Discuss about the Congestive Heart Failure.
This is a case study of M.G who is a 76 years old woman and has recently been submitted to the emergency department of the hospital with the diagnosis of congestive heart failure (CCF). Certain signs and symptoms she has been suffering from are breathlessness and swollen legs. Furthermore, this also has been analysed that she has gained 2kgs of weight and is not following provided restrictions on salt and fluid intake appropriately. The physical assessment determines the pulse rate to be 102 that is irregular, blood pressure to be 160/100, respiratory rate to be 24 and temperature to be 37.3 C. Furthermore, on the auscultation of chest creps were also analysed. Additionally, through the electrocardiogram (ECG) results atrial fibrillation is also diagnosed. Besides this, the radiology result has determined pulmonary congestion along with cardiomegaly (Yancy, et al., 2013).
The essay conducts analysis on the case study of M.G who is suffering from congestive heart failure and further analyzes the different nursing intervention plans for the effective remedial treatment of the patient.
This essay outlines detailed analysis on medical assessment, clinical findings and complications with the condition of M.G. Furthermore, analysis has been conducted statistics, pathophysiology, risk factor and nursing intervention plan has been conducted.
M.G has a prolonged case history of medical conditions and has been suffering from Hypertension (HT), Hyperlipidaemia, Chronic renal failure and Type 2 diabetes Mellitus (Buckingham, Donatelle, Thomas Jr, & Scherger, 2013). Furthermore, she is already on medication and is undertaking Enalapril, Potassium chloride, Hydrochlorothiazide (HCTZ) and Furosemide. Furthermore, she has undergone cholecystectomy at age 42 years and another Hysterectomy at age 48 years.
In addition to this, the complication that has arisen in M.G is Atrial Fibrillation that leads to irregular beating of heart by the formation of clots in the blood vessels inhibiting the normal flow throughout the body. This is a severe complication as it can prohibit the effective regulation of blood to certain part of the body prohibiting the working of that particular part (Ruff, et al., 2014).
As per the updated analysis by Australian Institute of Health and Welfare (AIHW) in 2016, 22% of the total population of Australia was suffering from cardiovascular disease in 2014-15 that amounts to 4.2 million people. Cardiovascular disease can occur due to environmental conditions as well as genetic factors. The parents of M.G died at lesser age due to Cerebrovascular Disease (CVA) and myocardial infarction. Such genetic history may have initiated severe heart condition in M.G. Furthermore, sever medical history and lifestyle may also contribute to the prevalence of severe heart condition in her (Backholer, et al., 2017).
Congestive Heart Failure (CHF) is a severe medical condition that leads to sudden stoppage in the working of heart. As most of the regulatory functions are associated to the pumping of the heart, eventually all associated regulatory processes stops leading to ultimate failure of the body. The pathophysiology includes curtailment in the cardiac output that affects the overall functioning of the body. The congestive heart failure (CHF) mainly targets the left ventricular of the heart by affecting its capability. Additionally, this occurs by decrement in the contractility of the muscles, increment in the systemic vascular resistance that occurs due to decrease blood pressure, occurrence of pulmonary congestion, dyspnoea due to increment in the pressure on left atrial and increment in the catecholamines that are responsible for circulation procedure and sympathetic tone that enhances the heart rate at a faster pace. These reasons lead to imbalance between meeting the supply and demand of the oxygen in the body and further increase in the size of the heart further enhances the demand of the oxygen and incompetent supply with respect to it (Mehra & Redline, 2014).
The congestive heart failure also affected the respiratory and renal system in M.G. She is showing restrictive respiratory framework, cardiomegaly, increased levels of fluids in lungs, pulmonary congestion and reduction in the gas diffusion. These symptoms indicate towards the abnormalities in normal respiratory system and impaired diffusion of the gas. Additionally, the congestive heart failure leads to blockage of the arteries and capillaries forcing the heart to pump excruciatingly in order to meet the demand of oxygenated blood throughout the body. This further leads to the weakening of muscles of the heart. Furthermore, this weakening of muscles prohibits effective regulatory mechanisms to be followed by heart that reduces the contractility further reducing the cardiac output (Tanai & Frantz, 2015).
The cardiac output is also essential for various associated compensatory mechanisms. Such compensatory mechanism is essential for the regulation of various procedures but under certain conditions it affects the myocardium further initiating the congestive heart failure (CHF). Additionally, the baroreceptors that are present in the aortic arch and carotids of the lungs initiate the sympathetic nervous system that enhances the rate of the heart to a tremendous extent. Furthermore, the heart pumps blood at much faster rate enhancing the rate of the heart at much higher level in order to increase the cardiac output. Furthermore, heart undertakes the structural changes in order to maintain the equilibrium between the demand and supply and increasing the stroke volume. Such structural changes leads to cardiac myopathy that makes the heart weak enough to undertake the procedure of effective pumping. In addition to this, another condition called as hypertrophic cardiomyopathy also occurs in order to reverse the structural changes. This condition leads to thickening of the heart ventricles making the normal flow of blood relatively tough. Such condition again affects the effective pumping of the heart (Severin & Phillips, 2017).
Severe heart condition also affects the renal function of the body by affecting the purification process conducted by the kidney. Additionally, the functioning of the kidney gets affected by cardiac output. Decrement in the levels leads to the release of rennin that produces hormone called as angiotensin. This hormone further releases aldosterone that undertakes the retention of salt, water and other components in the body. Furthermore, this retention causes the accumulation of the fluid leading to the condition called as pulmonary congestion. Such retention in the lungs inhibits normal breathing procedure causing the shortness of breath (Shimazu, et al., 2015).
The risk factors in M.G can be prevalent medical case history with severe medical maladies, age, blood pressure level, high pulse rate, high respiratory rate, temperature, creps and atrial fibrillation (McAlister, et al., 2017).
