Paul Carson is a 76-year old Polish Male. He has just been admitted to your ward as a direct entry via GP (no admission into the ED).
After a provisional diagnosis from the GP regarding congestive heart disease, he was admitted for investigation.
He has not had any previous admissions for this condition.
Paul has never had allergies.
You are Mr Carson’s primary Registered Nurse.PMHx:
MedicationsCoronary Heart DiseaseWidowed
ECHO machine not available in GP
Coversyl 2.5mg Daily
One son – lives with his father in Melbourne. He sees Mr Cason at least three times each year.
Was scheduled to visit this week, but was forced to cancel by work commitments
CXR is for not attended.
Direct admissionColecalciferol 800 IU dailyHypertension
Currently residing in my own home, but I use community nursing services twice a week.
Assistance with dressings and washing leg ulcers
Blood tests not performed.
Direct admissionFosamax 70mg weeklyL total hip replacement 1997
Strong ties to the Polish community that regularly checks on Carson.
Coach for local soccer club
RR – 30 – laboured breathing. Has been getting worse last monthPanadol Osteo 1330mg TDS
Gall stones 2005
2 glasses of red wines per day
HR-99 – There is no ECG at this time
Long term ulcer in the lower leg
Because of the shortness in breath, exercise is limited.
Coaching on the sidelinesSpO2 – 97%Ex-smoker.
1 pack per Day x 50 Years
States that he does not have an appetite. Some slight weight gain
BP – not attended
Noted bilateral swelling in calves
Weep and cough
You feel short of breath
Use accessory muscles
An increasing need to urinate at nights
Has not been seen yet by an admitting physician
Below are some guidelines:
Discuss the possible cause of CHF in Mr Carson.
Your first nursing care for Mr Carson after his admission to your ward. Consider what has been attended and what hasn’t.
What kind of client education would you offer Mr Carson if he is first admitted for this condition? And what lifestyle changes or recommendations would you make for him?
Define the probable course of Carson’s condition and possible treatment options.
Answer to Question: NURSING 7121 Heart Failure Management
Nursing professionals play an important role in managing the patient’s condition and providing holistic care.
Nursing care is what makes patients happy.
This means that nurses are accountable for accurately diagnosing and treating the patient’s medical conditions and their current needs. The assessment then determines the health care plan.
As part of the multidisciplinary care team, registered nurses play a key role communicating with patients, families and physicians.
They must educate patients and their family to ensure that they adhere to the treatment plans.
This essay will be centered on Mr. Carson (76 years old), who has been provisionally diagnosed with congestive cardiomyopathy by his doctor. He was admitted to hospital for further investigation and treatment.
The essay will describe the initial care given by the RN to Carson, the etiology of Carson’s condition and offer suggestions for his life style and treatment options.
There are many causes and etiologies for congestive cardiac failure.
Heart failure can result from conditions that cause damage to the heart muscle.
Coronary artery Disease (CAD) refers to a disease that affects the arteries. The arteries carry oxygen and blood to the heart chambers. This causes decreased blood flow to the muscle.
Due to lack of oxygen and nutrients, blockages in the arteries can cause damage to the heart muscles, leading ultimately to heart failure.
Heart attack can also be caused by sudden blockage or stoppage in blood flow to the heart muscle.
Rapid blockage can lead to scarring and blockage of the heart’s working function, which in turn causes damage to the muscle.
Cardiomyopathy on the other side is caused by reduced blood flow, arterial damage, or alcohol or drug abuse.
The other side of the coin is that damage to the heart muscle can be caused by other chronic conditions, such as diabetes, high blood pressure or valve disease.
There are many causes of CHF incidence in the case Mr. Carson.
It was revealed that Carson had a history of heart disease and coronary heart disease.
But, he also has hypertension, regular smoking, and other risk factors that could lead to CHF.
It was revealed from his health history that he is an ex smoker who has a habit of smoking 1 packet per day over the past 50 years.
He lives alone, and he has also been isolated.
In Mr. Carson’s case, his heart failure was caused by the combination of factors such as hypertension, coronary artery disease, smoking, and isolation.
Initially, after Mr. Carson’s arrival, the nurse must assess him thoroughly. The nurse should address his current condition, any needs or complications.
In order to support him in his adjustment to hospital life, the nurse must first establish a trusting relationship with Carson (Whang 2013, 2013).
A case study has shown that the GP at Carson’s clinic did not perform the initial assessment of his vital signs.
Given Mr. Carson’s current and past health history, vital signs assessments like BP, BGL or blood tests necessary for confirming the existence of CHF are important.
CXR, CT scan and echocardiogram should all be done immediately (Hall Levant & DeFrances 2012.
These tests are crucial in determining the cause of Mr. Carson’s damage to his heart muscle.
But, the symptoms show that there is congestion in his heart. The heart rate was 99 and he has been getting worse over the past month.
A number of symptoms including shortness and congestion of breath, cough and wheeze, urination problems at night, and use of accessory muscles were reported.
Therefore, the nurse would have to also check his old medication chart to see if any previous health issues had been addressed.
Based on this assessment, a medication plan must be created.
But, the assessment also shows that his lifestyle needs to be modified.
As you can see, Mr. Carson is taking medications to lower her blood pressure, high blood pressure, and osteoporosis.
For his leg ulcer care, Carson is receiving help from the community nursing.
Also, the nurse will need to evaluate and treat his leg ulcer issues.
His oxygen saturation does not indicate that he requires oxygen immediately. However, the nurse would closely monitor his vital signs, including oxygen saturation, and would administer oxygen masks to him if necessary (Clarke Shah and Sharma, 2011).
According to the initial assessment, Mr. Carson has a history smoking and he also drinks two glasses of wine each day.
