG attended as yet

Long term ulcer on L lower leg

Minimal exercise due to shortness of breath on exertion. Coaching from the sidelines now 

SpO2 – 97%

Ex-smoker. 1 packs per day x 50 years

States he has no appetite. Some slight weight gain

BP – not attended

Noted bilateral oedema of calves

Cough and wheeze

Short of breath

Use of accessory muscles

Increasing need to urinate at night

Has not yet been seen by an admitting physician

Outline the following:

Describe the aetiology of CHF and discuss what the likely cause of the condition is in Mr Carson

Your initial nursing care for Mr Carson on his admission to your ward, taking into consideration what has and has not been attended already

What client education you will provide as this is his first admission for this condition and what recommendations or lifestyle changes you would recommend for Mr Carson

Describe the likely progression of Mr Carson’s probable condition and the subsequent treatment options

Aetiology of CHF and Likely Cause in Mr. Carson

Nursing professionals have a significant role in managing patient’s condition, while ensuring holistic care for the patients. It is the nursing care, which determines patient’s satisfaction. In this context, nurses are also liable for correct diagnosis of the patient’s needs and current condition, based on which the assessment is done and the health care plan is made. Registered nurse plays a significant role in the multidisciplinary care team, while communicating with the patients, family as well as physicians. They are liable for educating the patients and family in order to ensure patient’s adherence with the treatment procedures, while giving significant value to the patient’s opinion. In this essay, the key focus is the 76 years old patient, Mr. Carson, who has been provisionally diagnosed to have an episode of congestive heart failure, by his GP; and got his admission in the medical ward for further investigation and treatment procedure. The essay will include the initial care by the RN, the etiology of his condition as well as recommendation for his life style management and treatment options.

There are several reasons or etiology for congestive heart failure. For instance, heart failure is caused by the conditions damaging the heart muscle, which especially includes coronary artery disease. Coronary artery disease (CAD) is a disease of the arteries, which carry blood and oxygen to the heart chambers, which ultimately causes reduced blood flow to the heart muscle. Blockage in arteries, due to lack of oxygen and nutrients, the heart muscles are damaged, causing heart failure. Another reason is heart attack, which is caused by sudden blockage and stop of flow of blood towards the heart muscle. Rapid blockage results in a scarred area, blocks proper working function of heart, leading to the damage to heart muscle (Hosenpud & Greenberg, 2007). On the other hand, cardiomyopathy is a condition, when damage to heart muscle occurs from the causes other than the reduced blood flow or arterial damage; for instance, alcohol or drug abuse or due to some infections. On the other hand, besides these systematic procedures, chronic conditions like high blood pressure, valve disease, kidney disease, thyroid disease, diabetes or other congenital heart defects during birth also can cause damage to heart muscle, causing the heart failure.

In case of Mr. Carson, there are several reasons for CHF incidence. It has been revealed that he already had the past medical history of coronary heart disease, which is a significant cause of congenital heart failure. On the other hand, he also has other risk factors for developing CHF, like hypertension and the habit of regular smoking. From his health history, it has been revealed that he is an ex-smoker with the habit of consuming 1 packet of cigarette per day, since last 50 years. In addition, he has been isolated, as he lives alone. Thus, it can be interpreted that in case of Mr. Carson, the combined risk factors including coronary heart disease, hypertension and smoking habit are the key causes of his congested heart failure.

Initial Nursing Care for Mr. Carson

Initially, upon Mr. Carson’s admission, the first priority of the nurse is to assess him thoroughly, addressing his current condition, needs and complications, he is experiencing at the time of admission. Prior to that, the nurse would have to build a relationship with Mr. Carson, in order to help him in coping with the hospital environment (Whang, 2013). It has been revealed from the case study that none of the initial assessments of his vital signs have been performed by his GP, due to the lack of instruments, at his clinic.

