Mr. Paul Carson, a 76-year-old polish male with poor English skills, was admitted to a medical ward via direct admission via GP. Mr. Carson has been admitted for investigation, following prior diagnosis of congestive heart failure by the GP. He has never been admitted for this condition and has no known allergies. In most cases, people mistake general cardiac failure for congestive heart failure. The two are very distinct from each other and confusion of the two must be avoided for the sake of handling patients like Mr. Carlson.
General cardiac failure can be described as the sudden electrical malfunction of the heart which causes irregular heartbeat commonly known as arrhythmia ( Abraham et al., 2011) . According to Abraham et al. (2011), this sudden disruption of the functionality of the heart, blood pumping to major organs within the body is affected making a person to lose his or her consciousness and pulse. Without immediate treatment, a person may die quickly. CHF, on the other hand, occurs when an individual heart muscle does not pump the blood as recommended ( Taylor et al., 2013 ) . Unlike general cardiac failure which renders the heart unable to regularly pump the blood, CHF results into weak pumping, to mean it pumps inefficiently. To understand CHF better, its causes, initial nurse care, effective lifestyle, and medication will be discussed in regards to Mr. Carlson.
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Aetiology of CHF
The common belief among people is that primary causes of Congestive Heart failure are Coronary artery disease acting either alone or as a combination of hypertension. Coronary artery disease (CAD) is a disease that affects the arteries that supply the blood and oxygen to the heart ( Ambrosy et al., 2014 ) . The condition reduces the amount of blood flow to the heart muscle leading to blockage or narrowing which lessen the supply of oxygen and nutrients to the heart ( Booley et al., 2010) . As much as it is true that CAD is one cause, scientists argue that it can’t be classified as the primary aetiology of CHF. Scientists claim that there are some diseases that can lead to CHF apart from CAD and Hypertension; for example, diabetes mellitus and atrial fibrillation.
In addition to the disease mentioned, various conditions and factors can lead to Congestive Heart Failure:
Heart attack : This is a condition that is commonly experienced when the coronary heart suddenly becomes blocked or narrowed ( Taylor et al., 2016) . Consequently, the flow of blood to the heart muscle is affected and reduced. This result in damage to the heart muscle making its work to become erratic.
Cardiomyopathy. This is a condition where the heart muscle functions are affected because of other factors other than artery and blood flow. They are as a result of heart infections or alcohol and drug usage. Such drugs are too much smoking of cigarettes ( Taylor et al., 2012) .
Conditions that render heart burdened. Some conditions can overwork the heart leading to CHF. These conditions include high blood pressure, valve disease, kidney disease, and heart defects from birth. When the heart is overworked heart failure can be the consequence ( Smeulders et al., 2010) . The heart can also be overworked when a person experiences various diseases at once.
Possible Causes of CHF in Mr. Carlson and the unattended Conditions
In the case of Mr. Paul Carson, various causes could have been the cause of his congestive Heart Failure. There are some of his past medical experiences that could lead him to attract the condition. Some of these include coronary heart disease (CAD), Hypertension, and smoking. Mr. Carson diseases history are composed of conditions that are frequent primary causes of Congestive Heart Failure (CHF). This disease could have caused CHF in Mr. Carlson cases because most of them were unattended to. For example, in the case of CAD, the GP didn’t have an ECHO machine. In the case of Hypertension, the disease was not attested, he was just admitted. The tests are necessary and more so for a patient that has a history of smoking like Mr. Carlson. Prior to being asked about medical symptoms and history, the patient will have to undergo a blood pressure test and their weight checked (Taylor et al., 2016. It is imperative that patients follow through the tests and avoid trying not to look bad as this withholds the process of treatment.
These diseases cumulatively could be the cause of Congestive Heart Failure because they could have overworked the heart and damaged the heart muscles. Another possible cause is infections a result of fifty-year smoking history. Mr. Carlson has a long history of being a smoker that has never received a BP attendance. Most of the medical history of Mr. Carlson is composed of various disease, unattended to, that are leading causes of heart muscle damage leading to Congestive Heart Failure.
