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Clinical Intervention: Congestive Heart Failure

Congestive Heart Failure (CHF)

Congestive heart failure (CHF) is a clinical condition characterized by a structural or functional cardiac disorder that inhibits the ability of the heart to pump blood and nutrients to the vital body organs in a normal way. Owing to the lack of definitive diagnostic tests for CHF, clinical diagnosis relies on physical and historical examination of the patient’s background. Conducted in conjunction with ancillary tests, including but not limited to chest radiography and echocardiography, this examination helps to identify patients suffering from or at risk of having CHF. It is important to note that CHF is a common clinical disorder affecting an estimated number of five million people in the United States, with most cases affecting people above the age of 65 years (Inglis, Conway, Cleland, & Clark, 2014). The purpose of this paper is to give an insight into clinical intervention measures for patients suffering from CHF.

The Medical Problem/Diagnosis/Disease

The central role of the heart is to supply all body organs with blood, oxygen, and crucial nutrients. It also helps to remove toxic products and waste from the body. To meet different requirements of the body, the rate of heartbeat varies depending on the condition of the body, allowing blood vessels to dilate to transport the required amount of blood to different parts of the body. However, CHF can constrict the heart from functioning fully. It is worth noting that CHF does not imply that the heart has stopped working; rather, it is not effective in executing its functions (Inglis et al., 2014). As a disorder common among the elderly, CHF acts by decreasing the pumping function of the heart, which can then lead to other medical complications, including the backflow of fluids into the lungs, legs, or feet. CHF can be reversed through proper medical interventions. Clinical interventions that eliminate the need for readmission among elderly CHF patients assist in prolonging their lives. As aforementioned, more than five million U.S. citizens over the age of 65 years suffer from CHF. These estimates continue to increase rapidly as many people enter the baby boomers age bracket and, consequently, the number of risks increases (Aston, 2013). In the absence of earlier intervention measures, this group of the population is at the risk of premature death and other medical complications. Nevertheless, evidence-based interventions can help to reverse this disorder when instituted in the early stages. In line with this observation, there is a need for an all-inclusive approach aimed at reducing incidences of readmission for patients suffering from CHF. This poses the question as to whether adopting a more focused approach, like engaging patients and caregivers in educational programs, can help to reduce cases of readmission as compared with the conventional follow-up approach.

Typical Presenting Signs and Symptoms

The cases of CHF have increased over the last couple of years partly due to the decline in the number of people who die from coronary heart disease and due to the prolonged lifespan because of medical advances. Still, there is a reason to worry owing to the number of readmissions, especially among elderly patients. CHF is mostly caused by the coronary artery syndrome that makes arteries narrow down. Despite the fact that this syndrome has been shown to occur at an earlier age, CHF is especially common among the elderly, especially women. Depending on the root cause, CHF can be acute or chronic. The condition often limits the amount of blood pumped out by the heart, thus increasing pressure in the heart’s chambers (Inglis et al., 2014). This, in turn, pushes incoming blood to retract back to the blood veins or the lungs. This may lead to excessive fatigue, as well as deposit of body fluids in body tissues and, subsequently, the lungs, legs, feet and, at times, in the liver or abdomen. Patients may also experience episodes of dyspnea (shortness of breath) as a result of the exercise of the buildup of body fluids in the lungs. Other symptoms of CHF include orthopnea, edema, pulmonary edema, and cyanosis. Patients may also gain weight owing to the retention of body fluids while elderly patients may experience impaired thinking ability or confusion due to the reduced brain oxygen.

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Patients diagnosed with CHF have a high risk of suffering from hypertension due to the changes in blood flow. Other concomitant disease states associated with CHF include thyroid disease, COPD/bronchiectasis, chronic renal failure, dementia, anxiety, and osteoporosis. COPD or chronic obstructive pulmonary disorder is a condition that arises when the lungs are inefficient in discharging air out of the body (Bhatt & Dransfield, 2013). Chronic renal failure occurs when the kidney progressively loses its functionality, which is characterized by fatigue and loss of appetite, among other symptoms (Deev, 2015). Osteoporosis is a condition associated with loss of strength in the bone structure largely due to lack of vitamin D or calcium and, in other cases due to hormonal changes.

Pathophysiology of CHF

Normally, CHF occurs as a result of a dysfunction in cardiac function, structure, conduction, or rhythm. In developed countries, most cases of CHF are caused by ventricular dysfunction. Excessive consumption of alcohol, idiopathic cardiomyopathy, and degenerative valve disease are also common causes of CHF in these countries. In addition, CHF is prevalent in adults suffering from multiple comorbid conditions such as chronic lung disease. The heart of a patient suffering from CHF adjusts to accommodate for the ineffective execution of functions (Gustafsson & Unwin, 2013), which leads to changes in stroke volume and heart rate. The two factors play an important role in understanding the pathophysiological outcomes of CHF and possible treatment options. The volume of blood entering the left ventricle is known as the preload and is used in determining stroke volume. Structural changes in the left ventricle impair preload, causing increased pressure in the left atrium, leading to pulmonary congestion. The heart responds differently to different stroke volumes. The latter is also determined by afterload or the volume of blood leaving the heart, which is normally 140 mm Hg. In the case of CHF, either the upload or the stroke volume changes, leading to changes in heart rate.

