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Faculty Of Applied Medical Science
Department Of M.Sc. In Critical Nursing
Case Study On
Heart failure
Overview Of
Heart failure
Results from changes in the systolic or diastolic function of the left ventricle. The heart fails when, because
of intrinsic disease or structural, it cannot handle a normal blood volume or, in the absence of disease, cannot
tolerate a sudden expansion in blood volume. Heart failure is a progressive and chronic condition managed by
significant lifestyle changes and adjunct medical therapy to improve quality of life.
Signs And
Symptoms
•
Left side:
•
1. Dyspnea or breath may be precipitated by
1.
minimal to moderate activity.
2. Cough. The cough associated with left ventricular
2.
failure is initially dry and nonproductive.
3. Pulmonary crackles. Bibasilar crackles are
detected earlier and as it worse’s , crackles can be
3.
auscultated across all lung fields.
4. Low oxygen saturation levels. Oxygen saturation
may decrease because of increased pulmonary
pressures.
Causes
•
•
•
•
Coronary artery disease
Atherosclerosis
Ischemia
Cardiomyopathy
•
Systemic or pulmonary hypertension.
Right side:
Enlargement of the liver result from venous
engorgement of the liver.
Accumulation of fluid in the peritoneal cavity
may increase pressure on the stomach and
intestines and cause gastrointestinal distress.
Loss of appetite results from venous
engorgement and venous stasis within the
abdominal organs.
Risk Factors
•
Non-modifiable:
•
•
•
•
Age: A damaged and narrowed artery is more
likely to develop as people age.
Gender: Men are at greater risk, but the risk
increases for women after menopause.
Family history of ischemic heart disease: There
is a high risk if the immediate male relative
(father or brother) had heart disease before age
55 or if the female relative (mother or sister)
had it before age 65.
Race/ethnicity: Minority groups such as
Hispanics and Blacks have a higher incidence
of CAD.
•
Modifiable:
•
Hypertension: The arteries may become stiff
and rigid if high blood pressure is uncontrolled.
Blood flow may be slowed by coronary artery
narrowing.
•
Hyperlipidemia/hypercholesterolemia: The risk
of atherosclerosis can rise if there is excessive
“bad” cholesterol (low-density lipoprotein –
LDL) or decreased “good” cholesterol (highdensity lipoprotein – HDL) in the blood.
Diabetes or insulin resistance:Diabetes or
insulin resistance causes hardening of the blood
vessels and fatty plaque buildup.
Kidney disease: Kidney diseaseimpairs the
blood pressure regulation function of the
kidneys.
Tobacco use: Firsthand and secondhand
smoke increases blood vessel constriction.
Obesity: Obesity increases cholesterol levels by
contributing to plaque buildup in the arteries,
narrowing of blood vessels.
Physical inactivity: Lack of physical activity
increases cholesterol in the blood.
Diet: Food rich in saturated fat raises LDL
“bad” cholesterol.
Stress: Stress increases inflammatory levels
causing the narrowing of the blood vessels.
Alcohol use: Alcohol weakens the heart muscle
and affects blood clot formation causing blood
vessel obstruction.
Lack of sleep: Poor sleeping habits
and insomnia increase stress levels resulting in
blood vessel constriction.
•
•
•
•
•
•
•
•
•
Case of Patient
(Sheet)
A.1.Personal history:
Special habits: Alcohol (N o ), Smoker (
A. HISTORY
A.2. Complaint:
No).
Norah Alanazi 54-year-old woman presented to the emergency department with
shortness of breath (SOB) for 2 months that progressed to an extent that she was
unable to perform daily activities. She also used 3 pillows to sleep and often
woke up from sleep due to difficulty catching her breath.
Her current home medications included aspirin, atorvastatin, amlodipine, and
metformin.
A.3. Present history: Her medical history included hypertension, dyslipidemia, diabetes mellitus.
A.4. Past history:
history of Thyroidectomy surgery 13years ago.
A.5. Family history:
– Similar conditions in the family: No ( ), yes ( )
– Consanguinity between parents: No ( ), yes ( ).
a. Monitor vital signs.
Due to the decreased oxygenated blood supply to the heart, vital signs (especially the pulse rate and
blood pressure) are expected to increase or alter.
b. EKG and telemetry monitoring.
An EKG should be completed immediately when a patient reports chest pain to assess for
dysrhythmias. Continuous telemetry monitoring is appropriate for a known cardiac history.
Assessment
c. Systemic assessment approach:
2. Neck: distended jugular veins
3. CNS: acute distress, dizziness, lightheadedness, syncope, and lethargy
4. Cardiovascular: tachycardia, chest pain, abnormal heart sounds (murmur at the apex or bruit on carotid
artery) upon auscultation, irregular heartbeats (arrhythmias)
5. Circulatory: decreased peripheral pulses
6. Respiratory: dyspnea, tachypnea, Orthoptera, abnormal sounds (crackles) upon auscultation, activity
intolerance
7. Gastrointestinal: nausea and vomiting
8. Lymphatic: peripheral edema
9. Musculoskeletal: neck, arm, back, jaw, and upper body pain, fatigue
• Integumentary: cyanotic and pale skin and excessive sweating
4. Calculate the patient’s ASCVD (atherosclerotic cardiovascular disease) risk score.
5. The ideal score is low ( 40%.
1. Auscultate the apex of the
heart sound S3 or S4 can be
heart.
detected by auscultating the
left lower sternal border.