The nursing care plan for M. G includes effective imparting of the remedial treatment in terms of pharmacological and non-pharmacological interventions in order to bring out positive resultants. As per the guidelines and procedural steps of Clinical reasoning cycle and NANDA-1, three different nursing care plans has been formulated (Rabelo?Silva, et al., 2017). These plans are decreased cardiac output, deficient knowledge and ineffective breathing pattern. These plans work on implementing effective treatment by reducing the levels of risk among the vulnerable people. These plans have been formulated with experienced skills and optimal knowledge (Jurgens, et al., 2015). These plans will target the three important issues which M.G is suffering from. Insufficient breathing pattern, deficient knowledge and decreased cardiac output nursing care plans will assess the nurses to implement effective remedial treatment in accordance with the rationale. For the analysis of these three different nursing plans on the basis of diagnosis, objectives, nursing intervention, rationale and evaluation please refer Appendix 1. Furthermore, health assessment questions has been prepared for the optimal conduction of communication in accordance with the condition related questioning (Please refer Appendix 2).
Conclusion:
M.G is an old woman who is suffering from critical condition that is congestive heart failure that has affected renal system and respiratory system of her as well. Optimal remedial treatment that is a concoction of pharmacological and non-pharmacological treatment must be instilled to her. These nursing plans are ineffective breathing pattern, deficient knowledge and decreased cardiac output. These three issues targets the main reasons prevailing in case of M.G as she is not undertaking medications as prescribed. Additionally, the nursing care plan will provide effective guideline to nurse to proceed further with the nursing care. Additionally, this plan will instil knowledge in M.G as well regarding her condition allowing her to undertake essential steps in accordance with the signs and symptoms under critical condition.
Azzolin, K., Mussi, C. M., Ruschel, K. B., de Souza, E. N., de Fátima Lucena, A., & Rabelo-Silva, E. R. (2013). Effectiveness of nursing interventions in heart failure patients in home care using NANDA-I, NIC, and NOC. Applied Nursing Research, 239-244.
Backholer, K., Hirakawa, Y., Tonkin, A., Giles, G., Magliano, D. J., Colagiuri, S., & Simmons, D. (2017). Development of an Australian cardiovascular disease mortality risk score using multiple imputation and recalibration from national statistics. BMC Cardiovascular Disorders, 17.
Buckingham, J. L., Donatelle, E. P., Thomas Jr, A., & Scherger, J. E. (2013). Family medicine: principles and practice. R. B. Taylor (Ed.). Springer Science & Business Media.
Doenges, M. E., Moorhouse, M. F., & Murr, A. C. (2016). Nursing diagnosis manual: planning, individualizing, and documenting client care. FA Davis.
Dovancescu, S. S., Riistama, J., Kuniyoshi, F. S., Meyer, T., & McManus, D. D. (2015). Detecting Heart Failure Decompensation by Measuring Transthoracic Bioimpedance in the Outpatient Setting: Rationale and Design of the SENTINEL-HF Study. JMIR research protocols.
Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., & Fleg, J. L. (2015). Heart failure management in skilled nursing facilities. Circulation: Heart Failure, 655-687.
McAlister, F. A., Wiebe, N., Jun, M., Sandhu, R., James, M. T., McMurtry, M. S., & Tonelli, M. (2017). Are Existing Risk Scores for Nonvalvular Atrial Fibrillation Useful for Prediction or Risk Adjustment in Patients With Chronic Kidney Disease? Canadian Journal of Cardiology, 243-252.
Mehra, R., & Redline, S. (2014). Arrhythmia risk associated with sleep disordered breathing in chronic heart failure. Current heart failure reports, 88-97.
Noh, H. K., & Lee, E. (2015). Relationships Among NANDA?I Diagnoses, Nursing Outcomes Classification, and Nursing Interventions Classification by Nursing Students for Patients in Medical?Surgical Units in Korea. International journal of nursing knowledge, 43-51.
Park, H. (2014). Identifying Core NANDA?I Nursing Diagnoses, NIC Interventions, NOC Outcomes, and NNN Linkages for Heart Failure. International journal of nursing knowledge, 30-38.
Rabelo?Silva, E. R., Dantas Cavalcanti, A. C., Ramos Goulart Caldas, M. C., Lucena, A. D., Almeida, M. D., Linch, G. F., & Müller?Staub, M. (2017). Advanced Nursing Process quality: Comparing the International Classification for Nursing Practice (ICNP) with the NANDA?International (NANDA?I) and Nursing Interventions Classification (NIC). . Journal of clinical nursing, 379-387.
Ruff, C. T., Giugliano, R. P., Braunwald, E., Hoffman, E. B., Deenadayalu, N., Ezekowitz, M. D., & Yamashita, T. (2014). Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials. The Lancet, 955-962.
Severin, R., & Phillips, S. A. (2017). Respiratory Muscles and Chemoreflex Sensitivity in Heart Failure: A Breath of Fresh Air.
Shimazu, S., Hirashiki, A., Kamimura, Y., Nakano, Y., Adachi, S., Kondo, T., & Murohara, T. (2015). Assessment of respiratory disturbance index determined with a non-restrictive monitor and of autonomic nervous system parameters in heart failure patients: A pilot study. Journal of cardiology, 218-223.
Souza, V., Zeitoun, S. S., Lopes, C. T., Oliveira, A. P., Lopes, J. D., & Barros, A. L. (2014). Content validation of the operational definitions of the nursing diagnoses of activity intolerance, excess fluid volume, and decreased cardiac output in patients with heart failure. International journal of nursing knowledge, 85-93.
Tanai, E., & Frantz, S. (2015). Pathophysiology of heart failure. . Comprehensive Physiology.
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.
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