Congestive cardiac failure.

It is a condition that arises when the heart ability to maintain cardiac output is not enough to meet the requirements of the body tissues.

Causes

            This condition is commonly caused by coronary artery disease which might result from myocardial infarction, hypertension, a condition of the abnormal heart muscle (cardiomyopathy) and the valvular disorders. Arteriosclerosis of the coronary vessels is the most common cause of the congestive cardiac failure, and it is found in most of the patients with the condition.

             Cardiomyopathy which is another cause of the condition is categorized into three types which are hypertrophic, dilated and the restrictive. The dilated type is the most common, and it results from diffusing cellular necrosis which will then lead to decrease in contractility, on the other hand, hypertrophic and the restrictive type results in reduced ability to distend and ventricular filling. This will thus result in congestive heart failure.

             Hypertension is the other cause, and it involves both systemic and pulmonary hypertension. It increases the afterload which in turn increases the amount of workload of the heart. This will cause hypertrophy of the heart muscle which will thus increase heart contractility (Rogers & Bush, 2015). Hypertrophy of the heart muscle and may hinder proper ventricular refill during the diastole, and also there is a likelihood that the dilated ventricle might fail.

            Valvular heart disorders is another cause. Complications in the valves allows the blood to flow back into the heart which increases the heart workload and might result in heart failure. Other systemic conditions such as pneumonia which present with fever and hypoxia usually increase the rate of metabolism and might speed up to development of congestive cardiac failure.

 

Incidence

Congestive cardiac failure increases with age, and there are 5 million cases and more in the United States (Ziaeian & Fonarow, 2016). Also, there are about 550,000 new cases which are diagnosed each yeah

Risk factors

            The condition is likely to occur in individuals with the following conditions; high blood pressure, diabetes mellitus, heart attack, obesity, high levels of cholesterol, coronary heart disease, viral or bacterial infections, decreased kidney function and valve defects (Benotti, 2017). These risk factors precipitate client development of heart failure.

Impact of the condition to the family

             Heart failure has a significant impact on patient life because it includes changes in lifestyle; for example, the client is unable to do gardening easily as before. The patients will experience physical, psychological and emotional health as well as cognitive abilities. There will also be significant changes in social interaction (Buck, 2015). The family, on the other hand, will feel little confidence in the health of the client and the might result in changes in roles in the family. There is also fear of losing their loved one, and others might find it difficult in parenting and taking care of them (Hasanpour-Dehkordi et al., 2016). Financial needs of the client might also be a challenge to the patient and the family.

 

 

 

 

 

Discuss three (3) common signs and symptoms of the selected disease and explain the

underlying pathophysiology of each (350 words)

1. Dyspnea

It is a sign of pulmonary congestion and occurring when the heart’s left ventricle cannot be able to pump blood from the heart effectively into the systemic circulation (Kupper et al., 2016). This will increase the blood volume in the left ventricle and will decrease blood flow into the left ventricle from the left atrium. This cause rise in volume and pressure occurring  at the left atrium which then leads to decrease in blood supply to the pulmonary circulation, with increased pressure in the blood vessels the blood will be forced out of capillaries into the tissues causing pulmonary congestion and thus signs of dyspnea.

2. Dizziness, and confusion

With an increase in pulmonary pressure there, the heart can pump enough blood into the system; this will result in low tissue and organ perfusion. The decrease in cardiac output will decrease the amount of blood reaching the brain and thus will lead to inadequate brain perfusion (Roy et al., 2017). This will result in the development of symptoms such as dizziness and feeling of light-headedness with confusion.

3. Edema

It results from the failure of the right ventricles. This causes congestion in peripheral tissues together with the viscera; this is due to failure of the right ventricle to pump blood effectively and therefore cannot have room for more blood returning from the systemic circulation. This will result in jugular venous distension and increase hydrostatic pressure of the capillaries in all the venous system. With an increase in this pressure blood will flow out of the vessels into the tissues and result in edema of the extremities (Adrogué, 2017). The fluid might also enter the peritoneal cavity and cause ascites. The patient will present with edema of the feet which worsen if the patient sits or stands for a long time.

