Congestive Cardiac Failure Case Study
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Congestive cardiac failure or congestive heart failure can be defined as the inability of the heart muscles to pump enough blood to all parts of the body, for example brain, liver and kidneys. Heart failure can develop slowly over time as the result of other conditions (such as high blood pressure and coronary artery disease) that weaken the heart. It can also occur suddenly as the result of damage to the heart muscle.(university of Maryland medical center 2014)
Congestive heart failure affects several organs in our bodies and it includes, heart, kidneys, lungs, brain, liver, skin and spleen. Then organ systems that are affected are, cardiovascular system, respiratory system, nervous system, circulatory system skeletal system, and urinary system
A brief overview of the normal functioning of the affected body systems. one of the body systems that is affected with congestive heart failure is the cardiovascular system, this system consists of heart, blood vessels and blood. Its responsible for pumping blood through the body as well as oxygen, nutrient, hormones and cellular waste. It regulates blood pressure through the contraction of the heart pumping and also helps to maintain fluid balance within the body.
The main function of respiratory system is to supply blood rich in oxygen to all parts of the body. The respiratory system does this through breathing. When we breathe, we inhale oxygen and exhale carbon dioxide. This exchange of gases usually takes place in the alveoli and the capillaries. The inhaled oxygen passes into the alveoli and then diffuses through the capillaries into the arterial blood. Meanwhile, the waste-rich blood from the veins releases its carbon dioxide into the alveoli. The carbon dioxide follows the same path out of the lungs when you exhale.
The circulatory system has its main functions as to pump blood containing oxygen and other nutrients around the body. the system consists of the heart, arteries, capillaries and veins. The heart, the lungs, and the blood vessels work together to form the circle part of the circulatory system, the circulatory system contains of two loops of circulatory, the pulmonary circulation which transports de-oxygenated blood from the right atrium and right ventricle to the lungs to pick up oxygen and nutrients and returns to the left side of the heart.
The systemic circulatory which transports blood rich in oxygen from left side of the body and transports it all the body tissues. The circulatory system control the pressure of the blood as it travels through the body and taking away the wastes
The urinary system consists of the kidneys, bladder, ureters and urethra. its main function is to filter metabolic wastes, excess ions, and chemicals from the blood to form urine. They also maintain the homeostasis of several important internal conditions by controlling the excretion of substances out of the body.through this it regulates the blood pressure. After the whole process of urine formation is completed the ureters carry urine to the urinary bladder and later discharged in the urethra.
The nervous system consists of brain, spinal cord, sensory organs, and all of the nerves that connect these organs with the rest of the body. Together, these organs are responsible for the control of the body and communication among its parts. Neurons transmit information through electrical signals to the brain. chemical help to bridge gap between one neuron and the other.
there are several signs and symptoms of heart failure and they are discussed here below:
- Shortness of breath. This is one of the signs and symptoms of heart failure, this happens due to the back up of blood in the pulmonary veins which leads fluid to leak and build up in the lungs because the heart cant keep up with the supply.
- Tiredness or fatigue. This happens because the heart cant keep up with the demand of supply of blood to all the body tissues so u feel tired because its being overworked.
- Edema. There build up of excess fluids in the body parts because the heart cant pump all the blood as a result there is the excess build up of fluids. there is slow cardiac output.
- Persistent coughing or wheezing due to the build up fluids in the lungs as a result of heart not pumping all the blood out of the lungs.
- Lack of appetite , nausea this occurs because there is less cardiac out as a result less blood reaches the digestive system which cause problems with the digestion process.
- Confusion. This is one of the symptoms and the reason behind is because there is less cardiac out the nutrients also is less and not enough for the body tissues, which will lead to less nutrients like sodium which will lead to someone having confusions and impaired thinking.
- Tachycardia. This is one of the signs and symptoms of heart failure. The increased heart rate is due to the heart pumping harder to meet the demands of supply of blood and nutrients to the rest of the body which is not enough.(American heart association 2014)
- sudden weight gain from fluid retention.
- Chest pain if the heart failure is caused by heart attack.
- Elevated blood pressure due to tachycardia as a result heart trying to pump more blood to other parts of the body.
When critically analysing Mr wrights admission form it clearly indicates signs and symptoms of congestive cardiac failure. his circulation is not okay because he suffers from peripheral vascular disease which it can easily contribute to heart failure. secondly considering the loss of appetite which can be attributed to low blood supply to the digestive system. Checking his oxygen saturation levels which are low due to the heart failing to pump lots of blood out of the lungs which can lead to leak of fluids in the lungs. another sign is the confusion. Despite him having dementia but have low cardiac out supply to the rest of the body tissues can lead to confusion which is also a sign of heart failure.
Well diabetes might be related to his leg ulcer considering the fact that patients who are diabetic at a certain stage they may have reduced sensation of the skin on there feet. They are nerve endings on the skin usually fails to detect any pain or sensation and as a result it can be a high risk of leg ulcer if the patient has a cut or blister on the feet it can easily develop to leg ulcer which can if its serious it may lead to amputation. for his case it might have played a role. In patients who are diabetic there might be poor circulation of blood to the feet which might be a contributing factor to his leg ulcer and finally the amputation of the left toe.