Therefore, based on Mr. Carson’s current condition, previous health history it is important to undergo vital signs assessments, like BP, BGL and blood tests required for identifying and confirming the incidence of CHF. On the other hand, coronary angiogram, CT scan, the echocardiogram and CXR should be attended immediately (Hall, Levant & DeFrances, 2012). These tests are important for determining the key damages in Mr. Carson’s heart muscle. However, the symptoms are showing the congestion in heart, as he has been getting worse last month and the heart rate was 99, although no ECG was attended. Due to congestion, cough and wheeze shortness of breath, increased urination at night and use of accessory muscles have been reported. Thus, the nurse would need to check his previous medication chart also, to understand whether his previous health issues were under control or not. Based on the assessment, his medication chart needs to be planned. However, based on the condition, his life style changes are also needed.

It has been reveled from the case study that Mr. Carson is right now on the medications for controlling her blood pressure, hypertension and osteoporosis. In addition, he is taking assistance from the community nursing for washing and dressing his leg ulcer. Therefore, the nurse also needs to assess and provide care to his leg ulcer related issues. Although his oxygen saturation is signifying that he does not require oxygen immediately, but the nurse would monitor the oxygen saturation with others vital signs very frequently and would provide oxygen mask, if severe breathing shortness is observed, with the consent of the physician (Clarke, Shah & Sharma, 2011).

Based on the initial assessment, it has been revealed that Mr. Carson has a history of smoking; he also consumes two glass of red wine regularly. However, consuming two glasses of red wine is not unhealthy for a person, experiencing a heart failure. It is because, evidences are supporting the facts that red wine is actually helping the people with cardiovascular issues, to keep heart healthy, by enhancing the amount of HDL; it prevents clots from developing inside the arteries, red wine also helps to relax them and reduce stress. Red wine also consists of antioxidant property, which reduces the risk of secondary heart muscle damage after heart attack or heart failure (McMurray et al., 2012). Thus, through health promotion or client education, the nurse would help Mr. Carson to understand the pros and cons of consuming red wine daily, while avoiding other kinds of alcohol drinks, which may enhance the risk of secondary heart muscle damage related complications.

Client Education and Recommendations

On the other hand, it has been revealed from the case study that due to shortness of breathing, his exercise is minimal. However, he has gain a slight weight, for which weight management is needed. Weight gain may further damage the heart muscle. Thus, Mr. Carson would be advised to undergo relaxation techniques as well as aerobic exercise. Considering his breathing shortness, a physiotherapist would he consulted, who would make a physical exercise schedule for Mr. Carson, addressing his current needs (Yancy et al., 2013). In addition, to cope with his social isolation, loneliness and stress, relaxation techniques and meditation would be helpful. In addition, Mr. Carson’s necessity for a healthy diet would also be conveyed to him.

A dietician would make a healthy diet chart for the patient, including foods with low saturated fats, trans fat, cholesterol and sodium, as these elements in food would enhance the risk of clot formation in blood arteries, thereby enhancing the chance of becoming physical activity. In addition, as he has leg ulcer, which may hinder his mobility issues, he may use walking assistance, like cane or walker. He would be informed regarding the need for adequate rest and sleep. Although Mr. Carson was an ex-smoker, secondary smoking is also risky for his condition (Bui, Horwich & Fonarow, 2011). Thus, he need to ensure that the environment, he is living, is smoking free. Regular checkups for vital signs are important, especially monitoring his BGL and BP is required, along with other blood tests, like cholesterol and lipid profiles. It is because, uncontrolled blood pressure or BGL or cholesterol may lead to second attack.

