Congestive Heart Failure

CongestiveHeart Failure

CongestiveHeart Failure

Subjective

Currentliterature

Congestiveheart failure (CHF) is a sickness that is characterized by asignificant decline in cardiac output, which results from theweakening of the vessels as well as the heart muscles. Signs andsymptoms of CHF include body weakness, shortness of breath, andswelling (Kulick, 2015). This indicates that the symptoms identifiedthrough subjective evaluation are correct. In addition, HDF resultsin coughing, bloating as well as vomiting (American HeartAssociation, 2011), some of which the clients denies during thesubjective evaluation. However, congestive heart failure is not ahereditary condition (AHA, 2011), which means that the fact that themother suffered from myocardial infarction does not necessarily implythat the patient inherited the heart condition from the parent.

Billinglevel: Expanded problem focused

  • General appearance: Weak body

  • Skin: No itches, no skin coloration

  • Lungs: No hemotysis, No wheezing, dry coughs.

  • GI: No vomiting, no hematemesis, no reflux.

  • Genitourinary: Frequent urination, no urinary infection.

  • Musculoskeletal: Feet pain, no joint disorder, no emotional impairment.

Objective

Culturalinfluence

Allaspects of cultural influence (including the significance of respect,family, and politeness) are critical for a Latino patient. However,the health care provider should consider the influence of uncertaintyon health beliefs of the Latino patients According to Carteret (2014)Latino patients are likely to believe that chronic illnesses(including the CHF) are God’s punishment, which makes them avoidthe western medication. This implies that the health careprofessional try to overcome such a belief in order to enhance thepatient’s compliance with the treatment procedures.

Literature

Patientssuffering CHF have impaired response to temperature changes, whichresults in irregular body temperatures (Morales, 2014). Althoughthese patients may suffer from fever and nasal discharge, these arenot direct symptoms of CHF, but they arise from respiratory illnessthat is common among the CHF patients. In addition, lymphadenopathyand lymph tenderness may occur as a result of other opportunisticinfections. The change of skin color coupled with the skin drynessresults from an inadequate supply of blood, which is directlycorrelated with the weakness of the heart and the blood vessels. Inessence, inadequate supply of blood to organs and tissues of the bodyreduces their capacity to carry out their normal functions, which inturn result in other health conditions, including the respiratoryproblems. Musculoskeletal disorder is one of the common symptoms, butit occurs in half of CHF patients (Morales, 2014).

Expandedproblem focused exam

  • Vital: Temperature 98.2, RR 22. BP 153/92

  • HEENT: PEERLA, EOMI, no carotid bruits, no nasal discharge, no jugular distension, no tongue lesion.

  • Lymph: No lymphadenopathy, no lymph tenderness

  • Respiratory: Asymmetric thorax expansion, no wheezing

  • Abdomen: No bulges, no bilateral CVA tenderness.

  • Musculoskeletal: Normal muscle tone, no deformities.

Assessment

Diagnosis

Congestiveheart failure has many signs and symptoms, but there is a combinationof about six signs that guides the health care professionals inmaking a nearly accurate diagnosis. First, CHF patients experiencethe shortness of breath, which may occur at rest, during theactivity, or even while sleeping (AHA, 2011). This occurs because theblood gets back to the pulmonary veins since the heart lackssufficient energy to keep up the supply. Secondly, CHF patientsexperience persistent coughing following the build-up of fluid in thelungs, which is one of the symptoms expressed by the present patient.Third, edema is common in all patients suffering from CHF becausefluids tend to accumulate in tissues since the blood flows slowly,and kidneys lose the capacity to dispose water and sodium (AHA,2011). The three symptoms in addition to the other three (tightness,loss of appetite, and an increase in heart rate) are critical duringthe CFC diagnosis. However, the health care provider shouldunderstand trends in which these symptoms unfold as the sicknessturns from chronic to acute.

Differentialdiagnosis

Congestiveheart failure has many risk factors, but five of them are relevantand the possible cause of CHF for the present patient. These riskfactors include smoking, advanced age, heart failure in the family’shistory, and prior heart attack, and hypertension (Kulick, 2015).

Therelationship between hypertension and CHF

Researchshows that hypertension contributes towards 50-60 % of CHF cases inthe modern world (Riaz, 2014). Hypertension results in the occurrenceof CHF because by altering the structures of coronary and myocardialvasculature. These changes contribute towards the occurrence ofventricular hypertrophy, which culminates in congestive heartfailure.

Plan

X-rayis a recommended lab test for initial cases of CHF because it revealsthe fluid build-up in the lungs and enlargement of the heart.However, X-ray test may be accompanied by other tests, such as theblood test that focuses on kidney functions, B-type Natriureticpeptide, electrolyte levels, low count of blood cells (Brien, 2014).In addition, a stress test is critical for the present patientbecause it will help the health care professionals in determiningwhether hypertension was the major cause of CHF.

Treatment

Asuitable combination of medication for CHF patients may include ACEinhibitors to open the blocked or narrow vessels, beta-blockers toregulate the heart beat, diuretics to lower the content of bodyfluids (Kruicik, 2014). Therefore, the medication for the presentpatient is appropriate because it includes the ACE inhibitors(Enalapril and Digoxin), a beta-blocker (Carvedilol), and a diuretic(Hydrochlorothiazide). However, there are some non-pharmacologicalapproaches (such as stress management and physical activities) thatshould be used to enhance the treatment.

Follow-up

Afollow-up of 7 days is appropriate is critical, but the duration canbe increased to 3-6 months one the patient responds well to thetreatment. However, a negative response to the mediation can call fora referral to a specialized health care center.

Education

Theeducation program recommended for the present patient is appropriate,but most important is the dietary and stress management skills, whichare appropriate in regulating the progression of HF into a chroniccondition. For example, the patient should be informed about thedangers of excess intake of sodium, which can worsen the condition oreven lead to death (Kruicik, 2014).

Culturalintervention

Thecultural intervention, which includes the use of Spanish language inthe interview, respecting patient and friends, and active listening,is appropriate and consistent with the cultural beliefs of the Latinopatient.

and Conclusion

CHFis a condition that occurs following the weakness of the bloodvessels or the heart. This results in a significant reduction in thesupply of blood to different parts of the body. Both the subjectiveand objective evaluation of the patient is important because theyhelp in the determination of the key symptoms and the risk factorsfor CHF. This facilitates the process of assessment and design of asuitable plan for treatment, follow-up, and patient education.

References

AmericanHeart Association (2011). Warningsigns of heart failure.Dallas, TX: AHA.

Brien,T. (2014). Congestive heart failure. WebMD.Retrieved January 25, 2015, fromhttp://www.emedicinehealth.com/congestive_heart_failure/page7_em.htm

Carteret,M. (2014). Cultural values of Latino patients and families.Dimensionsof Culture.Retrieved January 25, 2015, fromhttp://www.dimensionsofculture.com/2011/03/cultural-values-of-latino-patients-and-families/

Kruicik,G. (2014). Cognitiveheart failure.New York, NY: Health Line Incorporation.

Kulick,D. (2015). Cognitive heart failure (CHF). MedicineNetIncorporation.Retrieved January 25, 2015, fromhttp://www.medicinenet.com/congestive_heart_failure_chf_overview/article.htm

Morales,K. (2014). Heartfailures patients have impaired cooling response, UT southwesternresearchers find.Dalla, TX: Harry Hines Boulevard.

Riaz,K. (2014). Hypertensive heart disease. WebMDLLC.Retrieved January 25, 2015, fromhttp://emedicine.medscape.com/article/162449-overview

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