Children and athletes may
evidenced by:
naturally produce an S3 heart
1. Ejection fraction
less than 40%
sound, but it is an abnormal
finding in older adults and
those with heart failure.
2. Chest pain
Blood ejecting into a rigid
ventricle causes the S4 heart
sound.
2.
Obtain EKG.
•
EKG can help rule out HF
with a high sensitivity but
low specificity. It can
reveal the cause (such as a
history of previous MI) and
Keep patient stable
offer therapeutic
indications (such as
anticoagulation for atrial
fibrillation).
•
3. Excess Fluid
Volume r/t reduced
glomerular
filtration rate.
evidenced by:
Shortness of
breath
2. Edema in
extremities
3. Jugular vein
distention
1.
Patient will
1. Maintain upright position.
demonstrate
stable fluid
volume
through
balanced
intake and
output, normal
baseline
weight, and no
peripheral
2. Administer diuretics.
edema.
•
Semi-Fowlers or Fowler’s
positioning will help the
patient breathe easier and
maintain comfort. They
may require extra pillows
or need to sleep in a
reclining chair at home.
•
Diuretics are often
prescribed as they rid the
body of excess fluid which
will decrease edema and
dyspnea. Diuretics can be
given by mouth or IV and
must be monitored closely
as they increase urination,
decrease blood pressure,
and decrease potassium.
•
Diet education may
include decreasing sodium
and restricting fluids and
will be directed by a
provider. Patients should
not use table salt or add
salt to foods and should be
aware of sodium contents
in frozen or canned food.
3. Instruct on sodium and fluid
restrictions.
If a fluid restriction is
ordered, the patient can
track this by using a large
pitcher that is their daily
amount of fluid and
drinking from it
throughout the day. Ensure
the patient understands
their restriction includes
all sources of fluid: soups,
jello, and ice cream.
4. Teach how to monitor for fluid
volume overload.
•
Educate patients at
discharge on signs of fluid
retention. They should
weigh themselves daily,
using the same scale and at
the same time each day. If
a weight gain of 2 lbs in
24 hours or 5 lbs in a week
is observed, they should
call their doctor. Observed
swelling to ankles or feet
as well as an increase in
dyspnea also requires
assessment.
4.Ineffective Health
Maintenance r/t Lack •
of understanding of
heart failure and
prognosis.
evidenced by:
1. she was unable to
perform daily
activities.
1. Assess the level of understanding
Patient will
of the disease process.
take
•
responsibility
for their health
outcomes by
identifying
areas for
improvement.
•
2. Assess support system.
Determine the patient’s
present knowledge of risk
factors, symptoms, treatments,
and goals in order to tailor
teaching to meet their needs.
•
Goal is
partially
met.
Management of chronic
conditions can be very
challenging for patients and
having a strong support
system can assist in better
adherence to the treatment
plan.
Education &
Health Promotion
•
•
Patient education. Teach the patient and their families about medication management, low-sodium
diets, activity and exercise recommendations, smoking cessation, and learning to recognize the signs
and symptoms of worsening HF.
Encourage the patient and their families to ask questions so that information can be clarified and
understanding enhanced.
•
Shared decision making is the process through which clinicians and patients share information with each other and work toward
decisions about treatment chosen from medically reasonable options that are aligned with the patients’ values, goals, and
preferences.
•
For patients with advanced heart failure, shared decision making has become both more challenging and more crucial as duration
of disease and treatment options have increased.
•
Difficult discussions now will simplify difficult decisions in the future.
•
Ideally, shared decision making is an iterative process that evolves over time as a patient’s disease and quality of life change.
•
Attention to the clinical trajectory is required to calibrate expectations and guide timely decisions, but prognostic uncertainty is
inevitable and should be included in discussions with patients and caregivers.
•
An annual heart failure review with patients should include discussion of current and potential therapies for both anticipated and
unanticipated events.
•
Discussions should include outcomes beyond survival, including major adverse events, symptom burden, functional limitations,
loss of independence, quality of life, and obligations for caregivers.
•
As the end of life is anticipated, clinicians should take responsibility for initiating the development of a comprehensive plan for
end-of-life care consistent with patient values, preferences, and goals.
•
Assessing and integrating emotional readiness of the patient and family is vital to effective communication.
•
Changes in organizational and reimbursement structures are essential to promote high-quality decision making and delivery of
patient-centered health care.
Presentation rubric
Presenter’s Name:
Topic Name:
Date: ————————————– Group: —————————————————————–Evaluation Items
Items
Category
The content is comprehensive and clear.
The content was organized in logical manner.
The presentation contained examples and
useful techniques that applied to current
work.
The content focused on major facts or ideas.
Content
Poor
(1)
Fair
(2)
Good
(3)
Excellent
(4)
▪ Speaker summed up main points in
conclusion.
The presenter was knowledgeable about the
topic and any related issues.
The
presenter
answered
questions
effectively.
Presenter
The presenter had a fluidity of language.
The presenter maintained the attention and
interest of audiences.
The presenter appears prepared and
understand the material.
The presenter summarizes when needed.
Organization
Presentation
Style
Delivery
The presenter delivered the material in a clear
and structured manner.
Level of presentation is appropriate for the
audience.
Presentation is a planned
Conversation,
paced
for
audience
understanding.
The presenter talks about the slides rather
than simply reading them to the audience.
Total
Course instructor Name:
Comments: ———————————————————————————————————-
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