Congestive Cardiac Failure (CCF) Case Study

Student Name: Shinderpal Kaur

Unit of Competence: Analyse Health information

Assessment Title: Analyse Health Information Case Study Mr. Wright

Q1:- Mr. Wright’s admission states that he has CCF (congestive cardiac failure). Clearly define CCF. What organs and which body systems are affected by this disorder?

Heart failure, also known as congestive heart failure (CHF), occurs when your heart muscle doesn’t pump blood as well as it should. Conditions such as narrowed arteries in your heart (coronary artery disease) or high blood pressure gradually leave your heart too weak or stiff to fill and pump efficiently. Heart failureis condition in which thehearthaslosttheabilitytopumpenoughbloodtothebody’stissues. The organs and other tissues do not receive enough oxygen and nutrients to function properly. The major affected organs are Brain, Kidneys and Lungs.

The systems affected by this disorder:-

• The cardiovascular system
• Urinary system
• Digestive system
• Respiratory system
• Nervous System

Q2:- Give a brief overview of the function of the body systems affected by this disorder.

Respiratory System

The respiratory system brings air into the body and removes carbon dioxide. It includes the nose, trachea, and lungs. When you breathe in, air enters your nose or mouth and goes down a long tube called the trachea. The trachea branches into two bronchial tubes, or primary bronchi, which go to the lungs. The primary bronchi branch off into even smaller bronchial tubes, or bronchioles. The bronchioles end in the alveoli, or air sacs. Oxygen follows this path and passes through the walls of the air sacs and blood vessels and enters the blood stream. At the same time, carbon dioxide passes into the lungs and is exhaled.

Nervous System

The nervous system is made up of the brain, the spinal cord, and nerves. One of the most important systems in your body, the nervous system is your body’s control system. It sends, receives, and processes nerve impulses throughout the body. These nerve impulses tell your muscles and organs what to do and how to respond to the environment. There are three parts of your nervous system that work together: the central nervous system, the peripheral nervous system, and the autonomic nervous system.

Thecentral nervous systemconsists of the brain and spinal cord. It sends out nerve impulses and analyzes information from the sense organs, which tell your brain about things you see, hear, smell, taste and feel.

Theperipheral nervous systemincludes the craniospinal nerves that branch off from the brain and the spinal cord. It carries the nerve impulses from the central nervous system to the muscles and glands.

Theautonomic nervous systemregulates involuntary action, such as heart beat and digestion.

Digestive System

The digestive system is made up of organs that break down food into protein, vitamins, minerals, carbohydrates, and fats, which the body needs for energy, growth, and repair. After food is chewed and swallowed, it goes down the esophagus and enters the stomach, where it is further broken down by powerful stomach acids. From the stomach the food travels into the small intestine. This is where your food is broken down into nutrients that can enter the bloodstream through tiny hair-like projections. The excess food that the body doesn’t need or can’t digest is turned into waste and is eliminated from the body.

The circulatory system

It is the body’s transport system. It is made up of a group of organs that transport blood throughout the body. The heart pumps the blood and thearteriesandveinstransport it. Oxygen-rich blood leaves the left side of the heart and enters the biggest artery, called theaorta. The aorta branches into smaller arteries which then branch into even smaller vessels that travel all over the body. When blood enters the smallest blood vessels, which are calledcapillaries, and are found in body tissue, it gives nutrients and oxygen to the cells and takes in carbon dioxide, water, and waste. The blood, which no longer contains oxygen and nutrients, then goes back to the heart through veins. Veins carry waste products away from cells and bring blood back to the heart, which pumps it to the lungs to pick up oxygen and eliminate waste carbon dioxide.

Urinary System

The urinary system eliminates waste from the body, in the form of urine. The kidneys remove waste from the blood. The waste combines with water to form urine. From the kidneys, urine travels down two thin tubes called ureters to the bladder. When the bladder is full, urine is discharged through the urethra.

Q3:- Define the signs and symptoms of CCF, and explain why these signs and symptoms occur.

