The Disease and its Causes

1. In close association to the case study, it can be mentioned that the patient Mrs. McKenzie is diagnosed with the Congestive Cardiac Failure. According to SymanHorduna et al. (2013), Congestive Cardiac Failure (CCF) is characterized by the reduction of the efficiency of the heart to pump blood.  This interferes with the normal blood circulation mechanism and reduced the pace of the blood flow. As a result of reduced blood flow, the blood pressure substantially increases. As stated by SumanHorduna et al. (2013), decreased blood flow interferes with the normal functioning of the kidney and as a result an increased fluid build-up occurs within the arms, legs, feet and ankle.

As mentioned by Schultz et al. (2013), CCF manifests itself after other disease conditions have substantially deteriorated the normal physiology of the heart. Studies suggest that the disease condition occurs when the major areas within the heart concerned with pumping blood become stiff and are not able to refill the blood in adequate amount between the heartbeats. The condition also arises when the ventricles dilate to a maximum extent and the heart is not able to pump blood effectively. This means that the heart loses its ability to pump blood effectively so that it reaches appropriately to other parts of the body.

The condition of CCF is primarily triggered by a number of lifestyle factors such as consumption of a diet rich in fats and poor in fibres (Verbruggeet al.2013). In addition to this, patients with a previous medical history of cardiac disorder or cardiac failure are more vulnerable to suffer from CCF as their heart muscles are considerably weakened. It should also be noted here that individuals with a weakened heart who involve tremendously in sporting activities are at at an increased risk of developing CCF.

The prevalence of CCF has been documented to be roughly around 300,000 in Australia with individuals above the age of 42 to 45 years being placed at a high risk (Roger, 2013). The prevalence of Congestive Heart Failure in Australia as reported by overseas finding is equivalent to 4% among adults aged 45 years and above. In this regard, it should be mentioned that there is no Australian findings on the incidence rate of CHF (Australian Institute of Health and Welfare, 2019). The identified barriers in the process of determining the statistical prevalence has been attributed due to the lack of a universally agreed definition and complexities in diagnosing the condition at the initial stage (Australian Institute of Health and Welfare, 2019).

Incidence and Risk Factors of CCF

It should be critically noted in this context that individuals who have a previous medical history of cardiac failure or other cardiac issues are at a high risk of developing Congestive Heart Failure. Also, patients who have higher blood pressure levels are also at a significant high risk of developing the disorder. Other life style factors that increase the probability of developing the disorder comprise of excessive consumption of alcohol, consuming a high fat based diet and excessive smoking. Studies also mention that individuals who are prone to infections such as bacterial or viral infections can also develop Congestive Heart Disorder.

2. The case study critically mentions about three symptoms that the patient has been experiencing. The three symptoms along with their associated pathophysiology would be discussed underneath in the form of a table.

Signs and symptoms evident in the patient (Mrs. McKenzie)	Pathophysiology of the symptoms
The case study mentions that upon presenting to the emergency department (EU), Mrs. Mckenzie was experiencing increased shortness of breath. It was further mentioned by Mrs. McKenzie that her shortness of breath worsened when she went for a walk with her husband or indulged in gardening activities.	CHF is characterized by the poor ability of the heart to supply blood to the vital organs of the body. As a result of which, there is a fluid build up within the vital organs. Studies suggest that accumulation of fluid within the lungs and leads to increased shortness of breath and a feeling of congestion within the chest (Sahle et al., 2016). Mrs. McKenzie has been experiencing the similar symptom.
The second symptom would essentially include the assessment findings that revealed a high blood pressure (170/110) and Heart rate (54BPM)	As suggested by Savarese & Lund (2017), CHF weakens the heart’s ability to pump blood and supply it to the vital organs within the body. However, it is important to note here that in order to maintain the normal physiological body functions, it is essential that the heart pumps blood and makes it available to the different parts of the body. This is achieved by the heart by putting extra pressure on the ventricular muscles of the heart and as a result the pressure increases greatly in the blood vessels. Therefore, CHF in patients is marked by higher blood pressure and heart beat.
The third symptom can be identified as Mrs. McKenzie’s complain about her cold feet and fingers	Studies mention that patients suffering from CHF most commonly experience coldness in their hands and feet (Sippel et al., 2015; Tabloski, 2014). The pathophysiology for this symptom can be explained as the lack of adequate blood supply in these regions of the body and on account of the same these parts are unable to sustain warmth (Tabloskli, 2014). This causes coldness in these regions.

3. The chosen drug relevant to the patient in the case study can be stated as Frusemide (Lasix). The drug is used as a diuretic and belongs to the group of sulphamoyl benzene which resembles the group of thiazides (Ter Maaten et al., 2015). The prescribed dose to the patient can be states as 40 mg BD.  The chosen dug belongs to the pharamacotherapeutic group of High-Ceiling diuretic sulphonamides or loop diuretics. The drug is denoted by the cose CO3C A01 (Medicines.org.uk, 2019). The mechanism of drug action can be explained as the property of the drug to inhibit active chloride transport within the ascending loop of Henle (Ter Maaten et al., 2015). The drug further facilitates sodium chloride reabsorption and subsequently an isotonic or hypotonic urine is formed. Studies suggest that lasix acts along the complete nephron and does not restrict its effect at the distal exchange site (Verbrugge et al., 2013). The main effect of the drug can be explained as the diversion of the blood flow from the juxta-medullary region into the outer cortex. Studies have further mentioned that the administration of Furosemide could potentially alter the permeability of the glomerulas to the serum proteins (Verbrugge et al., 2013).

