Case Study: Congestive Heart F

1-In heart failure heart may not provide tissues with adequateblood for metabolic needs and cardiac related elevation ofpulmonary or systic venous preassures may result in organcongestion.In heart failure with low cardiac out putstate,activation of the RAAS serves as a compensatory mechanism tomaintain cardiac output.Reduced renal blood flow and sodiumdelivery to the distal tubule leads to renin release which isexacerbated further by increassed sympathetic tone.

2- The symptoms of Heart failure present in the patient is

• Shortness of breath
• swelling in the legs
• Reduced ability to excerise
• Persistent cough
• Sudden ,severe shortness of breath
• Chest pain
• Odema on the abdomen.

3- Here the patient having Cardiomegaly,and ventricularhypertrophy anf fluid filled in the both lungs.

Cardiomegaly can cause by many conditions,includinghypertension,coronary artery disease,infections.Right ventricularhypertrophy is usually caused by problemm in lung,but leftventricular hypertrophy occurs as a result of problem with aorticvalve.Here also fluid present in the lungs,it leasds to difficultyin breathing.Understanding the facts are very important to get adiagnosis and treat the disese at earlier.

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Digoxin 0.25 mg PO qd

· Furosemide (Lasix) 40 mg IV bid

· Potassium 40 mEq PO bid

· Enalapril (Vasotec) 5 mg PO qd

· 2 g sodium diet

· Oxygen 6 L/min

· Daily weights

· Daily 12-lead ECG, cardiac enzymes q8hr x 3

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Digoxin 0.25 mg PO qd

· Furosemide (Lasix) 40 mg IV bid

· Potassium 40 mEq PO bid

· Enalapril (Vasotec) 5 mg PO qd

· 2 g sodium diet

· Oxygen 6 L/min

· Daily weights

· Daily 12-lead ECG, cardiac enzymes q8hr x 3

4- Digoxin 0.25 – If the patient experincing the symptoms ofHeart failure ,Digoxin can improve the heart ‘s ability to pumpblood.This will often improves shortness of breath.

Furosemide- This is a Diuretic used to reduce extar fluid in thebody caused by conditions such as Heart failure,liverdisease,Kidney disease.This can reduse the symptoms of shortness ofbreath and swelling in the extrimities and abdomen.

Pottassium – Pottassium supplements is given to the patient tomaintaion the pottassium level in the body,A severe pottassiumdefficiency can cause breathing difficulties.This is becausepottassium helps relay signals that stimulate the lungs to contractand expand .When pottassium level are severly low the lungs may notexpand and contract properly.This results in shortness ofbreath.

Enalapril-This will reduce the severity of Heart failureandsymptoms of shortness of breath and tirdness

Sodium diet 2gm- Reducing the amount of sodium may help toreduce the blood preassure.Sodium makes the body hold on tofluid.To pump the added fluid the heart has to work harder.Too muchsalt can wrosen symptoms like swellin and shortness of breath andcause weight again.

Adult should eat 6gm of salt in a day,here it is restricted to2gm per day.

Oxygen 6l/min- To maintain the airway oxygen administration isneeded,oxygen therapy can help to decrease the shortness ofbreath.In heart failure the heart does not pump as effectievely asit should not meet the need of the body,Oxygen therapy helpscompensate by increassing the amount of oxygen delivered to thebody.

Daily weightIn heart failure first alerted sign is weight gainmore than two or three pounds in a 24 hour or more than five poundsin a week.Weight can give a accurate idea of sudden changes.

Daily ECG- ECG or EKG to assess the rate and rhytham.This helpsto identify diseases of heart,enlargement of heart,and if fluidpresent in lungs.Here it helps to understand the patient conditionbetter.

Cardiac enzymes Every eight hourly- cardiac enzymes can elevatein cardimyopathy,infections and other heart conditions,Hense itwill helps to identify the condition bette.

5- Immediate management is needed for this patient ,Ceratininterventions are

• Place the patient in comfortable position,High fowlers positionis adequate to reduce the pulmonary congestion,and releiveodema.
• Administer oxygen in high concentrations by mask to improve gasexchange and pulmonary function.
• Prepare for intubation,and ventilator support if required.
• Suction the fluid as needed to maintain the airway .
• Provide reasuurance.
• Insert Foleys catherter if advised to monitor the intake andout put ,
• Avoid administration of fluid.
• Assess the patient for complications,
• Administer medications as orderd.

6- We can prevent the severity of Heart failure by ceartainmesures.

Reduce the risk factors,Monitor and observe the patient ,Continemecication as prescribed.

7-There are several problems related with heart failure.

Decressed cardiac out put -Ineffective tissue perfusion relatedto decreassed cardiacoutput.

Excessive fluid volume,-

activity intolerance

,impaired gas exchange,

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