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Running Head: CONGESTIVE CARDIAC FAILURE CONGESTIVE CARDIAC FAILURE [Name of Student] [Name of Affiliated Institution CONGESTIVE CARDIAC FAILURE 2 1. Causes, incidence and risk factors of Congestive cardiac failure how it can impact on the patient and family Answer Congestive cardiac failure (CCF) is a complication that forces the heart to work too hard. Some of the major causes of congestive cardiac failure include coronary artery disease, hypertension, disorders of the heart valves, prolonged alcohol abuse, and unknown causes, such as the recovery from myocarditis (Felker G. M., Lee, Bull, Redfield, & Stevenson, 2011). Other occurring but rare causes include viral infections. This was the case witnessed in South Sydney hospital when a patient by the name of Sharon was admitted due to the stiffening of the heart muscle, disorders of the heart rhythm and thyroid disorders. The doctors further noted that she might had been having some underlying heart disease, from where she was forced to take certain medications (Calvillo–King, et al., 2013). This can also lead to the development congestive cardiac failure. Medicines from the nonsteroidal anti-inflammatory drugs category primarily play a leading role as they can cause sodium retention that inhibits the power of the heart muscle (Felker & Lee, 2011). Each year Chronic cardiac failure affects nearly 300 000 Australians while another 30 000 new cases are diagnosed each year. These figures lead to 43 000 hospitalisation cases and 2200 deaths per annum (Bart, Goldsmith, Lee, Givertz, & O'Connor, 2012). A recent survey showed that in every 1000 encounters, seven patients would come while complaining of chronic cardiac failure. Another study conducted by 341 Australian general practitioners also stated that in every 100 patients aged above 60, 11 would have been diagnosed with Chronic cardiac failure based on known aetiological factors and clinical features (Bart, Goldsmith, Lee, Givertz, & O'Connor, 2012). CONGESTIVE CARDIAC FAILURE Some of the risk factors associated with CCF include poorly controlled high blood pressure, diabetes, high cholesterol, smoking, and family history. The disease also becomes a risk factor for people as they hit certain ages. Over the years various studies have implicated infections, obstructive sleep apnea, drug and alcohol abuse and connective tissue disorders such as sarcoidosis, systemic lupus erythematosus and amyloidosis as major risk factors to contacting CCF. CCF is a condition that requires a routine management. Patients have to adjust to a new lifestyle where they watch what they eat, drink or smoke. As mentioned above with the case of Sharon her doctors recommendations was that she made physical exercise her daily routine since her heart muscles would get the energy to rhythmically pump blood. Family members have a huge role in supporting affected persons. They are the ones who support patients through their exercise routines. On being diagnosed with CCF medical bills follow and at times reconstructive heart surgeries may be required. Paying for such bills may be difficult for most families, and this is when families are forced to get into debt so as to save their loved one (Jones, Haldar, & Hussain, 2013). 2. Five common signs and symptoms of the Congestive Cardiac Failure. Answer: Exercise intolerance An early symptom of CCF includes exercise intolerance on things that a patient could have done before. During physical activities, the body requires oxygen and other nutrients and in the real sense the heart fails the patient in pumping enough blood to avail these nutrients to the body (Habedank, Meyer, & Hetzer, 2013). As a result, people feel tired in walking let alone jogging. This was the classic condition which was seen from Sharon who on her arrival at the hospital she was unable to walk to the doctor’s office (Calvillo–King, et al., 2013). 3 CONGESTIVE CARDIAC FAILURE Shortness of breath When congestive cardiac failure worsens, fluids get trapped in the lungs and inhibit oxygen that was to be mixed with blood, thus causing dyspnoea at rest and orthopnoea at night (Verissimo, et al., 2015). Affected people may be forced to wake up at night due to breathing difficulties and just to stand for relief. Fluid retention and swelling Oedema in the legs and ankle may occur, especially after prolonged sitting (Felker & Lee, 2011). Daily weight checks are advisable for people with heart failure since the amount of fluid retention replicated by the amount of weight gained. For this reason, people with heart failure are advised to know their dry weight. Persistent coughing Doctors who attended to Sharon noticed that she had a persistent cough and wheezing which were the direct consequences of heart failure (Calvillo–King, et al., 2013). On several occasions’ people with CCF cough up phlegm, a thick, mucous-like substance that