Write my Paper on Congestive heart failure

Analyze pathophysiological processes and mechanisms of human disease, identify clinical signs and symptoms and diagnostic data consistent with the pathology of common health problems and determine appropriate medical treatment and nursing care based on best practices found in the literature. This assignment emphasizes critical thinking and problem-solving through the correlation of cellular and multi-system pathology with related assessment and diagnostic data, medical treatment and nursing management.
The answers to the questions should be complete and include professional literature to support each answer. You should include at least 3 current references (< 5 years old) of which 2 must be journal articles. References should include current nursing journals and other professional health related literature. The assignment should be uploaded electronically into blackboard under the appropriate assignment link.
The paper should be typed using APA format. APA format requires that you use correct grammar and spelling and double-space your entire paper. Use the questions as your headers. Please include the

Answers to Questions
• Demonstrates comprehensive critical analysis of pathology, assessment and diagnostic data, medical and nursing management (points accrued in case study)
30

Congestive Heart Failure Case Study
Nena Clayton and Debi Webb
Patient Profile and Background Information
J.C. presented to the ER complaining of a “racing heartbeat.” She is an over-weight 80 year-old white female, who has been experiencing an increased shortness of breath over the past month. She is also experiencing increased swelling of the ankles and feet over the past two weeks. She feels easily fatigued and has been waking up the past couple of nights “trying to catch my breath”. She has been using several pillows to prop herself up at night. These symptoms are an indication of paroxymal nocturnal dyspnea (PND).
Four years ago she had had an aortic valve replacement along with a two-vessel coronary artery bypass surgery. Her family history is positive for atherosclerosis. Her father died from a heart attack at the age of 65 and her mother died at the age of 70 from complications related to multiple TIAs. She smokes one pack of cigarettes per day for 40 years and expresses the desire to quit smoking, but has failed at multiple attempts in the past. She lives at home alone since her husband’s death last year. She has three daughters that live near her, they each check on her once a week.
She has a history of coronary artery disease (CAD), dyslipidemia, hypertension, diabetes mellitus type II that is diet controlled, as well as a history of atrial fibrillation. The patient’s surgeries include a prosthetic aortic valve replacement, bypass surgery, an appendectomy and hysterectomy.
Question 1: What risk factors for heart disease and heart failure are present in JC’s past medical history? (2 points)

Question 2: What is the pathophysiology of congestive heart failure (CHF)? Include all compensatory mechanisms that further the progression of HF. (3 points)

Question 3: Describe left sided and right sided heart failure and the difference between systolic and diastolic heart failure. Include common manifestations of left and right heart failure in your answer. (4 points)

Question 4: Explain paroxysmal nocturnal Dyspnea (PDN) and what might be causing JC’s PND? (1 point)

Physical Assessment and Diagnostic Data
J.C.’s vital signs are: temperature is 98.7, heart rate is 105, blood pressure 111/73, and oxygen saturation is 94% on room air. Her weight is 278 lbs and height is 5 ft 5 inches, which equates to a body mass index of 40. Her general orientation is alert and oriented to person, place and time. She is sleepy but easily aroused. Her head is normocephalic, with no masses
or tumors noted, neck is supple, trachea midline, and no tenderness noted. PERRLA is intact with normal conjunctiva. Oral mucosa is assessed to be moist, no erythema or exudate noted. Heart rate is 105 beats per minute which is considered tachycardic, but the rhythm is normal. Upon auscultation of the heart S? and S2 is diminished and S? is also audible, no murmurs or bruits auscultated. Respirations are labored; inspiratory crackles are auscultated in the base of the lung field and wheezes are present and moderate. Breath sounds are diminished. There is symmetry noted in the chest wall upon expansion. The musculoskeletal system assessment resulted in normal range of motion, normal strength, no tenderness, and no deformity. Visual assessment of the lower extremities reveals edema 3+ and pitting, no redness is noted. The abdomen is soft, nontender, non-distended, with normal bowel sounds. Cranial nerves II-XII intact and normal speech is observed. No focal neurological deficit observed. No lymphadenopathy is noted. She is cooperative her mood and affect are appropriate with normal judgment.
Question 5: What is the significance of an S? gallop and when is it typically heard in the cardiac cycle? (2 points)

Table 1
J.C’s Arterial Blood Gas Results
Arterial blood gases Normal value J.C.
pH 7.35 – 7.45 7.45
pO2 80-100 mm Hg 118 mm Hg
PaCO2 35 – 45 mm Hg 74 mm Hg

HCO?

22 – 27 mEq/L 47 mEq/L

Question 6: Analyze JC’s ABG results and determine her acid/base abnormality. Give rationale for your answer. (2 points)

J.C. was admitted to the hospital with a diagnosis of congestive heart failure, coronary artery disease, and atrial fibrillation. Upon assessing the arterial blood gases it is noted that her
pO2, PaCO2, and HCO? were all elevated, indicating that the patient was in need of better ventilation and oxygen perfusion.

Table 2
J.C.’s Pertinent Laboratory Data

Lab value (Normal values) J.C. lab value Significance
White blood cell (N= 5-10 x 10?)

