CASE STUDY (HEART FAILURE)

Introduction (150 Words)

Introduce the patient

Identify 2 problems

Identify 4 interventions for 2 problems and their

evaluation.

Thesis Statement

Patient is identified as Mr. Reggie Simpson, 42, an

indigenous Australian. He was diagnosed with rheumatic
heart disease and compensated heart failure then after.
He is married with three children and the breadwinner of
the family. He was admitted with heart failure acute
decompensation. (Focus) This essay will discuss the
pathophysiology of and rationale of identified priority
nursing problems and will evaluate the interventions
provided.

There are two priority nursing problems identified in this

essay. The first refers to the ineffective breathing pattern
related to decreased lung volume capacity as evidenced
by crackles on both lung fields and compromised
breathing. Another identified problem is the fluid volume
excess related to decreased cardiac output, sodium and
water retention evidenced by bilateral pitting oedema,
coarse crackles and ascites.

The first problem can be remedied by proper positioning

and oxygen administration as prescribed, in order to
alleviate the signs and symptoms of respiratory distress.

The second can be managed by administering medication

as indicated and by collaborating with dietician to modify
the patient’s dietary intake to reduce fluid retention.
Thesis Statement---please insert nalang ate baka mali kasi
conclusion ko eh

_______________________________________________

Paragraph 1 (focus on patient problem/data) (Problem 1)

(160 words)

Topic sentence (identified problem)

Provide most relevant data from case study to

justify the choice of problem.

Pathophysiology(reference) p.152

The first priority problem is ineffective breathing pattern

related to decreased lung volume capacity as evidenced
by coarse crackles and low oxygen saturation.

Altered breathing pattern occurs when there is an inability

to provide adequate ventilation during inspiration and
expiration. The patient has heart failure (HF) and is
showing signs of altered oxygen supply. As HF progresses,
left ventricular pressure increases, causing enlargement of
both ventricle and atrium (Brahmbhatt, & Cowie 2018 p.
588). This will then result to increased back-pressure to
the pulmonary veins leading to pulmonary oedema (ref).
Fluid overload causes inability of the lungs to expand
when breathing, hence affects the normal breathing
pattern and oxygen distribution in the body (ref).

The patient has below normal oxygen saturation which at

92%, indicating that there is low oxygen supply from the
lungs. Coarse crackles sound is evident upon auscultation
that indicates presence of fluid in the lungs (ref).
Moreover, high respiratory rate which at 28bpm shows
that the body is compensating to breath more rapidly to
increase the oxygen supply in the blood.
Paragraph 2 (focus on Intervention 1)(160 words)

Topic Sentence (provide the key words that

answers the question)

Which type of Intervention? (independent or

collaborative)

Use summaries/paraphrase (reference)

What is the intervention? (ref)

Nurses responsibility in performing the

intervention (ref)

Why is it suitable for the patient?

Concluding Sentence: Link patient data and

evidence reference (intervention will
resolve/manage/relieve the patient s & S/
Abnormal data.

The first intervention called proper repositioning is to

maximise lung expansion and aid in breathing. It is an
independent nursing action that does not need
collaboration with other allied health care professionals.
Positioning the patient in Semi Fowlers position with the
head and upper body inclined to 15 to 45 degrees as
tolerated will promote maximum oxygenation because it
allows maximum chest expansion (ref). It also facilitates
the relaxation of tense abdominal muscle that will
facilitate improvement of breathing.

Nurses play a vital role to manage the signs and symptoms

of the patient and facilitate wellness. (add focus sentence
here) When performing this intervention, nurses should
determine if the patient can tolerate this position and
identify any circumstances where it is not permitted for
instance, during post-operative and patients with COPD
(ref).
Proper Repositioning is suitable for Mr. Simpson as
maximized lung expansion facilitates breathing and
improves his oxygenation.

Paragraph 3 (Critical Discussion of intervention 1) (160)

Topic Sentence

Discuss advantages/disadvantages and risks of

intervention(ref)

Benefits and Risks(ref)

Link risks/benefits to patient situation/medical

condition

Conclusions (repeat keywords and emphasise

why intervention is suitable.

Positioning to Semi Fowlers may have advantages and

disadvantages to patients. Firstly, it can facilitate
breathing and lung expansion. It is also a standard
position applied when feeding patients. Although this
intervention facilitates patient’s breathing, (ref) claims
that semi Fowlers position may bring a change in the
blood pressure and cardiac output of the patient.
Moreover in a study conducted by (ref) it could have a
same tendency among hypertensive patients. A slight
difference in posture may have an effect in the
heamodynamic and cardiovascular regulation.

