Case-study Congestive cardiac failure
Answer 1 Congestive cardiac failure can be referred to as a chronic progressive illness that crucially impacts the pumping function of the heart muscles. It generally regards as the Heart failure and can be defined as the chronic condition that causes the weakening of the heart muscles (Dick amp Epelman, 2016). The insufficiency of the hearts pumping action arises due to the deposition of fluid around the heart which is the main reason of congestive cardiac failure. The decrease in the cardiac output, the blood amount that the heart pumps, is not adequate to circulate the blood returning to the heart from the lungs and body causing the fluids mainly water to leak from the capillary blood vessels (Vinesh et al., 2018). The condition of the congestive cardiac failure is due to the destruction of functionality or structure of the heart that results in the impaired ventricular filling. The variety of reasons behind the progression of the complications involves a broad range of diseases that includes diseases of myocardium, pericardium, endocardium, heart valves, vessels and other metabolic disorders (Ewer, Ewer amp Suter, 2016). It has been found that more than 50-75 of the people die with a cardiac failure within 5 years of diagnosis. Many findings suggest that the incidences of being 10 more prevalent in the people of more than or equal to 75 years of age (Sahle et al., 2016). In the US, there are about 915,000 new cases of heart failure that accounts for incidence approaching 10 per 1,000 population after the age of 65 years (Savarese amp Lund, 2017). In Australia, more than 30,000 cases have been diagnosed every year with a lot of complications with predominantly among 10 of the population over 80 years of age (Hopper amp Easton, 2017). The various causes of the heart failure encompass a broad range of conditions including coronary artery disease, emphysema, high blood pressure, infection, excessive alcohol abuse, cardiomyopathy and previous history with a heart attack (AHA, 2017). The various risk factors related to the disease condition include age, hypertension, sex, diabetes, smoking, intake of alcohol, obesity, hypercholesterolemia, dyslipidemia and previous family history (AHA, 2017). The chronic condition of heart failures impacts extensively on the patients as well as families. All this burden of health condition deteriorates the health-related quality of life of the patient. It impacts the patients emotional and mental stabilities. Heart failure is an extensive condition that includes multiple disorders that limit the functioning, diets, and lifestyle of the patients (Dueas et al., 2016). The burden of various clinical conditions limits the social capacity of the person and increase the dependency on the family members. The fear of losing a loved one is immensely traumatic for the patients family. The demand for continuous care for patients with congestive cardiac failure impacts severely the lives of the caregivers posing an emotional and financial burden on them (Sav et al., 2015).
Answer 2 The three signs and symptoms that are related to many abnormalities among the vitals of the patient with congestive cardiac failure includes
Signs and Symptoms Pathophysiology
Heart rate The heart rate of the patient has been regarded as the speed at which the heart beats by the number of beats. In adults above 18 years of age, the normal heart is considered to be between 60 to 100 bpm (Cleveland Clinic, 2018). In this case study, the patients heart rate is low in this case with 54 bpm. The low heart rates indicate the problem of bradycardia. Bradycardia can be referred to as the condition when the heart doesnt pump enough oxygen-rich blood to the body and relates to low heart rate (Kane et al., 2016). It arises due to low impulse formation or low conduction from the sinus node to the arterial tissue. Shortness of breath, dizziness, and chest pain have been found as the symptoms of bradycardia. In the case study, the patient is 65 years of age with symptoms including chest pain and shortness of breath. Aging leads to nodal dysfunction because of the progressive nodal cell fibrosis that results in the sinoatrial blockage, bradycardia, and incidences of heart failure (Masarone et al., 2017).
Blood pressure The normal blood pressure of the person is 120/80 mmHg (Mayo Clinic, 2019). In the case study, the patients blood pressure is 170/110 mmHg which is considered as high blood pressure. Elevation in blood pressure leads to the changes in the structure and function of the left ventricle as well and blood vessels. Increase in the blood pressure leads to the condition of hypertensive crisis that often leads to stroke (Mayo Clinic, 2019). The elevations lead to the condition of inflammation of blood vessels and cause fluid or blood leakage. The various clinical conditions lead to the condition of stroke and heart failure.
Respiration rate Mrs. Sharons respiratory rate has been recorded at 30 bpm. It has been noticed that the normal respiratory rate of an individual is 12 to 20 bpm (Badawy et al., 2017). Having 30 bpm as the respiratory rate is considered as high that can severely impact the normal functioning of the patient and is referred to as the Tachypnea. Any alteration in the pulmonary perfusion and ventilator control leads to the failure of the circulatory system and results in abnormalities in respiration rate (Li et al., 2017). High respiration rate leads to the condition of excessive breathing that creates a low level of carbon dioxide in blood that can be caused by heart failure, extensive pain or infection.
