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CONGESTIVE CARDIAC FAILURE
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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).
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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).
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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
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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
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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
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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.
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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
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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
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Felker, G. M., Lee, K. L., Bull, D. A., Redfield, M. M., & Stevenson, L. W. (2011). Diuretic
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Felker, M., & Lee. (2011). Diuretic strategies in patients with acute decompensated heart
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Khand, A. U., Chew, P. G., Douglas, H., Jones, J., Jan, A., & Cleland, J. G. (2015). The
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