Initial Nurse Care for Mr. Carlson
On admission of Mr. Carlson to the ward, there are initial nursing practices that a nurse should perform considering that some diseases had not been attended to yet. The most important practice would be identifying clinical stability. This would enable the nurse to determine and ensure prompt transfer of Mr. Carlson to appropriate level care for an efficient and safe therapy. However, identification of clinical stability largely will depend on the local organization of services at the ward. Also, it will depend on the skills set of the nurse on duty or the nurses at the ward. However, in any case, Mr. Carlson would be in need of invasive cardiopulmonary support or if he is at high risk of clinical deterioration, the nurse should ensure he is transferred or the emergency resuscitation place ( Booley et al., 2010 ) . He could also be taken to an intensive or coronary care unit so that he gets close monitoring and medical staff which is readily available.
Some initial assessment and care for unattended conditions as the course of Congestive Heart Failure would be an objective measurement of dyspnoea severity ( Page et al., 2014 ) . These will include measuring respiratory rate, dyspnoea severity rate, the effort of breathing, and oxygen saturation. Another immediate assessment would be checking hemodynamic status; systolic and diastolic pressure monitoring. Clinical examination for any signs of heart congestion will also be carried out, that include, pulmonary rates, jugular venous pressure, and peripheral oedema especially in the legs ( Page et al., 2014) . Quick laboratory test should also be done given that previously blood tests were not done on Mr. Carlson. Some of the tests to be done immediately will include full blood count, urea, glucose level, troponin, electrolytes, and natriuretic peptide level ( Abraham et al. 2011) . Head to toe assessment will also be important to check for oedema. Monitoring of the weights during and after treatments will also be important so as to check on the fluid retention. Chest x-ray will also be vital. Other test and care that should be taken into consideration are cardiac output, heart rhythm and anxiety levels. Ambrosy et al., (2014) reports that Cardiac output assessment involves measuring the body temperatures, peripheral perfusion, urine output, and mental status. To assess the heart rhythm, a 12-lead electrocardiogram should be checked immediately. Upon assessing all the aforementioned, the nurse should alert medical officer about Mr. Carlson’s admission and wait for further orders.
Education and Appropriate Lifestyle for Mr. Carlson
Educating patients with Congestive heart failure is not an easy task to accomplish because most of the affected are the aged individuals, for example, Mr. Carlson is 76 years old and has never experienced the condition before. Teaching Mr. Carlson about the state will be an essential step because he has other comorbidities such as dementia, gall disease, hypertension among others. Several barriers to learning may exist, but he has to be educated about the condition anyway. First of all, patients suffering from congestive heart failure (CHF) have a higher prevalence of depression and anxiety ( Roge et al., 2013 ) . These conditions can make them have less if no interest in ways to perform self-care. Lack of social support, for example, given that Mr. Carlson is widowed may affect the education process. Scientists believe that social support from close relatives might be beneficial to the patient. It is therefore important that Mr. Carlson invite his close family members, for example, his children ( Krum et al., 2011: Krum et al., 2013 ) .
There are various topics that Mr. Carlson can be taught about the disease, how to avoid advancement, and fit lifestyle to prevent the condition from being worse. Some of the relevant education include medication, emergency conditions, and healthy lifestyle ( Sahle et al., 2016 ).
The most important education will be on drugs used. Most of the time drugs employed in the treatment of CHF are based on the guidelines and recommendations from American Heart Association and Brazilian Society of Cardiology (Krum et al., 2011: Krum et al., 2013) . The common medications that Mr. Carlson must be taught on how to use and times of usage include diuretic, angiotensin-converting enzyme inhibitors, digitalis, beta-blockers, and spironolactone. Mr. Carlson will need to be taught about the amount of medication required, maintenance of therapeutic regime, and the doses recommended on a daily basis. Mr. Carlson will need to be informed that for his condition, the higher some drugs, doses, and therapeutic regimes employed, the greater the possibility of stop using them and also reduce risk. Apart from medication education, Mr. Carlson should also be taken through the importance of daily weight and decompensating signs and symptoms monitoring ( Scott et al., 2013 ) . This should be shared with family members to prevent any resurfacing of the condition.