Here, it is important to discuss the possible progression of the condition. Mr. Carson has experienced a serious, chronic cardiac condition, which tends to get worse gradually over time; if not controlled adequately, it may shorten the life of the patient also. In case of Mr. Carson, if proper along with medication management, it is possible that the symptoms remain stable for months or years. However, if the instructions are not maintained properly, rapid progress of the disease would further damage the heart muscle, causing the second heart attack. These kinds of progression further decreases the flow of oxygen to the heart muscle, which can be fatal in further attacks (Eckel et al., 2013). High blood pressure, high cholesterol or blood glucose level can enhance the risk of clot formation in blood vessels, which further reduces the blood flow through the heart chamber, causing the heart attack or stroke related disorders. However, with proper medical and life style management procedure, the progression of the condition can be slowed down, in case of Mr. Carson.  

Immediately after the admission of Mr. Carson, an echocardiogram and blood tests should be performed, to identify the activity of the heart, the area that has been affected as well as whether fluid buildup has been occurred. Based on the findings, the specific treatment options would be required. There are several treatment options for the health failure patients. For Mr. Carson, the following treatment options are provided.

Likely Progression and Treatment Options

Medications: There are several groups of medications administered to heart failure patients, in order to improve the function of heart. Medications for controlling blood pressure and the formation of blood clot in the vessels, as well as the medications for improving the heart functioning would be administered. ACE inhibitors, beta-blockers, diuretics and blood thinners would be administered to meet the above mentioned health needs of Mr. Carson. However, based on his exact situation, physician would recommend a combination of the above prescribed medications, while considering his previous medication and health history.

Lifestyle changes: The lifestyle changes are crucial for Mr. Carson, in order to protect him from further heart attacks or fatal consequences. For this, healthy diet, physical exercise, smoking cessation and alcohol consumption reductions is important, which has already been discussed in previous section (Eckel et al., 2013).

Heart failure devices: There are several heart failure devices, used for special cases. For instance, pacemaker is a device, implanted in chest, for controlling heart rhythm. On the other hand, Cardiac resynchronization therapy is used for helping the walls of the left ventricle all contract at the same time. Implantable cardioverter defibrillators are devices that continuously monitor heart rhythm by electrical shock. In case of Mr. Carson, ICDs can be implanted, to reduce risk of further attacks or heart failure. Telemonitoring is another device that has a significant potentiality in reducing the risk of secondary attacks or complications for Mr. Carson, as it provides the opportunity to monitor his vital signs at his home environment, regularly (Clarke, Shah & Sharma, 2011).

Surgery: Surgery is needed in severe stage, however, in Mr. Carson’s case, surgery would not be needed.

Nurses are liable for educating the patients and family in order to ensure patient’s adherence with the treatment procedures, while giving significant value to the patient’s opinion. In conclusion, it can be said that in case of Mr. Carson, the nursing diagnosis and assessment are crucial for determining the immediate care in order to control Mr. Carson’s situation. Finally, the lifestyle modifications, medications as well as other treatment options have also been discussed.


Bui, A. L., Horwich, T. B., & Fonarow, G. C. (2011). Epidemiology and risk profile of heart failure. Nature Reviews Cardiology, 8(1), 30-41.

Clarke, M., Shah, A., & Sharma, U. (2011). Systematic review of studies on telemonitoring of patients with congestive heart failure: a meta-analysis. Journal of telemedicine and telecare, 17(1), 7-14.

Eckel, R. H., Jakicic, J. M., Ard, J. D., Hubbard, V. S., de Jesus, J. M., Lee, I. M., ... & Nonas, C. A. (2013). 2013 AHA/ACC guideline on lifestyle management to reduce cardiovascular risk. Circulation, 01-cir.

Hall, M. J., Levant, S., & DeFrances, C. J. (2012). Hospitalization for congestive heart failure: United States, 2000–2010. age, 65(23), 29.

Hosenpud, J. D., & Greenberg, B. H. (Eds.). (2007). Congestive heart failure. Lippincott Williams & Wilkins.

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.

Whang, W. (2013). Congestive heart failure. In Encyclopedia of behavioral medicine (pp. 485-486). Springer New York.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & Johnson, M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure. Circulation, CIR-0b013e31829e8776.

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