Lasix (furosemide) is a diuretic (water pill) that prevents your body from absorbing too much salt, allowing the salt to instead be passed in your urine(drug14).if you got excess fluids it helps to reduce them. it treats fluid retention in people with congestive heart failure, kidney problems and liver diseases. He is given the drug in order to get rid of the excess fluids retention. the systems affected by this drug re cardiovascular and urinary system.
Conditions that are commonly associated with aging according to Mr wrights relevant medical history.
- Arthritis the inflammation of the joints, and creates pain and stiffness when moving these joints. Osteoarthritis is the most common in the elderly. when cartilage is damaged or worn out the bone rub on each other causing friction which causes pain when moving the joints.
- diabetes mostly type 2 which affects the older people though young people Can also develop it. The risk of developing type 2 diabetes increase with age mostly over 55 years of age. Its where the pancreas produces insulin but its not sufficient enough to work effectively.
- Glaucoma is an eye diseases that results to blindness in the elderly especially over 80 years. Its a group of eye disease in which the optic nerve at the back of the eye is slowly destroyed. Poor blood supply to the vital optic nerve can lead to glaucoma.(glaucoma2014)
Factors that may impact his safety whilst in hospital and when he returns home. Checking through his admission history and assessment increased level of confusion can be one of the factors that can impact his safety. He fails to remember because the low blood supply and low oxygen levels in the body which fail to supply enough to the brain and as a result this will lead to increased levels of confusion. He may not remember why he is in hospital, he may forget to take his medications as prescribed the correct dose at the right time and this is likely to occur when he is at home.
Mr. Wright is receiving meals on wheels while he is at home, because of his loss of appetite as a result of congestive heart failure he may not take his meals and he can be at a risk of being malnutrition, which will eventually lead to a high falls risk because he will not have the strength and energy to walk.
From the assessment it seemed he cared for his dog and as a result of being hospitalised he his anxious about the dog which can lay an impact on his safety. He is not settled at all and it may increase risk of more complicated health problems considering he has congestive heart failure. he worries a lot about the dog wondering who is going to care for it yet he is not well.
While he is at home because of the level of consciousness which at time deteriorate he might just forget to walk with the walking stick at all times and combine with the nutritional problems he might be of high falls risk. Because he got glaucoma this might also play a role considering his safety back at home which can have a huge impact on hi mobility.
Other health professionals that can be involved in Mr Wrights can and what services they can provide
Dietician because he is diabetic and has lost appetite, the dietician would assess and provide the best solution to help improve his appetite. Physiotherapist would also be involved in Mr wrights care to assesses the mobility levels and recommend the best way of care he needs as fur as mobility is concerned. he would check if he is a high or low falls risk and provide the best tool to aid mobility.
Optometrist would also be involved in his care, he would assess the level of glaucoma and check if its worsening or getting better and the likely impacts it can have on his levels of mobility.
From the medical history he has dysphagia the speech pathologist will be involved to assess his level of swallowing if the problem is worsening or it has improved and make necessary recommendations so that when he goes home the meals on wheels can supply him with the recommended type of food that he can tolerate.
An occupational therapist would also be involved in his care he or she will come in handy to assess the hazard at home and all the id tools that he requires in order to reduce any risk of injuries occurring at home. For example He may assess and recommend commode at night to avoid the walking to the toilet at night in order to reduce the risk of falling.
A social worker will also be involved in his care considering he is at home alone with his dog, he might need home visits where the social worker will check how he is coping in the community and assess if he is socially isolated or he gets involved in the society, if family and friends visit him at all.
The nursing documentation expected to be used in the care of MR. Wright are as followed.
- Admission form and passed medical history form.
- medications chart
- nursing care plan.
- progress notes
- allied health chart,
- ECG charts,
- observation charts
- fluid balance chart
- and bowel chart.
- University of Maryland Medical Center 2014 viewed 18th sept 2013 http://umm.edu/health/medical/reports/articles/heart-failure#ixzz3CXXtD2EZ
- Virtual medical center 2014 last reviewed 7th may 2010 respiratory system http://www.myvmc.com/anatomy/respiratory-system/
- Cardiovascular system the inner body last viewed 2013 http://www.innerbody.com/image/cardov.html
- Urinary system the inner body last viewed 2013, http://www.innerbody.com/image/urinov.html#full-description
- Nervous system the inner body last viewed 2013 http://www.innerbody.com/image/nervov.html#full-description
- American heart association (2014) warning-Signs-for-Heart-Failure last reviewed 20/8/2012 http://www.heart.org.
- Australia, Diabetes. (2014, January 6). Diabetes and Your Feet. Retrieved from Australia Diabetes: https://www.diabetesaustralia.com.au/Living-with-Diabetes/Mind--Body/Diabetes--Your-Feet/
- Drugs.com. (2014). Retrieved from Lasix: http://www.drugs.com/lasix.html
- Australian institute of health and well being (2013)osteoarthritis http://www.aihw.gov.au/osteoarthritis/
- Gabrielle K, Kate S and Jodie H (2013)theory and practice Tabbners nursing care 6th edition.
- Glaucoma Australia (2014)Retrieved from Glaucoma http://www.glaucoma.org.au/what.html.
- The human heart circulatory system:(2014)retrieved from Franklin institute: http://learn.fi.edu/learn/heart/systems/circulation.html