Overall, it is still beneficial for Mr. Simpson as he has

compromised breathing and positioning him in Semi
Fowler’s will improve his oxygenation.
Paragraph 4 (focus on Intervention 2)(160)

Topic Sentence (provide the key words that

answers the question)

Identify intervention 2 to match the priority nsg

prob 1.

Which type of Intervention? (independent or

collaborative)

Use summaries/paraphrase (reference)

What is the intervention? (ref)

Nurses responsibility in performing the

intervention (ref)

Why is it suitable for the patient?

Concluding Sentence: Link patient data and

evidence reference (intervention will
resolve/manage/relieve the patient s & S/
Abnormal data.

The second identified intervention for ineffective

breathing pattern is administration of supplemental
oxygen as ordered. This is to maximise oxygen available
for cellular uptake (ref). This is a collaborative
intervention, as oxygen administration can be
implemented by nurses once prescribed by the physician.
When giving oxygen to the patient, nurses should secure
an order from the physician, follow the prescription, dose
and use the appropriate device (ref). Oxygen
supplementation is recommended to manage hypoxemia
for patients with less than 90-94 percent of oxygen
saturation. Since Mr. Simpson has 92% oxygen saturation,
oxygen supplementation is therefore recommended to
benefit him. His diagnosis being heart failure is also
indicative that it is necessary for him to have
supplemental oxygen as oxygen therapy has been
prescribed in management of patients with cardiac
problem. This can improve his oxygen saturation and
respiratory rate thus improve the overall health of the
patient.

Paragraph 5 (Critical Discussion of intervention 2)

Topic Sentence

Discuss advantages/disadvantages and risks of

intervention(ref)

Benefits and Risks(ref)

Link risks/benefits to patient situation/medical

condition

Conclusion (repeat keywords and emphasise why

intervention is suitable.

Oxygen administration can be prescribed for patients

experiencing respiratory distress. However, there are
some precautions and consequences that requires
consideration.

Advantages - Oxygen therapy improves the oxygen supply

in the body. It improves tissue perfusion up to peripheral
area. It also relieves respiratory distress hence, reduces
anxiety resulting to improved breathing pattern.

Disadvantages – Some studies shows that it is not

beneficial for long term use (ref). It is essential to check
for sign of oxygen toxicity, where there is an excess
oxygen administered to the patient(ref).

For long term use, the accessories used for oxygen

therapy such as masks may place the patient to risk for
pressure sore (ref).
Paragraph 6 (Evaluation Criteria)

Topic Sentence

Identify types of evaluation data

Explain specific evaluation tools and data that

shows patient improvement

Link measurement to abnormal patient data from

the case study (aligns prob just)

Use literature to support evaluation tools

Proper positioning and administering oxygen to patient

with Acute Decompensated Heart Failure is beneficial. It
helps to improve their prognosis. The patient is
manifesting signs of respiratory distress. The goal is to
increase the oxygen saturation from 92 percent to normal
range which is 95 to 100 percent(ref). Those nursing
intervention can also facilitate the improvement of his
respiratory rate and breathing. As the patient is fatigued,
improved oxygenation and proper posture will help him to
minimize energy consumption (ref).
Nursing Problem 2

Paragraph 7 (focus on patient problem/data) (Problem 2)

(160 words)

Topic sentence (identified problem)

Provide most relevant data from case study to

justify the choice of problem.

Pathophysiology(reference) p.152

Fluid Volume Excess related to altered cardiac output

(Increased isotonic fluid retention related to increased
antidiuretic hormone(ADH) production, and sodium and
water retention evidenced by weight gain, abnormal
breath sounds, hypertension and signs of respiratory
distress.

Pathophysiology – Heart Failure results to decrease blood

flow to the renal artery. This stimulates the baroreceptor
reflex and the release of renin in the bloodstream will be
initiated. Renin interacts with angiotensin and will
stimulate the production of Angiotensin 1. When
Angiotensin 1 reacts with Aniotensin Converting Enzyme it
will be converted to Angiotensin II. Angiotensin II then
increases the arterial vasoconstriction that promotes the
release of norepinephrine of sympathetic nerve endings
and stimulates adrenal medulla which secretes
aldosterone that enhances sodium and water retention.
Thus the activation of Renin Angiotensin System (RAS)
causes overload of plasma volume resulting to oedema,
sudden weight gain, and respiratory distress(ref).
Paragraph 8 (focus on Intervention 1)(160 words)

Topic Sentence (provide the key words that

answers the question)

Which type of Intervention? (independent or

collaborative)

Use summaries/paraphrase (reference)

What is the intervention? (ref)

Nurses responsibility in performing the

intervention (ref)

Why is it suitable for the patient?

Concluding Sentence: Link patient data and

evidence reference (intervention will
resolve/manage/relieve the patient s & S/
Abnormal data.