contains small pigments of blood (Davies, Manisty, & Petraco, 2013). This event often leads to other conditions such as pneumonia. The wheezing or coughing might also be as a result of congestion or fluid accumulation, in the lungs, which raises the effort needed for breathing. Cold in the leg, feet and arms People with congestive cardiac failure may realise that they over and over again feel cold on their legs, feet and arms (Sommer, Hijazi, & Rhodes Jr, 2014). That happens as a result of the body circulating most of the blood to the brain and to other vital organs while trying to make up for the failing heart's failure to pump enough blood to the whole body. The result is that 4 CONGESTIVE CARDIAC FAILURE extremities receive less blood and without blood keeps them warm certain parts of their bodies feel cold. These symptoms are mainly experienced by people who have chronic or severe heart failure. 3. Two common classes of drugs used for patients with Congestive Cardiac Failure Answer 1: Beta-blocker The Beta-blocker is a class of medicine used to treat cardiac failure symptoms that are made worse by the presence of catecholamines hormones. The body excretes these hormones in response to heart failure. For this reason, beta-blockers have been put to the test, and they have come out clear as effective treatments for heart failure. Beta-blockers have different effects throughout the body. They are recommended in the for the treatment of heart disease that cause high blood pressure, chest pain, arrhythmia and heart attacks (McMurray, et al., 2012). Beta-blockers also work by decelerating the heart rate, thus enables the left ventricle to fill more completely (McMurray, et al., 2012). Other medicines within this class help to widen blood vessels in the body. Thus making them useful to people with certain types of heart failure that may be accompanied high blood pressure. Examples of medicines from this class include metoprolol and bisoprolol (McMurray, et al., 2012). Beta-blocker drugs have varying side effects that range from feeling tired, hives, swelling of legs along with cold feet and hands. Answer 2: Angiotensin-converting enzyme (ACE) This class of inhibitors hamper with the activities of an enzyme which makes blood vessels to constrict. Therefore blood vessels dilate, easing up the flow of blood through the vessels, and later reducing blood pressure. Stopping blood vessels from narrowing helps to improve blood flow and reduces the backing up of blood in the lungs and heart, and reduces the pressure that 5 CONGESTIVE CARDIAC FAILURE the heart's left ventricle must pump against (Calvillo–King, et al., 2013). ACE also increases the discharge of water and sodium in the urine, thus lowers blood pressure. ACE inhibitors also have an impact on the hormones that regulate water and sodium balance through the body. Patients with systolic heart failure, which comes as a result of left ventricular dysfunction, are often given ACE inhibitors. In people who show the symptoms of heart failure, these drugs can relieve symptoms, lower risk of death and reduce the risk of being hospitalized for heart failure (Khand, et al., 2015). Side effects include trouble breathing, swelling of face, tongue, lips or throat, hives, irregular heartbeats which comes as a result of much potassium in the blood, dizziness or lightheadedness or fainting, dry cough and headache. Examples of this drug include benazepril, captopril and trandolapril. 3. The priority of nursing care strategies to be used within the first 24 hours post admission of a patient. Answer With the heart failing to pump enough blood to meet all of the metabolic needs of the body a patient gets tired and might sometimes get pale thus the first nursing intervention will to make the patient participate in activities which will reduce the workload of the heart (Liu, et al., 2012). These nursing care strategies will be given in accordance to a case study on Sharon who was admitted to the South Sydney hospital after being discovered that she was suffering from Cardiac failure. As a nurse one will also have to assess for abnormal lung and heart sounds. This will enable a detection of left sided heart failure that occurs with chronic renal failure patients who have excess fluid volume which the kidneys are unable to excrete. Monitoring of blood pressure, due to the fact that renal failure patients are often hypertensive, which comes from excess 6 CONGESTIVE CARDIAC FAILURE 7 fluid (Felker, Lee, Bull, Redfield, & Stevenson, 2011). Doing an assessment of the patient’s peripheral pulses and skin temperature is important. This is because oxygenation and perfusion of tissues secondary to pump and Anemia ineffectiveness may result in decreased temperature and peripheral pulses which are difficult to palpate (Felker, Lee, Bull, Redfield, & Stevenson, 2011). With fluid samples taken from the patients it will be advisable to monitor results