Causes And Symptoms Of Congestive Cardiac Failure Essay Paper
Congestive Cardiac Failure: Causes, Clinical Manifestations, And Nursing Interventions
Congestive Cardiac failure is a chronic situation that worsens with the passing time. Heart failure sounds like the heart of the person has completely stopped working, but in actual case, the heart is not able to pump the blood as efficiently as it should when the heart pumps less blood than it should, it leads to organs getting damaged and collection of fluids in the lungs (Macon, 2021). When this happens, the blood starts backing up in the lungs along with fluid accumulation which can result in shortness of breath (Macon, 2021) as in the case of Mr. Aloha Das.
Mr. Das has a history of heart diseases such as hypertension, inferior myocardial infarction, heart failure, and non-ischemic cardiomyopathy. He also has type two diabetes mellitus (Referred to case study). These kinds of diseases make the heart too weak and stiff. It does not fill or pump the blood efficiently. The clinical manifestations generally include fatigue, difficulty in breathing, nausea, vomiting, retention of fluid and pain in the chest (Beckerman, 2020). Mr. Das is experiencing symptoms like shortness of breath, wheezing, chest pain on the right side, vomiting and nausea (Referred to case study).
There are many types of abnormalities that can cause Congestive heart failures such as overload of blood volume or pressure on the heart, loss of muscle, primary muscle illness, or severe peripheral requirements, like high output insufficiency. In the normal type of cardiac failure, the contractility of the muscles of the heart is lost. This results in a decrease in cardiac output. This leads to insufficiency of fulfilling the peripheral requirements of the body (Dharmarajan & Rich, 2017). The main determinants of the performance of heart ventricles that gets altered are a decrease in the contractility of muscles of the heart, filling of the arteries is increased which leads to congestion in the lungs and results in shortness of breath, increase the vascular resistance which eventually decreases the cardiac output, and increase in the heart rate which is a compensatory mechanism linked with the elevation in sympathetic tone and circulating catecholamines (Gabriel-Costa, 2018). The heart rate of Mr. Aloha is 128 bpm (Referred to case study). Causes And Symptoms Of Congestive Cardiac Failure Essay Paper
The renin-angiotensin-aldosterone system (RAAS) gets triggered by the reduction in the cardiac output which leads to retention of salt and water. It also increases vasoconstriction. It works as fuel in the maladaptive mechanisms in the heart and results in progressive cardiac failure. Along with this RAAS also secrets angiotensin II. It has been known to increase myocardial cellular hypertrophy and interstitial fibrosis. Angiotensin II’s regressive activity has been found to enhance myocardial remodelling (Malik, 2021).
The top priority nursing intervention for Mr. Das is reducing fluid volume overload.
As the heart is not able to pump the appropriate quantity of the blood that is needed by the body through the arteries and bring it back to the heart with the help of veins, the blood starts getting accumulated, particularly in the lower limbs (Miller, 2016). The veins then need a very large amount of pressure from the heart so that blood can keep flowing to the heart and then to the lungs. Here the blood receives nutrients and oxygen. The blood pressure inside the veins increases due to an increase in pressure because of heart failure. Unless and until there are medications or technologies which can be used to provide strength to the tissues of the heart muscles, the blood does not flow that efficiently in the patients suffering from cardiac failure. Excessive blood and other fluids in the capillaries can seep into the body’s tissues and cause edoema. In many cases, edoema is the first indication of heart failure (Stickel, et al., 2019).
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Renin-Angiotensin-Aldosterone System And Cardiac Failure
Fluid retention can very quickly lead to a situation that can very dangerous for the life of Mr. Das. It overloads the heart in the case of cardiac failure as the more amount of fluid in the blood stream makes it difficult for the heart to work efficiently. The pain in the swollen legs, as well as the ascites, demand hospitalization (Brennan, 2021). Fluid retention is associated with a sense of being out of breath, particularly when patients develop pulmonary oedema and pleural effusions. It also has an influence on the liver’s function, reducing it and making it uncomfortable. As previously indicated, fluid retention causes renal injury by lowering the trans renal pressure differential. Anaemia, which is frequent in Heart Failure patients, can be aggravated by fluid retention through dilution, worsening symptoms, and causing cardiovascular damage (Xinwei, 2017).