Answer 3 It has been found that in the case of the patients suffering from congestive cardiac failures, the drugs used to treat the medical condition involves angiotensin convertase enzyme inhibitors or ACE inhibitors. It has been classified as the kind of drug that is used for the relaxation of blood vessels (Ouwerkerk et al., 2017). In the case study, enalapril which is the medication of the patient is a kind of ACE inhibitor. This class of the drug is used in the treatment of heart failure and hypertension among the patients. The drugs help in improving cardiac functioning and lowering blood pressure by improving the functioning of the vital organs of the patient (McMurray et al., 2016).
Pharmacodynamics
ACE inhibitors display hemodynamic effects and result in reducing an enzyme in the body that is responsible for producing angiotensin II, that causes narrowing of blood vessels and is responsible for raising blood pressure and aldosterone secretion. It has been noticed that a single oral dose of ACE inhibitor helps in resulting 10-30 decrease in (systolic and diastolic) blood pressure and also reducing systematic vascular resistance without any change in cardiac outputs and heart rate and also helps in reducing arterial and pulmonary pressure by 24-29 within 30-90 minutes (Lainscak et al., 2016). Using ACE inhibitors helps in enhancing cardiac index, cardiac output and stroke index by 20-44 (Regulska, Stanisz, Regulski amp Murias, 2014).
Pharmacokinetics
ACE inhibitors bind to tissues and plasma proteins. The free drug is eliminated by the glomerular filtration through kidneys (Wen et al., 2016). The concentration of plasma to the time profiles indicates a long-lasting eliminating stage of the drugs. The average absorption rate of ACE inhibitor drugs is 40-75 (Lainscak et al., 2016). The drugs half-life is dependent on each ACE inhibiting drug composition. However, the metabolization of ACE inhibitors takes place in hepatic cells in the body.
Answer 4 Nursing care plan related to congestive cardiac failure
Serial No Goals Nursing Interventions Rationale
1 To maintain oxygen saturation of the patient
Supplying oxygen with the help of nasal cannula.
Monitoring oxygen saturation of the patient continuously.
Supplying additional oxygen helps in overcoming the problem of breathlessness. It can be provided with the help of cannula at 2L/m to maintain adequate oxygen saturation (SCRIBD, 2019).
Monitoring the patient condition is important to prevent harmful reaction of excessive supply of oxygen.
2 To monitor the hemodynamics of the patient
Auscultating heart rate, respiration rate, rhythm, and apical and radial pulse along with continuous monitoring of blood pressure.
Monitoring dyspnea and breathlessness after every 2 or 4 hours.
Tachycardia is generally found in patients with cardiac failure condition as it is a compensatory mechanism for reducing ventricular contractility (SCRIBD, 2019). With an increase in systematic vascular resistance, there is an increase in the blood pressure of the patient which creates difficulties in hemodynamic functioning of the body making it a necessary condition to monitor.
Monitoring helps in preventing shortness of breath and dyspnea resulting in further severe conditions of stroke and heart failure (Kane et al., 2016).
3 To reduce the overload of fluid volume
Monitoring and documenting color changes in urine output.
The fluid restriction at the rate of 1500 mL/day.
Cautious administration of diuretics with consistent monitoring.
Kidney responds to a reduction in the cardiac output by significant retainment of sodium and water. The urine color reflects the concentration of urine (Legrand et al., 2016). Continuous monitoring is important as urine output decreases in case of patients with heart failure.
For the prevention of swelling, rapid heartbeat and increased blood pressure.
Administering diuretics helps in controlling blood pressure and edema. Monitoring of this vitals is important to prevent any harmful effect (SCRIBD, 2019).
4 To provide care and support to the patient
Administering time to time medications.
Providing enough rest to the patient not exceeding activity intolerance level.
Encouraging lifestyle modifications including exercise and dietary changes.
Advising the patient to avoid cool places.
Advising patient for consistent position changing by elevating legs, avoiding pressure and promoting High Fowlers position.
Medications such as ACE inhibitors help in relaxing blood vessels and managing patient health condition (SCRIBD, 2019).
Physical rest should be promoted in order to improve cardiac function and reduce demand for oxygen (Carthon et al., 2015).
Exercises help the patient in overcoming dizziness and weight issues whereas dietary changes enhance improved metabolism (Hopper amp Easton, 2017).
Cool temperatures cause blood vessel constriction.
Elevation of legs helps in reducing venous stasis, preventing thrombus formation, preventing ulcers. High Fowlers position facilitates cardiovascular regulation and effective breathing (Hewitt, Bucknall amp Faraone, 2016).
5 To facilitate understanding and support to patient and family members Counseling for depression and anxiety among the patient and the family members.
Losing ones life or someone close is the mental trauma that is not easy to deal with and can cause emotional distress and anxiety issues among patients and families. Counseling helps in reliving the mental pressure and balancing the emotional status of the patient as well as family members (Payne et al., 2015).