Differential Diagnoses

Patients suffering from CHF may also show signs of pneumonia as seen in cases where the patient shows signs of coughing, fever, or spitting of productive sputum with focal indicators of consolidation. Interventions, in this case, include administering oxygen through the cannula, assessing the status of the patient’s respiratory system, and encouraging them to rest in comfortable positions. Patients may also suffer from cirrhosis, which may lead to fatigue, jaundice, peripheral edema, haematemesis, or ascites. CT scan is used for detecting ascites and any abnormalities in the liver (Gustafsson & Unwin, 2013). Interventions for cirrhosis include preventing respiratory, vascular and circulatory disturbances and encouraging patients to exercise gradually. It also involves recommending a high protein diet. Finally, CHF patients may show signs of the nephritic syndrome characterized by fatigue, edema, loss of appetite, and dyspnea.

SOAP

CHF is a clinical condition characterized by a structural or functional cardiac disorder that inhibits the ability of the heart to pump blood and nutrients to the vital body organs in a normal way. Owing to the lack of definitive diagnostic tests for CHF, clinical diagnosis relies on physical and historical examination of the patient’s background.

Subjective Data

The patient, 68 years male, was visiting the hospital for a follow-up appointment following a recent discharge. The patient’s subjective data were collected as per the standard requirements of the hospital. The patient was hospitalized thrice in the past due to CHF, once in the current institution and twice in another institution. Different clinical tests were conducted to ascertain the well-being of the patient. They included general examination, respiratory tests, neurological tests, cardiovascular tests, pulmonary tests, urinalysis, echocardiography, pericardium biopsy, Doppler examination, and complete blood count.

History of Present Illness

The patient had a past history of suffering from CHF. In the past, he was hospitalized three times due to CHF, and proper medication and treatment interventions were administered. The current visit was a follow-up on the progress of the patient and a continued effort to keep him informed of the best ways of living, including the best nutritional diet to take in order to avoid a recurrence of the disease.

Initial Differential Diagnoses

Given the medical history of the patient, the initial diagnosis was the recurrence of CHF.

Objective Data

A physical examination revealed that the patient was in relatively good condition, though there were indications of fatigue and increased weight (93lbs). The patient did not have any other indications of physical suffering.

Labs or Other Testing

Tests carried out included a urinalysis test, microscopy, and immunofluorescence. The urinary test results were positive with proteinuria levels standing below 3.5g/24hours while hypoalbuminemia levels were above 30g/l. Microscopy test showed signs of membrane thickening and immunofluorescence indicated diffuse, granular depositions in the capillary walls.

Initial Impression or Refined Differential Diagnoses

The patient was diagnosed with nephrotic syndrome, a condition characterized by peripheral edema, dyspnea, and fatigue. The disease is marked by increased levels of proteinuria and hypoalbuminemia. It usually exhibits symptoms of many diseases and hence can present a challenge in relation to determining its underlying etiology (Deev, 2015). In older patients, nephrotic syndrome is mostly caused by membranous nephropathy as a result of hepatitis B, adverse drug reaction, and autoimmune disease. In an effort to test for abnormalities in the kidney, a biopsy and a kidney ultrasound were conducted. Clearly, there were signs of fluid retention in the kidney, which is an indication that the patient may be suffering from the nephrotic syndrome.

Results of Additional Testing

Additional tests sought to establish the glomerular filtration rate. This test was important as it could indicate whether the patient showed any signs of being diabetic before prescribing the treatment.

Diagnosis

Medical Diagnoses

Based on the results of the examinations and tests conducted, it was noted that the patient needed medication for CHF. It was observed that the major cause of the nephrotic syndrome was peripheral edema caused by the dysfunction in body fluid drainage. The patient was diagnosed with nephrotic syndrome and put on corticosteroids and diuretics in order to reduce edema. Enzyme inhibitors were added to the previous medication to reduce proteinuria.

Plan and Implementation

Management

The medical prescriptions given to the patient were aimed at enhancing his immunity system and reversing his condition to enable him to live a healthy life. The prescriptions, which included corticosteroids and diuretics enzyme inhibitors, will help normalize his proteinuria and hypoalbuminemia levels while helping to reverse the peripheral edema. Another notable fact is that the patient lives together with his son, which presents an advantage as the son, who is well versed with his father’s illness, will be able to provide the necessary care.

Evaluation and Revisions

Follow-up with the Patient to Report Results of Intervention(s)

The examinations and tests conducted were appropriate and detailed given the medical history of the patient and his current condition. The patient and his son, with whom he had come, were furnished with all the necessary information. Follow-up visits are designed to reinforce the knowledge of the patient and the caregiver concerning the best way of managing the medical condition.

Subsequent follow-up visits will be accompanied by teach-back programs where the patients and his caregiver will be educated on the best lifestyle to follow to prevent the medical problem from aggravating. Advice on the best dietary intake will also form a major agenda of the learning program and the patient will be advised on the best diet intake to deal with the medical condition. While patients suffering from nephrotic syndrome are not subject to dietary limitations, there will be a need to keep a close check on what they consume, especially taking into consideration their age and ability to exercise.