1. Increased heart rate:- The heart beats faster to “make up for” the loss in pumping function
2. Tiredness, fatigue:-Heart can’t pump enough blood to meet needs of body’s tissues
3. Oedema:-Decreased blood flow out of the weak heart
   1. Blood returning to the heart from the veins “backs up” causing fluid to build up in tissues
4. Lack of appetite:-The digestive system receives less blood causing problems with digestion
5. Muscle weakness:-due to insufficient blood supply and oxygen to the muscles.
6. Chronic cough or wheezing:-due to the fluid in the lungs and the lungs need to work harder.
7. Swelling in ankles, feet, hands or abdomen:-due to the veins filling up with excess fluid.
8. Confusion:-Changing levels of substances in the blood ( sodium) can cause confusion
9. weight gain :-because of fluid in the body and kidneys are not working properly
10. Sleep apnoea.The inability to breathe properly at night results in low blood oxygen levels and increased risk of abnormal heart rhythms.
11. Shortness of breath: Blood “backs up” in the pulmonary veins because the heart can’t keep up with the supply an fluid leaks into the lungs
12. Lung congestion:-The lungs may become congested with fluid (pulmonary oedema)
13. Nausea and vomiting:-as peristalsis slows and bile and fluid back up in the stomach
14. Infarct:- may be cause of decreased cardiac output
15. Decreased urine output:- kidneys are not working properly because not getting enough blood for filtration
16. Skin pale or cyanotic :-Because of insufficient oxygen in the blood
17. Heart enlargement:-Heart pumps the blood with more force than usual, which puts the strain on the heart muscles and the heart muscles become enlarged.
18. Increased urination at night:-When you lie down at night time, the fluid that is build up in your legs can move up into your bloodstream and is taken to your kidneys to be eliminated as waste urine.
19. Cool extremities:-because of poor circulation in the body and heart is trying to send more blood to the major organs of the body such as brain.
20. Orthopnea:-In general, shortness of breath is a common symptom of congestiveheart failure. This is because increased fluid in thelungs can interfere with the exchange of oxygen, resulting in not enough oxygen reaching the tissues, this is most typically noticed during exercise, but it can also occur when a person is lying down.
21. Exercise intolerance:-
    1. A person may be unable to tolerate exercise or even mild physical exertion that he or she may have been able to do before. The body needs oxygen and other nutrients during physical activity. A failing heart cannot pump enough blood to provide these nutrients to the body.
    2. The ability to exercise, or even to walk at a normal pace, may be limited by feeling tired and having shortness of breath.

Q4:- List the information taken on his admission that demonstrates these signs and symptoms.

• Temperature-35.8C
• Pulse – 124
• Respiration – 32
• Hypotension – 90/40
• Cyanosis – lack of oxygen
• SaO2 – 87% on room air
• Dyspnoea
• Confusion
• Age (77)
• Constipation
• Loss of appetite
• Smoking

Q5:- Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain

People with diabetes are prone to having foot problems, often because of two complications of diabetes: nerve damage (neuropathy) and poor circulation. Neuropathy causes loss of feeling in your leg, taking away your ability to feel pain and discomfort, so you may not detect an injury or irritation. Poor circulation in your feet reduces your ability to heal, making it hard for even a tiny cut to resist infection. Tissue in the leg will die due to lack of oxygen and nutrients, which leads to infection and gangrene.

Q6:-One of the medications he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. (Your answer need only be brief.)

Lasix is also known as Furosemide. It is a potent diuretic (water pill) that is used to eliminate water and salt from the body. In the kidneys, salt (composed of sodium and chloride), water, and other small molecules normally are filtered out of the blood and into the tubules of the kidney. The filtered fluid ultimately becomes urine. Most of the sodium, chloride and water that are filtered out of the blood are reabsorbed into the blood before the filtered fluid becomes urine and is eliminated from the body. Furosemide works by blocking the absorption of sodium, chloride, and water from the filtered fluid in the kidney tubules, causing a profound increase in the output of urine (diuresis).Mr. Wright is ordered Lasix because of oedema.