If fluid retention is not treated, it can lead to swelling of the tissues of the heart, tissues breakdown, improper bowel function as well as formation of blood clots. Fluid overload harms the body as a result of the consequences of edoema fluid in the interstitial membrane. Excessive extracellular fluid water present in the lung inhibits the exchange of gases, diminishes flexibility of the lungs, and boosts strain on respiration, all of which decrease the concentration of oxygen in the blood and enhance the volume of oxygen utilized by the respiratory muscles. Fluid overload may disrupt the distribution of oxygen and energy sources in the blood circulation, restrict the flow of blood in the capillary and lymphatic drainage, deform tissue structure, and disrupt cell-to-cell connections (Hansen, 2021).
- Furosemide 40 mg
Furosemide is used to induce the process of diuresis. It is done by blocking the reabsorption of ions of sodium and chloride. This process takes place in the proximal and distal tubules, as well as the thick ascending loop of Henle. This diuretic action is mediated through specific suppression of sodium-potassium-chloride cotransporters (NKCC2) conveyed along these tubules in the nephron, which prevents ions of sodium from being transported from the luminal side into the basolateral side for reabsorption. This restriction causes a rise in excretion of water excretion as well as ions of sodium, chloride, magnesium, calcium, hydrogen, and potassium. Furosemide, like other loop diuretics, reduces uric acid excretion (Khan, Patel & Siddiqui, 2018).
Furosemide has immediate vasodilatory actions, which contribute to its clinical efficacy in the therapy of acute pulmonary oedema. Vasodilation decreases response to vasoconstrictors like angiotensin II and noradrenaline, as well as the synthesis of endogenous natriuretic hormones having vasoconstricting effects. It also increases the generation of prostaglandins with vasodilatory effects. Furosemide might even activate channels of potassium ions in the arteries that are showing resistance. Furosemide’s principal mechanism of action is unrelated to its inhibition activity on carbonic anhydrase and aldosterone (Ellison, 2019).
This medication has been prescribed to Mr Das to reduce the retention of fluid. The nurse must look for indicators of dehydration and low electrolyte levels, hypotension, a drop in blood volume, and cardiac arrhythmias in Mr Das.
- Glyceryl Trinitrate:
Glyceryl Trinitrate gets transformed into nitric oxide (NO) with the help of mitochondrial aldehyde dehydrogenase (mtALDH), an effective chemical that is responsible for triggering the enzyme guanylate cyclase. Following the stimulation of this enzyme, cyclic guanosine 3′,5′-monophosphate (cGMP) is produced, triggering a sequence of protein kinase-dependent phosphorylation processes in smooth muscle cells. This mechanism finally results in the dephosphorylation of the smooth muscle myosin light chain, resulting in relaxation and enhanced flow of blood in veins, arteries, and heart tissue. The aforementioned mechanisms result in reduced cardiac activity, lower blood pressure, alleviation of symptoms of angina, and enhanced flow of blood to the heart (Zhou, 2018).
This drug is used to cure angina, hypertension and heart failure. It is a type of vasodilator. Tachycardia, bradycardia, low blood pressure, twitching of muscle, and the level of oxygenation saturation in Mr Das are all ongoing clinical observations that must be made.
Beckerman, J. (2020). Congestive Heart Failure and Heart Disease. https://www.webmd.com/heart-disease/guide-heart-failure
Brennan, D. (2021). What Is Fluid Overload? https://www.webmd.com/a-to-z-guides/what-is-fluid-overload
Dharmarajan, K., & Rich, M. W. (2017). Epidemiology, pathophysiology, and prognosis of heart failure in older adults. Heart failure clinics, 13(3), 417-426.
Ellison, D. H. (2019). Clinical pharmacology in diuretic use. Clinical Journal of the American Society of Nephrology, 14(8), 1248-1257. Causes And Symptoms Of Congestive Cardiac Failure Essay Paper