If you have a history of heart failure, two glasses red wine isn’t harmful.
This is because there are many evidences to support the fact that red wine is beneficial to people suffering from heart disease. Red wine increases HDL and prevents clots developing in the arteries. It also relaxes the body and reduces stress.
McMurray, et al. (2012). Red wine is also rich in antioxidants which can reduce the risk of secondary muscle damage following heart attack or failure.
A nurse could help Carson to understand the pros and disadvantages of drinking red wine every day through client education or health promotion. However, avoiding alcohol may increase the likelihood of secondary heart muscle damage.
His exercise routine is also limited by his breathing problems, as shown in the case study.
However, he has gained some weight. For this reason, weight management is essential.
Additional weight gain could further damage the heart muscle.
As such, Mr. Carson should learn relaxation techniques in addition to aerobic exercise.
Due to Carson’s shortness of breath, a physiotherapist would consult him. The physiotherapist would devise a plan for Carson’s physical exercise, addressing his current needs. (Yancy et. al., 2013).
Meditation and relaxation techniques could also be helpful to him in dealing with his loneliness, social isolation, stress, and stress.
A healthy diet would also need to be communicated to Mr. Carson.
A dietician will create a healthy eating plan for the patient.
Additionally, his leg ulcer may restrict his mobility. He might need to use a cane, or walker.
He would be informed of the need for sufficient rest and sleep.
He was an ex-smoker but secondary smoking is dangerous for him (Bui, Horwich & Fonarow 2011).
It is important that he ensures that his environment is smoke-free.
It is essential to check your vital signs regularly, particularly monitoring your BGL or BP. Also, you need to test for cholesterol and lipid profile.
Second attacks can be caused by uncontrolled blood pressure.
It is important that we discuss the possibility of this condition getting worse.
Mr. Carson was diagnosed with a serious, long-term, and chronic condition in his heart. It tends to worsen over time, so if it is not treated properly, it could lead to the patient’s death.
The symptoms of Mr. Carson can be stable for months to years if the medication is taken as directed.
The instructions must be followed carefully to avoid further damage to the heart muscle and a second attack.
These progressions can also reduce oxygen flow to the heart muscle, leading to more severe attacks (Eckel et. al., 2013,).
A high blood pressure, elevated cholesterol, or high blood glucose can increase the risk of blood clot formation, which further reduces blood flow through your heart chamber. This can lead to heart attack and other stroke-related disorders.
If you have Mr. Carson, you can slow the progress of your condition by following a proper medical and daily life style management process.
To determine the extent of fluid buildup and the activity of the heart, it is important to perform an echocardiogram immediately following Mr. Carson’s admission.
Based on the findings, you will need to determine the best treatment options.
There are many treatment options for those suffering from severe health issues.
Here are some options for Mr. Carson.
Medicines: Heart failure patients can take several medications to improve their function.
These medications would include medication to reduce blood pressure and prevent blood clots from forming in the vessels.
To meet his health needs, Mr. Carson would receive ACE inhibitors as well beta-blockers and diuretics.
A combination of the prescribed medications would be recommended depending on Carson’s exact medical situation.
Lifestyle changes: To protect Mr. Carson from future heart attacks or other serious consequences, it is crucial to make lifestyle adjustments.
Healthy eating, exercising, quitting smoking and cutting down on alcohol consumption are key to this.
Heart failure devices: Special cases require special heart failure devices.
Pacemaker, for example, is a device implanted in the chest to control heart rhythm.
Cardiac-resynchronization therapy, on other hand, helps the left ventricle’s walls contract simultaneously.
Implantable cardioverter-defibrillators, which continuously monitor the heart rhythm using electrical shocks, are available.
ICDs are implantable in the case of Mr. Carson to reduce the chance of further heart attacks or failure.
Telemonitoring can also be used to help Mr. Carson reduce his risk of having complications or secondary attacks. This allows him to have his vital signs monitored at his home (Clarke Shah and Sharma, 2011).
Surgery: Surgery may be necessary for severe stage. But, in the case Mr. Carson’s, surgery wouldn’t be necessary.
Nurses are responsible for the education of patients and their families to ensure that they adhere to treatment protocols.
We can conclude that the nursing assessment and diagnosis in the case of Mr. Carson is crucial in determining the right care for Mr. Carson.
We also discussed lifestyle changes, medications and other treatment options.
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Epidemiology & risk profile of heart attack.
Nature Reviews Cardiology 8, 1 – 41Clarke, M., Shah, A., & Sharma, U. (2011).
A meta-analysis of studies that have examined telemonitoring for congestive heart failure patients.
Journal of telemedicine & telecare 17(1): 7-14Eckel, R. H., Jakicic, J. M., Ard, J. D., Hubbard, V. S., de Jesus, J. M., Lee, I. M., … & Nonas, C. A. (2013).
2013 AHA/ACC guideline for lifestyle management to reduce cardiovascular risks. Circulation, 01-cir.Hall, M. J., Levant, S., & DeFrances, C. J. (2012).
Hospitalization for congestive-heart failure: United States. 2000-2010. age, 65(23), 29.Hosenpud, J. D., & Greenberg, B. H. (Eds.). (2007). Congestive heart failure. Lippincott Williams & Wilkins.McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Bohm, M., Dickstein, K., … & Jaarsma, T. (2012).
ESC Guidelines to diagnose and treat acute and chronic hearts failure.
European journal for heart failure, 14(8). 803-869.Whang, W. (2013). Congestive heart failure.
Encyclopedia of behavioral Medicine (pp. 485-486). Springer New York.Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., … & Johnson, M. R. (2013).
2013 ACCF/AHA guideline regarding the management and treatment of heart failure. Circulation, CIR-0b013e31829e8776.