The body systems are affected by it:-

• Urinary system
• Digestive system
• Nervous system
• Cardiovascular system
• Respiratory system
• Integumentary system
• Special senses

Q7:-List three conditions in Mr. Wright’s relevant medical history that are commonly associated with ageing.

Arthritis: Osteoarthritis (OA), at one time called degenerative joint disease, is the most common type of arthritis in older people. Symptoms can range from stiffness and mild pain that comes and goes to severe joint pain and even disability.

Glaucoma: Glaucoma is a term describing a group of ocular disorders with multi-factorial etiology united by a clinically characteristic intraocular pressure-associated optic neuropathy. Also, people over the age of 60 years have a higher risk of developing the glaucoma disease.

Diabetes type 2: Diabetes mellitus type 2 (formerly noninsulin-dependent diabetes mellitus (NIDDM) or adult-onset diabetes) is a metabolic disorder that is characterized by high blood glucose in the context of insulin resistance and relative insulin deficiency

Q8:- Using Mr. Wright’s admission history and assessment, lists the factors that may impact on his safety whilst in hospital and when he returns home.

Mobility–.Diabetes type 2 increase the risk of falls when Mr. Wright returns home as people with type 2 diabetes mellitus may rarely present with nonketotic hyperosmolar coma (a condition of very high blood sugar associated with a decreased level of consciousness and low blood pressure).

Asthma: Mr. Wright may feel very difficult to breathe when he returns home as asthma symptoms includes shortness of breath and struggling to breathe.

Arthritis: arthritis can decrease Mr. Wright mobility and increase the risk of falls when he returns home. It is because the symptoms of arthritis are pain, stiffness and inflammation (heat and swelling) in the joints.

Hypotension: abnormally low blood pressure

Decreased appetite: Lack of appetiteis the feeling that you are not hungry. When he returns home may be he wouldn’t eat much because he is not feeling hungry, it can effect on his health.

Vision impairment: – risk for falls, unable to read medication labels properly

Low SaO2: lack of oxygen can make him dizziness.

Mental Confusion– Unable to understand that how and when to take the medicine.

Q9:-What other health professionals will be involved in his care and what services can they provide for Mr. Wright.

Dietician: – Dieticians are professionals with qualification and skill to provide expert nutrition and dietary advice. So Dietician can provide information and dietary needs for his diabetes.

Support workers: – They are supporting people to complete everyday tasks that they are unable to complete on their own due to illness, disability.

Psychiatrists:-A psychiatrist who specialized in the diagnosis, treatment and prevention of mental health and emotional problems. So psychiatrist can help Mr.wright to decrease his anxiety level.

Local GP: – is amedical practitionerwho treatsacuteandchronic illnessesand providespreventive careandhealth educationto patients. He can assist with medication refills and refer to specialist if needed.

Physiotherapist: – help with some exercises that can improve his mobility.

Q10:-List the nursing documentation you would be expect to be used in the care of Mr Wright.

• Fluid Intake and output chart
• Pain assessment chart
• Wound chart
• Mobility assessment chart
• Bowel chart
• Observation chart
• Food chart
• Admission forms
• Allergy tags
• Weight chart
• Medication chart
• Progress notes
• Nursing notes
• Care plan

References:-

• http://www.factmonster.com/ipka/A0774536.html
• http://www.foothealthfacts.org/footankleinfo/diabetic-amputations.htm
• http://www.medicinenet.com/furosemide/article.htm
• http://www.netdoctor.co.uk/heart-and-blood/medicines/lasix.html
• http://www.abc.net.au/health/consumerguides/stories/2005/10/15/1836929.htm
• http://www.rightdiagnosis.com/h/heart_failure/intro.htm
• http://www.emedicinehealth.com/congestive_heart_failure/page4_em.htm

Shinderpal Kaur

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