References
AHA. (2017). Causes of Heart Failure. Retrieved from http//www.heart.org/HEARTORG/Conditions/HeartFailure/UnderstandYourRiskforHeartFailure/Causes-of-Heart-Failure_UCM_477643_Article.jsp.XI35zCgzbIU
Badawy, J., Nguyen, O. K., Clark, C., Halm, E. A., amp Makam, A. N. (2017). Is everyone really breathing 20 times a minute Assessing epidemiology and variation in recorded respiratory rate in hospitalized adults. BMJ Quality amp Safety,26(10), 832836.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., amp 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), 255263.
Cleveland Clinic. (2018). Pulse amp Heart Rate Menu. Retrieved from https//my.clevelandclinic.org/health/diagnostics/17402-pulse--heart-rate
Dick, S. A., amp Epelman, S. (2016). Chronic heart failure and inflammation what do we really knowCirculation research,119(1), 159176.
Dueas, M., Ojeda, B., Salazar, A., Mico, J. A., amp Failde, I. (2016). A review of chronic pain impact on patients, their social environment and the health care system.Journal of pain research,9, 457.
Ewer, M. S., Ewer, S. M., amp Suter, T. (2016). Cardiac Complications.HollandFrei Cancer Medicine, 121.
Hewitt, N., Bucknall, T., amp Faraone, N. M. (2016). Lateral positioning for critically ill adult patients.Cochrane database of systematic reviews, (5).
Hopper, I., amp Easton, K. (2017). Chronic heart failure.Australian Prescriber,40(4), 128.
Kane, E. M., Hinson, J. S., Jordan, C. D., Paziana, K., Sauber, N. J., Rothman, R. E., amp Stolbach, A. I. (2016). Bradycardia and hypotension after synthetic cannabinoid use a case series.The American journal of emergency medicine,34(10), 2055-e1.
Lainscak, M., Vitale, C., Seferovic, P., Spoletini, I., Trobec, K. C., amp Rosano, G. M. (2016). Pharmacokinetics and pharmacodynamics of cardiovascular drugs in chronic heart failure.International journal of cardiology,224, 191-198.
Legrand, M., Le Cam, B., Perbet, S., Roger, C., Darmon, M., Guerci, P. amp Gayat, E. (2016). Urine sodium concentration to predict fluid responsiveness in oliguric ICU patients a prospective multicenter observational study.Critical Care,20(1), 165.
Li, M., Zhang, N., Zhou, Y., Li, J., Gu, Y., Wang, J., amp Liu, C. (2017). A 50yearold woman with haemoptysis, cough and tachypnea cholesterol pneumonia accompanying with pulmonary artery hypertension.The clinical respiratory journal,11(2), 254257.
Masarone, D., Limongelli, G., Rubino, M., Valente, F., Vastarella, R., Ammendola, E. amp Pacileo, G. (2017). Management of arrhythmias in heart failure.Journal of Cardiovascular Development and Disease,4(1), 3.
Mayo Clinic. (2019). Hypertensive crisis What are the symptoms Retrieved from https//www.mayoclinic.org/diseases-conditions/high-blood-pressure/expert-answers/hypertensive-crisis/faq-20058491
McMurray, J. J., Krum, H., Abraham, W. T., Dickstein, K., Kber, L. V., Desai, A. S., ... amp Shao, Q. (2016). Aliskiren, enalapril, or aliskiren and enalapril in heart failure.New England Journal of Medicine,374(16), 15211532.
Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., ... amp Ng, L. L. (2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure a prospective European study.European heart journal,38(24), 18831890.
Payne, A. Y., Surikova, J., Liu, S., Ross, H., Mechetiuc, T., amp Nolan, R. P. (2015). Usability testing of an internet-based e-counseling platform for adults with chronic heart failure.JMIR human factors,2(1).
Regulska, K., Stanisz, B., Regulski, M., amp Murias, M. (2014). How to design a potent, specific, and stable angiotensin-converting enzyme inhibitor.Drug Discovery Today,19(11), 17311743.
Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., amp Reid, C. M. (2016). Prevalence of heart failure in Australia a systematic review.BMC Cardiovascular Disorders,16(1), 32.
Sav, A., King, M. A., Whitty, J. A., Kendall, E., McMillan, S. S., Kelly, F., ... amp Wheeler, A. J. (2015). Burden of treatment for chronic illness a concept analysis and review of the literature.Health Expectations,18(3), 312324.
Savarese, G., amp Lund, L. H. (2017). Global public health burden of heart failure. Cardiac failure review, 3(1), 7.
SCRIBD. (2019). Nursing care plan for heart failure chronic. Retrieved from https//www.scribd.com/document/17471577/Nursing-Care-Plan-for-Heart-Failure-Chronic
Vinesh, U., Divyashree, N., Kurian, N., Nivya, P. S., Vanendra Yadav, S., amp Nandan, H. N. (2018). Congestive cardiac failurea detail review. World Journal of Pharmaceutical and Medical Research, 4(4), 107112.
Wen, Y., Huo, S., Zhang, W., Xing, H., Qi, L., Zhao, D., ... amp Chen, X. (2016). Pharmacokinetics, biodistribution, excretion and plasma protein binding studies of acteoside in rats.Drug research,66(03), 148153.
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