Congestive Cardiac Failure: Causes and Effects

Analyse Health Information – Case study

The scenario relates to Mr Alby Wright who has been admitted into your ward. His patient history and admission form is available for you to review.

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

Congestive heart failure is a condition where the heart muscle becomes less strong and is unable to pump as well as it usually would. The ventricles which most important pumping chambers become bigger or thicker and aren’t able to squeeze or relax as well as they should be able to. This makes it easy for fluid retention to occur especially in the legs, abdomen and lungs (better health channel. 2013). This is all usually caused by diabetes, coronary heart disease, previous heart attack, high blood pressure and or other conditions that have damaged the heart and made it weak. Sometimes the fluid that gets in the lungs and it makes it uneasy to breathe and causes shortness of breath when the person is lying down on their back. This is called pulmonary oedema and can cause other respiratory issues if it not treated (American heart association. 2012).

Generally if someone was to have heart failure, it would occur on the left side first mostly but can occur in both sides. If someone is experiencing left side heart failure, the left ventricle doesn’t fully empty and is unable to distribute enough oxygen rich blood around the body which causes heightened pressure in the upper chambers of the heart and the veins that are close to the area which is called systolic failure.

Because of the build-up of blood in there, it can cause oedema in the legs, lungs and abdominal organs. The kidneys are affected by this hinders the way that they work and it leads to salt and water retention which causes further oedema. In some cases of heart failure, instead of not being able to pump blood around properly out of the left ventricle there is also unsuccessful relaxation of the left ventricle because the muscle has gone stiff which leads to blood pooling (better health channel. 2013) and also that the heart isn’t able to fully fill with blood during the resting period between each heartbeat (American heart association. 2012).

Right sided heart failure usually happens because of left sided failure. When the left ventricle has failed, more fluid pressure is then transferred back through the lungs which damages the right side of the heart. When the right side of the heart loses the strength to properly pump, blood builds up in the veins and that causes swelling in the legs and ankles.

The cardiovascular system is affected the most by congestive heart failure. The heart has been weakened and is unable to pump blood efficiently and doesn’t function properly in general and the muscle is also weakened.

The respiratory system is affected because of the fluid in the lungs which is also known as pulmonary oedema. This can affect your breathing and leave you short of breath. Fluid may also build up in the liver resulting in an impaired capability to get rid of the body’s toxins and to produce the proteins that the body needs to live.

The intestines can become not as good at absorbing nutrients and medicines as that would have when they were healthy (providence health network. 2014)

2. Give a brief overview of the normal function of the body systems affected by this disorder.

Cardiovascular system is most affected by this disorder. The functions of this system are to basically keep the blood running and pumping through by the arteries, veins, and capillaries (cliffs notes. 2013). The blood carries important nutrients around the body and helps to remove metabolic waste. The heart, blood vessels and blood help to regulate body temperature by controlling the blood flow to the surface of the skin. The white blood cells help to protect the body from foreign toxins and pathogens. Platelets help to clot blood so that you won’t have excessive blood loss and stop bleeding (cliffsnotes. 2013).

Respiratory system function is so you can breathe and supply oxygen to your whole body (how stuff works. 2014). This works by breathing; inhaling oxygen filled air and exhaling carbon dioxide air. First you breathe in air through your nose and mouth and it travels down the windpipe and through the bronchial tubes then into the lungs. The diaphragm and abdominal muscles and make the lungs contract and expand so that you are able to breathe in and out. The bronchial tubes connect to blood vessels which carry blood through your body and exchange gases.

The digestive system absorbs and moves the nutrients around the body that it needs to work well and gets rid of what the body doesn’t need as waste. First there is ingestion which is when eaten and then makes its way down into the stomach to be stored and waits for digestion. It then moves into the small intestines where the enzymes and bile work to break down the food where the body can absorb more nutrients that it needs and it continues on its way to the large intestine where it absorbs more fluid to make the solid faeces and moves through and gets excreted as waste (how stuff works. 2014). The liver aids in breaking up fats, absorbing them and digesting them.

Urinary system works along with other parts of the body such as skin, lung and intestines to keep up the stability of chemicals and water in the body (live science. 2013).This system’s role is to filter and excrete. Kidneys work at reducing blood pressure by reducing the blood volume. The body filters blood to create urine which goes into the bladder and the bladder fills up until it is full and ready to excrete waste that the body does not need which is urination (live science. 2013).