 

Discuss the pharmacodynamics & pharmacokinetics of one (1) common class of drug

relevant to the chosen patient (300 words)

ACE inhibitors

These drugs inhibit an angiotensin-converting enzyme which then results in a reduction of the levels of the angiotensin 2 in the blood as well as the aldosterone. Angiotensin 2 is formed through the proteolytic action by the renin released by the kidneys. Inhibition of by conversion by the ACEI increases the endogenous vasodilators of the kinin family such as the bradykinin (Bezalel, 2015). They work by promoting vasodilation and also diuresis through decreasing the preload and afterload in the heart. Vasodilation is significant in reduction of the resistance to removal of blood in the left ventricle which thus reduces the workload of the heart and at long last promote emptying of the ventricles.

The drugs also work by decreasing secretion of the aldosterone which promotes retention of the sodium and water in the kidney. Through this, they cause kidney stimulation to remove the fluids and sodium while on the other hand maintaining potassium (Adrogué, 2017). This creates a reduction of the ventricular heart pressure and will, therefore, reduce congestion.

The absorption of the drugs varies within its class from 25% to about 75%, and most of them are prodrugs. In the body, they remain inactive until when they are converted into through the process of hydrolysis which occurs in the liver or the gastrointestinal tissue to be absorbed well into the body (e Silva & Teixeira, 2016). ACE inhibitors are eliminated mostly through the renal route while others have their significant elimination through the liver. Most of the drugs when administered intravenously they achieve high bioavailability, and they are distributed and might cross the placenta.

In order of priority, develop a nursing care plan for your chosen patient who has just arrived on the ward from ED. Nursing care plan goals, interventions, and rationales must relate to the first 8 hours post ward admission (500 words)\

Nursing assessments

• Patient report of dyspnea and fatigue on doing any activity and shortness of breath on walking
• Patient report sleep disturbance resulting from breathlessness.
• Presence of edema in the extremities
• Difficulty in performing activities of daily living
• The patient report reports a feeling of powerlessness due to the condition
• Patient report of forgetting taking the drugs at times as prescribed.

Nursing diagnosis

• Anxiety related feeling of breathlessness as evidenced by patient report of shortness of breath lack of quality sleep (Ponikowski et al., 2016).
• Activity intolerance and fatigue relating to the decrease in cardiac output which is evidenced by the patient reporting difficulty in performing activities of daily living and fatigue when they walk.
• Excess fluid volume related to the congestive cardiac failure as evidenced by presences of edema in the extremities.
• Powerlessness which is related to the chronic illness and patient hospitalization as evidenced by the patient report on powerlessness due to the condition
• Ineffective drug regiment management related to lack of knowledge of drug importance as evidenced by patient report forgetting taking the drugs.

Nursing planning and goals

• To promote activity and reduce fatigue within the hospital stay
• To relieve the fluid congestion symptoms within the hospital stay
• Decreasing anxiety within the hospital stay
• Reducing the feeling of powerlessness

Nursing interventions

Controlling anxiety

             Provision of physical and psychological support to promote comfort to the patient, encourage the family members to visit the clients regularly along with reassuring the patient that her condition will improve (Ponikowski et al., 2016). The patient is also taught on ways to control anxiety and the use of relaxation techniques to foster comfort.

Promoting activity tolerance

            Physical activity of at least 30 minutes a day should be encouraged. Though temporary bed rest should be indicated in patients with acute illnesses. Physical exercise decreases dyspnea and increases the functional capacity of the individual (Cox, 2017). A good regime of at least five minutes of warm should be practiced every day before the actual activity of 30 minutes, and all this should be under the prescribed intensity level to the client

            In addition to the 30 minutes exercise the patient is also encouraged to walk daily. It is also essential to alternate a period of exercise with rest and avoiding activities that require high energy from the patient. Ensure the patient can talk during the activity and the exercise is scheduled at least 2 hours after eating, however in case of pain and shortness of breath the practice should be stopped. If the patient tolerates well to the activities will be necessary to develop short and long term goals.