He, Mr. Carlson, should be advised on the new lifestyle he opts to follow to prevent further advancement of the CHF condition. Some of the best lifestyle he needs to adopt include continuous exercises. CHF has been proven to result in fatigue symptoms and progressive dyspnoea at stress or rest. This consequently leads to continual seeking of urgent medical help. Carrying out physical activities, therefore, would be very beneficial to Mr. Carlson recovery as well as general health (Mehra et al., 2013). However, the physical activity should be integrated according to CHF grade and the age of Mr. Carlson. Some physical activities for example in the case of Mr. Carlson would just involve walking to avoid negative physiological and psychological repercussions of inactivity. The walking distance should be increased gradually with time (Mehra et al., 2013). Mr. Carlson should also not take part in heavy works; activities that require too much effort and energy.
Regarding diet and social events, Mr. Carlson and the family could be advised to reduce salt usage on his food. Research indicates that too much sodium, especially those added to already cooked meal enhances heart failure ( Koh et al., 2013 ). Fluid restriction in case of severe CHF should also be upheld though there is limited scientific evidence for doing so. Mr. Carlson should as well be advised to stop drug use such as alcohol and tobacco. These drugs have adverse effects on the cardiovascular system ( Koh, 2013 ). Finally, Mr. Carlson should be encouraged to visit the hospital for annual immunization against influenza to reduce respiratory infections which might lead to the CHF decompensation.
Progress of CHF and subsequent Treatments
There are three progressive stages of Congestive Heart Failure (CHF). They are divided into four classes based on the patients, for example, Mr. Carlson, ability to function: Classes I, II, III, and IV (Smeulders et al. 2010). Class I patients due to CHF are those with a weakened heart, with little or no symptoms. Class II are those patients who have a problem with performing heavy workloads. Class III, on the other hand, are those patients who have limitation and problem of carrying their day to day activity (Abraham et al. 2011). Finally, the patients in Class IV are those with severe symptoms and are at rest and lack effort of doing any activity. With proper treatment, there is a possibility that Mr. Carlson would prevent his condition to progress to the worse classes reaching the fourth stage.
As previously mentioned the best subsequent treatment apart from the change of lifestyle include the use of diuretics, vasodilators, and inotropic agents. These drugs that have these agents are recommended by ESC, ACCF, CCS, and HFSA ( Holliday et al., 2015 ). Diuretics help in the production of urine and aid in water excretion. It is widely known that patients with CHF experience lung congestion or peripheral oedema, for example, the case of Mr. Carlson, and therefore diuretics help to release these fluids to relieve symptoms. Diuretics are recommended to be done intravenously and oral dosing in some patients. If symptoms persist, the second diuretic may be needed. However, during the treatment, monitoring of the fluid level in the body is paramount to prevent low blood pressures which consequently affect the kidney ( Chang et al., 2015 ).
Vasodilators on the hand are applied to widen the blood vessels ( Gallagher et al., 2012 ). However, they should be used together with diuretics to prevent low blood pressure leading to acute CHF. Vasodilators should not be given to people with low blood pressures. Finally, inotropic agents are suitable for patients at the worst stage. They act on the heart muscle directly by increasing the force of contraction hence increasing the blood pumped to the heart and other body tissues. However, inotropic agents should be applied to only those with acute heart failure because of the possibility of having adverse effects ( Gallagher et al., 2012 ).
In the case of Mr. Carlson, there are some medicines that he is still under. Some of these medications are for the purposes of Hypertension and CAD treatment. These medications include Coversyl (2.5mg) which he is taking on a daily basis for CAD and Fosamax (70mg) which he takes per week. It is therefore important when administering treatment, the medications must be taken into consideration.
In conclusion, congestive Heart failure is a common condition in old people due to the weak heart muscle. Weak heart muscle leads to low blood pressure. In most cases, people mistake congestive heart failure to general cardiac failure. The two are distinct given that CHF is a result of weak heart muscle hence little pumping of blood while cardiac failure is sudden damage to the heart muscle preventing the flow of blood. In the case of Mr. Carlson, the causes of CHF could be due to unattended Hypertension, gall disease, history of smoking and lack of exercises. He could undergo treatment using drugs containing agents of Vasodilators, Inotropic, and diuretic depending on the stage of his condition. Apart from medication, he can develop particular healthy lifestyle like physical activities, less taking of sodium, and checking on weight.
Reference
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