3. Define the signs and symptoms of heart failure, and explain why these signs and symptoms occur.

Breathlessness or shortness of breath is a symptom because when the heart starts failing, the blood in the veins gets backed up in the pulmonary veins because it cannot cope with the supply while trying to carry oxygenated blood from the lungs to the heart. At this point, the fluid is starting to pool in the lungs which hinders regular breathing. A person suffering heart failure may suffer with breathlessness upon exertion including exercise or other activities. As the condition progresses, breathlessness or shortness of breath may even be present while at rest or even sleeping which may cause the person to wake up (USCF medical center. 2014). Fatigue occurs when heart failure develops and worsens; the heart cannot pump the adequate volume of blood that is needed to meet all of the body’s needs. To make up for this, the blood is taken away from less vital such as the limbs to supply the heart and brain. Because of this, people suffering with heart failure usually feel tired, weak and have difficulty doing normal tasks such as walking, going up stairs, or even carrying items. (USCFmedicalcenter.2014). Someone suffering shortness of breath as a symptom of heart failure will also experience fatigue if they are being woken up with breathing difficulties while they are sleeping. Chronic coughing and wheezing is a symptom because of the fluid backup in the lungs which may cause a thick, whitish mucus like substance called phlegm to be coughed up from the lungs which may even be tinged pink from traces of blood (USCFmedicalcenter.2014). Rapid or irregular heartbeat is a symptom because it may speed up to make up for its inability to pump blood around the body properly. People suffering this in heart failure may experience a fluttering sensation of heart palpitations, or a heartbeat that they are aware of and seems irregular or out of the normal rhythm. It may feel like the heart is racing or pounding hard (USCF medical center. 2014). Lack of appetite/ nausea because the digestive system isn’t as vital as the heart or brain so the blood has been pulled away from the digestive systems to these areas instead which means there will be problems with digestion including the feeling of fullness or sickness even though they have not eaten anything (USCF medical center. 2014). Confusion/ impaired thinking because unusual sodium levels in the blood and lessened blood flow to the brain can cause bafflement or memory loss even know the person suffering with this may not even realise, and someone else may pick up on this sign before they do (USCF medical center. 2014).

Oedema or swelling due to restricted blood flow to the kidneys which means that they produce hormones which lead to the retention of salt and water. This causes swelling of (most often) in the legs, ankles, and feet. Oedema may also cause weight gain (USCF medical center. 2014).

Rapid weight gain can occur as a result of oedema and the fluid retention (USCF medical center. 2014). Heart grows in size because it wants to make its pumping power greater so the muscle mass in the heart gets bigger to make this happen. The chambers inside of the heart also grow larger and stretch so that they can fit more blood in. While the heart grows in size, the cells that control its contractions also grow with it. An enlarged heart does not function as well as a normal sized one and the added muscle mass puts stress on the whole cardiovascular system (USCF medical center. 2014). The heart pumps faster as it tries to circulate more blood around the body. If the heart pumps blood too fast for a long period of time, it can damage the heart muscle and hinder its regular electrical signals, which can cause an unsafe heart rhythm disorder (USCF medical center. 2014). Blood vessels narrow because less blood is flowing through the veins and arteries and that means blood pressure can drop to seriously low levels. Because of this, the blood vessels narrow which keeps the blood pressure higher while the hearts power decreases. Narrowing of the blood vessels also limits the amount of blood that can flow through which may contribute to other conditions such as heart disease, clogged or blocked vessels in the legs or other body parts, or stroke (USCF medical center. 2014). Blood flow is diverted away from less vital areas such as the limbs when there is not enough of it to meet the body’s needs and gets given to more crucial organs such as the heart and brain which are the most important for survival. This can cause limb weakness due to lack of blood in the areas. The areas where the blood is diverted from may deteriorate over time from a lack of oxygen (USCF medical center. 2014). Increased urination at night because if the patient suffering heart failure lays down all day, the fluid that has been accumulating in their legs all day may move back up into the blood stream and gets taken to the kidneys and is excreted as urine (heart failure matters. 2014). Low blood pressure because the hearts power has decreased and the veins have narrowed. Chest pain if your heart failure is due to a heart attack.

4. List the information taken on his admission that demonstrates these signs and symptoms.

Cyanotic

Appetite loss

Confusion and anxiety

Low blood pressure

Temperature below 35.8 degrees

Sa02: 87% on air

Respirations: 32

Low blood pressure

Constipation

5. Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain.

Yes. High blood sugar levels in diabetic patients damage nerves and blood vessels which results in poor circulation to the feet and may cause ulcers, infection, and amputation. This is more likely to happen if the patient has had diabetes for a long amount of time, they smoke, they don’t move around much, or their blood glucose levels have been high for an extended period of time (diabetes Australia. 2014).

6. 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.

Lasix is a diuretic. It increases the amount of urine that is made in the kidneys and excreted as waste (c health. 2014). It is also used to regulate and control slight to moderate high blood pressure. It affects the urinary system because it involves the kidneys and the cardiovascular system because it involves the heart.

I think that Mr. Wright is ordered Lasix to get rid of the excess fluid that would be built up in his body and to lessen the oedema.

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

Glaucoma

Type 2 diabetes

Arthritis

8. Using Mr Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home.

Hypotensive- low blood pressure

He needs a walking stick because he is unsteady on his feet

He gets anxious, especially about his dog. This can sometimes cause an asthma attack.

He gets confused

His vision is impaired and gets blurry after he has eye drops and he also needs reading glasses.

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

Paramedics will care for Mr Wright in the ambulance and pass him over to emergency.

Mr Wright needs a doctor to in emergency to diagnose him. General Nurses will be involved to provide care for him and to care for his wounds.

A diabetes educator can be involved to help him to understand the needs of his condition and set up an action plan and give him support. A dietician can also help with this condition and set up meal and nutrition plans etc.

Exercise physiologist assists patients to have a physical lifestyle to prevent and manage chronic conditions.

A pharmacist will dispense his prescriptions so he can have medications and to give information on them.

He may be able to talk to a psychologist to improve his anxieties, especially about his dog (better health. 2013).

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

Progress notes Medication chart Vital signs chart Nursing history and assessment Care plan Asthma action plan FBC- fluid balance chart Wound monitoring chart Falls risk assessment

(tafesa. 2014)

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