11.14 (High) To assess pt’s ability to fight off infection, check immunity. Also indicates inflammation or an infection
RBC (N= Female 4.2- 5. 4 x 10¹² /L)
3.18 (low) To assess for possibility of hemorrhage, anemia.

Hemoglobin (N= 12-15) 7.1 (low) Measures the capability of carrying gases within the blood.

Hematocrit (N= 37% – 47%)

23.2 (low) To assure proper levels of complete RBCs
INR (N= 3.0 – 4.5) 3.5 Indicates the risk of bleeding and bleeding-related events

Sodium (N= 136 – 145mEq/L) 141 To assess electrolytes (balanced/ unbalanced) cell structure

Potassium (N= 3.5 – 5.1mEq/L)
4.1 To assess electrolytes (balanced/ unbalanced) cell structure

Chloride (N= 95 – 112mEq/L) 94 (low) To assess electrolytes (balanced/ unbalanced) cell structure.

Carbon Dioxide (N= 22 – 32mEq/L)
44 mEq/L (high) To assess electrolytes (balanced/ unbalanced) cell structure.

Glucose Level(N= 70 – 105)

135 mg/dL To assess pt. ability to control glucagon and insulin release

Blood Urea Nitrogen (BUN) (N=10 – 20 mg/ dl)

23 mg/dL Assess the amount of urea nitrogen in blood.
Calcium (N= 9 – 10.5mg/dl) 9.3 mg/dL (low) To asses parathyroid function and calcium metabolism

CK (N= 10-70 IU/L) 26 IU/L An enzyme found in high concentration in heart muscles. CK MB (N=0-3%) 2.5 ng/mL To suggest myocardial or skeletal disease. Troponin (N=< 0.1ng/mL) 0.03 ng/mL Indicates myocardial infarction

EGFR Caucasian Female (N= 90 – 120mL/min)

53 mL/min (low) Indicates glomerular functioning

BNP (N=<100 pg/ml)

ANP (N= 20-77pg/ml)
458 pg/ml) (high)

16 (low)
Has an important diagnostic, therapeutic, and prognostic implication.

The hemodynamic effects are mediated by decreases in the atrial filling pressure.

Upon assessing the lab values it is noted that the white blood cells were slightly elevated which indicates the patient is fighting off an infection. CHF is a precursor to pneumonia; therefore the infection she is fighting could be related to pneumonia. Red blood cells, hemoglobin and hematocrit are all low and suggest anemia as well as decreased oxygen carrying capacity of the blood. The decreased glomerular filtration rate is a sign that the patient’s kidneys are not functioning properly as was seen in J.C.’s lab work and poor production of erythropoietin.

Question 7. What is the significance of BNP and ANP in CHF? Explain the physiologic effects and where these hormones are produced. (3 points)
The patient’s portable chest x-ray revealed prominent cardiomegaly, moderate diffuse pulmonary venous congestion, moderate perivascular edema, and postoperative changes from prior heart surgery. Although diagnosis of congestive heart failure may be limited by chest Xray, it is one of the most useful tools available to screen for abnormalities in the size or structure of the heart and lungs (Kee, 2007, p. 636). A 2-D echocardiogram identifies the regional wall motion abnormalities that are associated with congestive heart failure. An echocardiogram can also help identify cardiac tamponade, pericardial constriction and possible valvular heart disease. J.C.’s echocardiogram results revealed a dilated heart with hyperdydamic ejection fraction (EF) of 39%. An EF that is less than 40% is consistent with CHF. A 12-lead electrocardiogram (ECG) was also done; it showed sinus tachycardia with occasional premature ventricular contractions and an old anterior MI. An ECG is a non-specific test that may be useful in diagnosing cardiac ischemia that is caused by congestive heart failure. ECG can also diagnose dysrhythmias that are caused by left ventricular hypertrophy, which often occurs in left sided failure
Clinical Course
J.C.’s medications consist of Lisinopril 5mg twice a day, Simvastatin 40 mg at bedtime, Warfarin 3.5mg once a day at the same time, Carvedilol 12.5mg twice a day and Lasix 20 mg IV every 8 hours. In addition, J.C.’s anemia was treated with a transfusion of 2 units of packed red blood cell transfusion. Lasix was administered post transfusion of the first unit and prior to
administering the second unit to prevent further fluid volume overload. As a result of the blood transfusion, the hemoglobin increased to 9.3 and the hematocrit to 29.4. The electrolytes were within normal limits therefore, there was no indication for intravenous fluid resuscitation or maintenance fluids.
Question 8. What are major actions of medications used for CHF and J.C.’s medical problems? Relate the mechanism of action of the medications to the pathophysiology. (5 points)

Question 9. What is the purpose of the packed red blood cell transfusions for this patient? (1 point)

Question 10. List two nursing diagnoses with related interventions (nursing and medical) that are essential in J.C.’s nursing care? Include rationale for interventions. (4 points)

Question 11: Discuss three patient educational needs that should be addressed? (3 points)