of diagnostic and laboratory tests as they will give clues on the status of the disease alongside the best response to treatments. The next measure involves measuring arterial blood gases (ABGS) and oxygen saturation. This will allow give information on the heart’s ability to supply distal tissues with oxygenated blood (Bart, Goldsmith, Lee, Givertz, & O'Connor, 2012). With the given results a nurse can administer oxygen to the patient based on the symptoms, ABGs and oxygen saturation. The next stage will be to implement strategies that will help to treat electrolyte and fluid imbalances. This will help to decrease the chances of developing cardiac arrests due to imbalances (O'Connor, et al., 2011). A nurse has to also help the patient to assume a high Fowler’s position which allows chest expansion, thus improving the pulmonary capacity. As a nurse should encourage periods of rests and help the patient with all activities since this will reduce cardiac workload and reduce the myocardial oxygen consumption. This period also call for adequate sleep for the patient to enhance the relaxation of the body (Pocock, et al.). It is also advisable to offer the patient cardiac glycoside agents, especially if they exhibit signs of a left sided failure, while doing this the nurse must also monitor for any signs of toxicity (New South Wales Goverment, 2007). A prescribed drug to be used for this event often includes digitalis which has a boosting isotropic effect on the patient’s myocardium which also boosts contractility, thus enhancing the cardiac output. CONGESTIVE CARDIAC FAILURE 8 References Bart, B. A., Goldsmith, S. R., Lee, K. L., Givertz, M. M., & O'Connor, C. M. (2012). Ultrafiltration in decompensated heart failure with cardiorenal syndrome. New England Journal of Medicine, 2021-2042. Calvillo–King, L., Arnold, D., Eubank, K. J., Lo, M., Yunyongying, P., & Stieglitz, H. (2013). Impact of social factors on risk of readmission or mortality in pneumonia and heart failure: systematic review. Journal of general internal medicin, 232-300. Davies, J. E., Manisty, C. H., & Petraco, R. (2013). First-in-man safety evaluation of renal denervation for chronic systolic heart failure: primary outcome from REACH-Pilot study. International , 27-67. Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., & Stevenson, L. W. (2011). Diuretic strategies in patients with acute decompensated heart failure. New England Journal of Medicine, 232-321. Felker, M., & Lee. (2011). Diuretic strategies in patients with acute decompensated heart failure. New England Journal of Medicine, 254-632. Habedank, D., Meyer, F. J., & Hetzer, R. (2013). Relation of respiratory muscle strength, cachexia and survival in severe chronic heart failure. Journal of cachexia, sarcopenia and muscle, 277-285. Jones, D. G., Haldar, S. K., & Hussain. (2013). A randomized trial to assess catheter ablation versus rate control in the management of persistent atrial fibrillation in heart failure. Journal of the American College of Cardiology, 10-54. CONGESTIVE CARDIAC FAILURE Khand, A. U., Chew, P. G., Douglas, H., Jones, J., Jan, A., & Cleland, J. G. (2015). The Effect of Carvedilol on B-Type Natriuretic Peptide and Cardiac Function in Patients with Heart Failure and Persistent Atrial Fibrillation. Cardiology, 149-192. Liu, S., Ngo, D. T., Chirkov, Y. Y., Sheikh, A. R., Licari, G., Stewart, S., & Horowitz. (2012). Brain Natriuretic Peptide (BNP) Suppresses Neutrophil Superoxide Release: Attenuation in Patients with Congestive Heart Failure (CHF). Circulation. Circuation, 453-532. McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., & Ben Lamin, H. A. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure. European journal of heart failure, 465-579. New South Wales Goverment. (2007, May 1). The Prince of Wales Hospital & Community Health Services. Retrieved from Nurse Practitioner Clinical Guideline - The Management of Heart Failure. The Patient With Chronic Heart Failure In Australia: http://www0.health.nsw.gov.au/resources/nursing/p O'Connor, C. M., Starling, R. C., Hernandez, A. F., Armstrong, P. W., Dickstein, K., Hasselblad, V., & Tanomsup, S. (2011). Effect of nesiritide in patients with acute decompensated heart failure. New England Journal of Medicine, 20-34. Pocock, S. J., Ariti, C. A., McMurray, J. J., Maggioni, A., Køber, L., & Squire, I. (n.d.). ., ... & Doughty, R. N. (2013). Predicting survival in heart failure: a risk score based on 39 372 patients from 30 studies. European heart journal, 1928-2045. Sommer, R. J., Hijazi, Z. M., & Rhodes Jr, J. F. (2014). Circulation. Pathophysiology of Congenital Heart Disease in the Adult. Sysdney: Wiley and Sons. 9 CONGESTIVE CARDIAC FAILURE Verissimo, P., Timenetsky, K. T., Casalaspo, T. J., Gonçalves, L. H., Yang, A. S., & Eid, R. C. (2015). High Prevalence of Respiratory Muscle Weakness in Hospitalized Acute Heart Failure Elderly Patients. PloS one, 34-76. 10