Heart Failure Case Study

2229 words - 9 pages

Heart failure (HF), also known as congestive cardiac failure (CCF), is the inability of the heart to pump sufficiently to meet the body's oxygen demand. HF is highly associated with other cardiovascular diseases, and it is one of the major leading causes of death in Australia (Brown, Edwards, Seaton, & Buckley, 2015). This paper will examine CCF based on the case study of M.G, 76 year old female, who is admitted to hospital with dyspnoea, bilateral leg oedema and weight gain. A comprehensive patient medical and family history and clinical assessments will be provided. Using the clinical reasoning model three nursing diagnoses will be identified with specific interventions and rationales; it will also reflect and evaluate the care. Clinical reasoning cycle is a decision-making framework for healthcare professionals to develop care plans for the patient. It includes 8 steps that are considering patient situation, collecting information, process information, identify problems, establish goals, and take actions, followed by evaluation and reflection (Brown et al., 2015).
HF involves inadequate pumping or filling of the heart, resulting in insufficient blood supply to the body. This means a decrease in cardiac output (CO). CO is determined by heart rate (HR) and stroke volume (SV) (LeMone, 2017). Therefore, when the heart fails, compensatory mechanisms are activated in order to restore the normal CO by either increasing HR or SV. The mechanisms include sympathetic nervous system (SNS) activation, neurohormonal responses, ventricular dilation and ventricular hypertrophy (Brown et al., 2015). SNS activation is the first line but the least effective. SNS stimulates both cardiac and vascular response which increase HR, myocardial contractility, and cause peripheral vasoconstriction (LeMone, 2017). Although this mechanism will be effective temporarily, it will eventually hasten the progress of the condition as it increases the heart's workload and oxygen needs. The second mechanism is renin-angiotensin-aldosteron system. The kidneys will receive less blood flow due to the decreased CO. As a response, the kidneys release renin which results in sodium and water retention and vasoconstriction in order to increase the fluid volume (Brown et al., 2015). The posterior pituitary gland also releases antidiuretic hormone (ADH) in order to increase water reabsorption in the kidneys. Due to this mechanism, blood volume will increase, resulting in heavier workload to the heart. Dilation of the heart chambers will occur because of the increased blood volume. Initially, more stretched muscle fibre increases ventricular contractility, according to the Frank-Starling law. However, the heart muscle fibre will be eventually overstretched and lose its elasticity, resulting in decreasing CO. Hypertrophy can also occur as the heart muscles over work for a long period. Again, this will become ineffective in contraction while the increased muscle mass require more oxygen to...

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