NUR 631 Topic 8 DQ 2

Sample Answer for NUR 631 Topic 8 DQ 2 Included After Question

Select three of the following questions for your discussion response. Indicate which questions you have chosen using the format displayed in the “Discussion Forum Sample.” 

Scenario

C.H. presented to your office with the complaint of a “racing heartbeat.” She is an overweight, 66-year-old African American female, who has been experiencing increasing shortness of breath during the past 4 months and marked swelling of the ankles and feet during the past 3 weeks. She feels very weak and tired most of the time and has recently been waking up in the middle of the night with severe breathing problems. She has been sleeping with several pillows to keep herself propped up. Five years ago, she suffered a transmural (i.e., through the entire thickness of the ventricular wall) anterior wall (i.e., left ventricle) myocardial infarction.

She received two-vessel coronary artery bypass surgery 4.5 years ago for obstructions in the left anterior descending and left circumflex coronary arteries. Her family history is positive for atherosclerosis as her father died from a heart attack and her mother had several CVAs. She had been a three-pack-per-day smoker for 30 years but quit smoking after her heart attack. She uses alcohol infrequently. She has a 9-year history of hypercholesterolemia. She is allergic to nuts, shellfish, strawberries, and hydralazine. Her medical history also includes diagnoses of osteoarthritis and gout. Her current medications include celecoxib, allopurinol, atorvastatin, and daily aspirin and clopidogrel. 

Questions

  1. Based on the limited amount of information provided above, do you suspect that this patient has developed heart failure based on the most recent guidelines? Explain your answer.
  2. What are the most common causes of congestive heart failure (CHF) in an adult? Given the information in this case, which causes seems to be the most likely?
  3. From the information given above, identify three risk factors that probably contributed to the patient’s heart attack 5 years ago.
  4. You are curious as to the usefulness of the S3 in making a diagnosis of CHF. You go to the literature and find two studies. The first study started with 100 patients with echocardiographically proven LV systolic dysfunction and an ejection fraction estimated at less than 35%. Of that group, 80 patients had an S3. The other study took 100 normal volunteers and performed auscultation and echocardiography. Of that group, 10 patients with normal echocardiograms had an S3. You then see a patient in your office with a history of exertional dyspnea. You estimate before examining her that she has a “50-50 chance” of having congestive heart failure. If you hear an S3, what do you then think are her chances of having CHF?
  5. What diagnostic tests would you consider in this case?

A Sample Answer For the Assignment: NUR 631 Topic 8 DQ 2

Title: NUR 631 Topic 8 DQ 2

What are the most common causes of congestive heart failure (CHF) in an adult? Given the information in this case, which causes seems to be the most likely?

Congestive heart failure (CHF) is a syndrome that affects the quality of life and circulation. The development of heart failure in adults is based on overall cardiac health and activity, to begin with. Heart failure occurs when the chambers are weakened and unable to contract fully to provide enough cardiac output, also known as a ventricular refilling disorder (Malik et.al, 2022). Problems with ejection fraction and inadequate cardiac output lead to pulmonary hypertension and congestion, which manifests as shortness of breath (dyspnea), reduced exercise intolerance, and fluid retention (Malik et.al, 2022).

The most common cause of CHF in adults is a weakness in the left ventricular chamber, also known as left ventricular ejection fraction (LVEF). CHF is classified on the symptoms and calculation of LVEF but generally, an EF of 40% or less is indicative of CHF (Malik et.al, 2022). Given this case scenario, the patient had already suffered a transmural anterior wall myocardial infarction, which already vastly affects the strength of her cardiac function. That would explain the patient’s complaints of dyspnea overnights and swelling of her ankles and feet.

From the information given above, identify three risk factors that probably contributed to the patient’s heart attack 5 years ago.

Risk factors for the development of heart failure are like those of coronary artery disease and diabetes mellitus. Most of them are modifiable and required change to improve quality of life. Based on the information gathered from above, the patient’s risk factors that most likely contributed to the heart attack 5 years ago include smoking (3 pack-per-day smoker), obesity, a 9-year history of high cholesterol, and a positive family history of cardiac issues. Other risk factors for CHF include obesity, diabetes, cardiomyopathies, excessive drinking, and kidney failure (McCance et.al, 2019).

What diagnostic tests would you consider in this case?

As a result of the vascular congestion and inadequate perfusion, we would need to perform studies that would measure how well the heart and other tissues are being oxygenated. Diagnostic studies include an electrocardiogram, a chest x-ray, serum cardiac markers such as troponin, BNP levels, and an echocardiogram. An echocardiogram can assess heart size and function within the chest cavity. Echocardiograms confirm the diagnosis of heart failure (McCance et.al, 2019). A chest X-ray measures the function of the heart and provides imaging of both the lungs and heart.

References:

Malik A, Brito D, Vaqar S, et al. Congestive Heart Failure. [Updated 2022 Nov 7]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK430873/

McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S. (2019). Pathophysiology: The biologic basis for disease in adults and children (Eighth ed.). Elsevier.

A Sample Answer 2 For the Assignment: NUR 631 Topic 8 DQ 2

Title: NUR 631 Topic 8 DQ 2

There are several indicators that suggest the patient has developed heart failure. The symptoms of shortness of breath, weakness, fatigue, edema in the lower extremities, and orthopnea are common manifestations of heart failure. The patient’s history of myocardial infarction and coronary bypass surgery indicates a pre-existing cardiovascular condition that can contribute to the development of heart failure. Considering the definition of heart failure as the inability of the heart to generate adequate cardiac output and increased diastolic filling pressure, the symptoms and medical history align with the presentation of heart failure.

The most common causes of congestive heart failure in adults include coronary artery disease and heart attack, high blood pressure, and diseases of the heart valves. Other factors that can contribute to heart failure include cardiomyopathy, congenital heart defects, certain infections, alcohol and drug abuse, and certain medications or treatments. In this particular case, the most likely cause of heart failure appears to be coronary artery disease and the previous heart attack. The patient’s history of obstructed coronary arteries and bypass surgery suggests that CAD has played a significant role in the development of heart failure.

Three risk factors that likely contributed to the patient’s heart attack 5 years ago are high LDL cholesterol, smoking, and obesity. High LDL cholesterol is a major risk factor for atherosclerosis, which is the underlying process that leads to coronary artery disease and heart attacks. Smoking is a well-known risk factor for cardiovascular disease, including heart attacks, as it can damage blood vessels and promote the formation of blood clots. Obesity is also associated with an increased risk of heart disease and heart attacks, as it contributes to high blood pressure, diabetes, and abnormal lipid levels.

McCance, K. L., Huether, S. E., Brashers, V. L., Rote, N. S., & McCance, K. L. (2019). Pathophysiology: The biologic basis for disease in adults and children. Elsevier.