The aim of this scenario-based assignment is to discuss the therapeutic intervention in the care of a patient with Congestive Cardiac Failure (CCF). A brief summary of the patient’s medical history will be given while discussing one specific nursing problem in terms of heart rate/ rhythm. Also, an overview of aetiology will be given as well as pathophysiology in order to explain the rationale for treatment and monitoring. Relevant research relating to the literature will be utilised throughout in order to critically analyse the care provided for the patient and determine if the patient received evidence based up-to-date care. In accordance with the statement from the Nursing and Midwifery Council (2008) code of conduct regarding patient confidentiality, no personal details of the patient involved will be disclosed. Therefore, the patient will be identified as Mrs S.
Mrs S. is an 88 years old female patient who lives on her own, and was admitted into a rehabilitation ward following a hip operation due to a fall at home. She has a past medical history of Congestive Cardiac Failure (CCF), diverticulitis, and asthma. Also, Mrs S presented with rapid weight loss, palpitation, feeling tired, peripheral oedema, fatigue, difficulty breathing when lying flat in the bed, waking up at night with shortness of breath and anxiety. In addition to all that she had a pressure sore in her bottom that was not broken. In order to have good holistic care of Mrs S, the nursing process was used as identified by Sibson. Sibson (2010) identifies four key steps to the nursing process, which are assessment, planning, implementation and evaluation; which are important for ensuring a quality standard of nursing care.
Malik et al (2004) referred to reflection in practice or on practice as an essential to bring about positive change in care delivery. Reflecting on Mrs S’s care needs all of the following observation are important: temperature, heart rate, respiration, blood pressure, urinalysis, drug administration, electrocardiogram, weighing, and care of pressure area; however for the purpose of this assignment heart rate/rhythm will be discussed.
Firstly, the normal mechanism the heart rate operates when the heart muscular wall contracts to push the blood out and around the body, and then relaxes to load the heart with blood again. According to Crumbie (2007) the pressure in the heart drives the blood through the circulatory system and the electric recoil of the large arteries increases to some extent. An uninterrupted sequence of alternate myocardial tightening and relaxing occurs regularly on an average of 60 to 70 times per minute pumping the blood through the body. Each ventricular tightening expels a volume of blood into the aorta, producing a rise in the blood pressure which causes an enlargement of the artery. The elastic recoil of the aorta during ventricular diastole pushes the blood into the next allocation of the artery which expands and then recoils....