Intervention 1 –
Administer medication as prescribed by the physician.
Diuretics can be administered to relieve fluid overload(.
(Paul, & Hice, 2014, p. 366.). For patients with ADHF,
diuretic is used to treat oedema, it enables excretion of
fluid from the tissue back into the circulation by reducing
the plasma volume. Medication administration is a
collaborative intervention, nurses should follow physicians
order and follow the patients’ rights during administration
(ref). Diuretic, Furosimide is prescribed to Mr. Simpson, it
is administered parenterally. Nurses should ensure that
the intravenous site is not compromised, observe for signs
of infection and swelling before administering the
medication, also following an aseptic technique(ref).
Monitoring the fluid intake and output is necessary when
giving diuretics (ref). Therefore, this nursing action is
useful in the management of fluid retention.

Paragraph 9 (Critical Discussion of intervention 1) (160)

Topic Sentence

Discuss advantages/disadvantages and risks of

intervention(ref)

Benefits and Risks(ref)

Link risks/benefits to patient situation/medical

condition

Conclusion(repeat keywords and emphasise why

intervention is suitable.

Loop diuretics promotes diuresis, reduces fluid

retention.
Disadvantage – There are adverse effects such as
hypovolemia, hypokalemia and metabolic
alkalosis. It also promotes frequent urination to
excrete the excess fluid in the body. Setting up a
 bed side commode or bed pan is one of the
nursing consideration to assist patient when
urinating. Drug interaction is also another risk to
be considered in drug administration. Because
Mr. Simpson is taking Diuretic and Metoprolol, it
is crucial that he should not take any NSAIDS as it
may result to triple whammy effect(ref).

Paragraph 10 (focus on Intervention 2)(160)

Topic Sentence (provide the key words that

answers the question)

Identify intervention 2 to match the priority nsg

prob 1.

Which type of Intervention? (independent or

collaborative)

Use summaries/paraphrase (reference)

What is the intervention? (ref)

Nurses responsibility in performing the

intervention (ref)

Why is it suitable for the patient?

Concluding Sentence: Link patient data and

evidence reference ( intervention will
resolve/manage/relieve the patient s & S/
Abnormal data.

Follow fluid restriction and low sodium diet as

prescribed. It is a collaborative intervention, that
needs to be ordered by dietician. Dietary plan
that aim for low sodium diet- 2-3g/day to reduce
fluid retention and the symptoms of pulmonary
and peripheral congestion. Furthermore, restrict
 fluid consumption each day to reduce fluid
retention. Taking into consideration that fluid
includes yoghurt, gelatin, sauces, pudding, ice
cream and juicy fruits(ref). Nurses ensures to
monitor food intake and encourage the patient
to follow dietary plan. Monitoring fluid intake
and output using Fluid Balance Chart is also
recommended. Measured Ice cubes can also be
provided to ease thirst if desired by the
patient(ref). It is counted as an intake but it will
last long than a regular drink. Providing health
teachings to solicit understanding about the
importance of following dietary plan may
empower the patient to self-management.

Paragraph 11 (Critical Discussion of intervention 2)

Topic Sentence

Discuss advantages/disadvantages and risks of

intervention(ref)

Benefits and Risks(ref)

 Link risks/benefits to patient situation/medical
condition

Conclusion (repeat keywords and emphasise why

intervention is suitable.

Advantages - reduce fluid retention and the

symptoms of pulmonary and peripheral
congestion.
Sodium causes the body to retain extra fluid.
Following low sodium diet will improve the fluid
overload in the body thus improves shortness of
breath and swelling.
Disadvantages – It could limit patient intake and
gives restriction on what to eat and what not to
eat. May cause dry mouth and increase thirst.
Provide oral care and rinse mouth without
swallowing the water as it is also counted as a
fluid intake.
Paragraph 12 (Evaluation Criteria)

Topic Sentence

Identify types of evaluation data

Explain specific evaluation tools and data that

shows patient improvement

Link measurement to abnormal patient data from

the case study ( aligns prob just)

Use literature to support evaluation tools

Nursing Priorities – Improve myocardial contractility and

improve systemic perfusion. Reduce fluid volume overload

Desired outcome – Patient will be able to demonstrate

stabilised fluid volume evidenced by balanced fluid intake
and output, clearing breath sounds, vital signs within
normal range, stable weight and absence of oedema.

Verbalised understanding of dietary and fluid

restrictions.

Conclusion (100-150 Words)

Review patients problem

Identify interventions discussed

 Re estate benefits of intervention to resolve the
problems

It should paraphrase the thesis

statement, main points, reflect(not repeat) your intro.
Leave reader wit strong impression