The pharmacokinetic property can be explained under the following broad properties (Medicines.org.uk, 2019):

Absorption: After oral absorption 65% of the drug is absorbed and the plasma half life is biphasic with the terminal elimination phase lasting for 1.5 hour. Upon oral administration the drug is 60% absorbed but the effect is over within 4 hours (Medicines.org.uk, 2019). The ideal site of absorption in the upper region of the duodenum at pH 5.0.

Common Signs and Symptoms of CCF and its Pathophysiology

Distribution: The drug is 99% attached to the plasma proteins (Medicines.org.uk, 2019)

Biotransformation: The drug is attached to plasma albumin and there is no sign of biotransformation

Elimination: 90% of the drug is eliminated from the kidneys and is excreted in the form of urine, a small amount is also eliminated through faeces

In order of priority, develop a nursing care plan for your chosen patient who has just arrived on the ward from ED. Nursing care plan goals, interventions and rationales must relate to the first 8 hours’ post ward admission

In the words of Dykes et al. (2014), a nursing care plan essentially focuses on the care needs of the patient and accordingly devises care goals in order to render holistic wellness. After 8 hours of Mrs. McKenzie’s admission the following nursing plan would be followed:

Nursing care plan Goals	Interventions	Rationales
To relieve the patient of shortness of breath and ensure comfort	· Administration of mild breathing exercises and ensuring adequate rest can help in relieving the patient of her shortness of breath	Research studies indicate that administration of mild breathing exercises and deep breathing exercises can help in clearing chest congestion and improve the symptoms of shortness of breath (Savarese & Lund, 2017).
To relieve the patient of cold feet or pain	· Conduct pain assessment to detect the presence of pain · Conduct vital sign assessment to detect any physiological abnormalities · Provide compressive stockings to facilitate easier mobility and keep the patient warm	Conducting pain assessment would help in determining the pain score that would help in the implementation of further intervention Conducting vital assessment would help in monitoring the physiological abnormalities Compressive stockings would keep the patient’s feet warn and reduce the risk of developing pressure ulcer (Sippel etal., 2015).
To educate the patient about her physical health condition and ensure that she is aware of CFH	· Impart education about the disease condition and the pathophysiology of the symptoms in lucid language · Educate the patient about the medication routine and create a note to remind the patient about the timings of the medication	Educating the patient about the disease would help in being cautious and avoiding further risk factors Creation of a post it note or routine would help the patient in remembering her medication dose and timings (Tabloskli, 2014).

References:

Australian Institute of Health and Welfare (2019). Heart failure. . . what of the future?, Summary – Australian Institute of Health and Welfare. [online] Australian Institute of Health and Welfare. Available at: https://www.aihw.gov.au/reports/heart-stroke-vascular-diseases/heart-failure-future/contents/summary [Accessed 25 Mar. 2019].

Dykes, P. C., Samal, L., Donahue, M., Greenberg, J. O., Hurley, A. C., Hasan, O., … & Bates, D. W. (2014). A patient-centered longitudinal care plan: vision versus reality. Journal of the American Medical Informatics Association, 21(6), 1082-1090.

Medicines.org.uk (2019). Furosemide Tablets 40mg – Summary of Product Characteristics (SmPC) – (eMC). [online] Medicines.org.uk. Available at: https://www.medicines.org.uk/emc/product/5665/smpc [Accessed 25 Mar. 2019].

Roger, V. L. (2013). Epidemiology of heart failure. Circulation research, 113(6), 646-659.

Sahle, B. W., Owen, A. J., Mutowo, M. P., Krum, H., & Reid, C. M. (2016). Prevalence of heart failure in Australia: a systematic review. BMC cardiovascular disorders, 16(1), 32.

Savarese, G., & Lund, L. H. (2017). Global public health burden of heart failure. Cardiac failure review, 3(1), 7.

Schultz, S. E., Rothwell, D. M., Chen, Z., &Tu, K. (2013). Identifying cases of congestive heart failure from administrative data: a validation study using primary care patient records. Chronic diseases and injuries in Canada, 33(3).

Sippel, K., Seifert, B., & Hafner, J. (2015). Donning devices (foot slips and frames) enable elderly people with severe chronic venous insufficiency to put on compression stockings. European Journal of Vascular and Endovascular Surgery, 49(2), 221-229.

Suman-Horduna, I., Roy, D., Frasure-Smith, N., Talajic, M., Lespérance, F., Blondeau, L., …& AF-CHF Trial Investigators. (2013). Quality of life and functional capacity in patients with atrial fibrillation and congestive heart failure. Journal of the American College of Cardiology, 61(4), 455-460.

Tabloski, P. A. (2014). Gerontological nursing. New York, NY, USA: Pearson.pp.111-114

Ter Maaten, J. M., Valente, M. A., Damman, K., Hillege, H. L., Navis, G., & Voors, A. A. (2015). Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Nature Reviews Cardiology, 12(3), 184.

Verbrugge, F. H., Dupont, M., Steels, P., Grieten, L., Malbrain, M., Tang, W. W., &Mullens, W. (2013). Abdominal contributions to cardiorenal dysfunction in congestive heart failure. Journal of the American College of Cardiology, 62(6), 485-495.