Management of fluid volume

            Administration of diuretics such as the furosemide that the patient receives should be administered during the morning to avoid interference during the night. It is, therefore, necessary to discuss the timing of medication with the patient (Rogers & Bush, 2015). Monitoring of the patient fluid status is also essential, measuring of the daily patient weight and helping the client to adhere to a diet low in sodium (Jurgens, 2015). If the patient is put on fluid restriction, planning of fluid intake during the day is also. It is also necessary to assess for skin breakdown due to the chances of development of pressure ulcers in the edematous areas, encourage the patient to turn regularly. Leg exercises are also necessary.

Reduction the feeling of powerlessness

            Teach the patient that she should not feel powerless, and they can influence the way they want to spend their life and even the way they get their treatment. Assessing the patient to understand more about the factors that make her feel powerless and giving the appropriate intervention as needed (Scott & Winters, 2015). Encourage patient to express themselves and ask questions, and also providing the patient with the opportunity to make their own decisions. It is also essential to help the patient to understand those things which they can be able to control or not.

References

Adrogué, H. J. (2017). Hyponatremia in Heart Failure. Methodist DeBakey cardiovascular journal, 13(1), 40.

Benotti, P. N., Wood, G. C., Carey, D. J., Mehra, V. C., Mirshahi, T., Lent, M. R., ... & Hirsch, A. G. (2017). Gastric bypass surgery produces a durable reduction in cardiovascular disease risk factors and reduces the long‐term risks of congestive heart failure. Journal of the American Heart Association, 6(5), e005126.

Bezalel, S., Mahlab-Guri, K., Asher, I., Werner, B., & Sthoeger, Z. M. (2015). Angiotensin-converting enzyme inhibitor-induced angioedema. The American journal of medicine, 128(2), 120-125.

Cox, S. (2017). Congestive heart failure. Hospice and Palliative Care for Companion Animals: Principles and Practice, 109-114.

Buck, H. G., Harkness, K., Wion, R., Carroll, S. L., Cosman, T., Kaasalainen, S., ... & Strachan, P. H. (2015). Caregivers’ contributions to heart failure self-care: a systematic review. European Journal of Cardiovascular Nursing, 14(1), 79-89.

e Silva, A. C. S., & Teixeira, M. M. (2016). ACE inhibition, ACE2 and angiotensin-(1⿿ 7) axis in kidney and cardiac inflammation and fibrosis. Pharmacological research, 107, 154-162.

Fitchett, D., Zinman, B., Wanner, C., Lachin, J. M., Hantel, S., Salsali, A., ... & Inzucchi, S. E. (2016). Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME® trial. European heart journal, 37(19), 1526-1534.

Hasanpour-Dehkordi, A., Khaledi-Far, A., Khaledi-Far, B., & Salehi-Tali, S. (2016). The effect of family training and support on the quality of life and cost of hospital readmissions in congestive heart failure patients in Iran. Applied Nursing Research, 31, 165-169.

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: a scientific statement from the American Heart Association and the Heart Failure Society of America. Circulation: Heart Failure, 8(3), 655-687.

Kurmani, S., & Squire, I. (2017). Acute heart failure: definition, classification and epidemiology. Current heart failure reports, 14(5), 385-392.

Kupper, N., Bonhof, C., Westerhuis, B., Widdershoven, J., & Denollet, J. (2016). Determinants of dyspnea in chronic heart failure. Journal of cardiac failure, 22(3), 201-209.

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.

Rogers, C., & Bush, N. (2015). Heart failure: pathophysiology, diagnosis, medical treatment guidelines, and nursing management. Nursing Clinics, 50(4), 787-799.

Roy, B., Woo, M. A., Wang, D. J., Fonarow, G. C., Harper, R. M., & Kumar, R. (2017). Reduced regional cerebral blood flow in patients with heart failure. European journal of heart failure, 19(10), 1294-1302.

Scott, M. C., & Winters, M. E. (2015). Congestive heart failure. Emergency Medicine Clinics, 33(3), 553-562.

Ziaeian, B., & Fonarow, G. C. (2016). Epidemiology and aetiology of heart failure. Nature Reviews Cardiology, 13(6), 368.