Nursing: Case Based Written Assignment


The present research study has been emphasizing on MG who is a 76-year-old female currently admitted to emergency department and she is also diagnosed with congestive heart failure problem. From past medical history, it is identified that she is having hypertension and chronic renal failure. Thus, looking towards her medical situation, the study has analysing several risk factors that present in MG’s case due to cardiovascular disease

Describe the pathophysiology, health assessment and clinical findings specific to MG’s condition

Heart failure develops when the heart fails to pump blood at a rate commensurate with the requirements of the metabolizing tissues. Congestive heart failure is a syndrome that can be caused by a number of abnormalities such as loss of muscle, pressure and volume overload and high output failure (Hockenberry, Wilson, & Rodgers, 2016). For the purpose of maintaining normal cardiac output, several mechanisms are important to consider such as compensatory enlargement cardiac hypertrophy and cardiac dilatation. Heart failure also results in depression of the ventricular function curve and compensation arises in the form of stretching of myocardial fibres (Abrahams-Gessel and, 2016).

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Heart failure is the pathophysiologic state that may be caused because of myocardial failure and it may also occur in the presence of near-normal cardiac function under conditions of high demand. It is an apparent aspect that heart failure always causes circulatory failure because of noncardiac conditions such as hypovolemic and septic shock. The major symptoms of congestive heart failure includes the following things:

  • Exertional dyspnea
  • Acute pulmonary edema
  • Nocturia and oliguria
  • Distention of neck veins
  • Increased intensity of P2 heart sound
  • Fatigue and weakness
  • Anorexia, weight loss and thread pulse
  • Central or peripheral cyanosis (Connolly and, 2017)

In acute heart failure, patient care consists of stabilizing the patient’s clinical condition, establishing the diagnosis, etiology and precipitating factors. However, in the usual form of heart attack, the heart muscle reduced contractility and this produces a reduction in cardiac output which then becomes inadequate to meet the peripheral needs of the body. In this disease, heart rate is generally increased.

According to the health assessment, it is identified that that her pulse rate is 102 and her BP level is 160/100, RR is 24 and temperature is 37.3C. According to the diagnosis, she has widespread creps on chest auscultation and she is sweaty as well. At the same time, after conducting ECG, it is ascertained that MG has atrial fibrillation (Ding and, 2017). After conducting radiology, it is being analysed that she has cardiomegaly and pulmonary congestion. Laboratory testing is also carried out and it is analysed that the level of potassium and sodium is high because she is not following the fluid and salt restriction which was ordered to her at the time when she was admitted in the hospital.

According to the case analysis, she was discharged from the hospital prior 11 days and after that again she come up in the hospital as she is unable to catch the breath and because of that her legs are getting big and heavy (Faithfull and, 2017). When question was asked from the health care practitioner, she said that she is not following the fluid and salt restriction; hence reportedly she gained 2kg weight after her discharge. Since, she had the issue of hypertension; thus currently the level of BP is getting low and at the same time she is also having type 2 Diabetes mellitus.

State the risk factors she have for cardiovascular disease

It is being observed that the majority of cardiovascular disease is caused by risk factors under which certain can be controlled, treated or modified (Hockenberry, Wilson & Rodgers, 2016). High blood pressure, cholesterol, overweight, diabetes and lack of physical activities are included under this. However, on the other hand there are several major CVD risk factors that cannot be controlled. Thus, the identified leading CVD risk factor is raised blood pressure which also leads to deaths in many cases. Further, physical inactivity and overweight are also some of the risk factors that can be controlled; but then it leads to certain other health issues (Hu and, 2016). This also considers family history if anyone has the issue related to CVD. It is also identified that hypertension is the single biggest risk factor that leads to stroke and it also play significant role in heart role.

In the present research study, MG is having the issue of hypertension and she also has diabetes; moreover on the basis of past history it is identified that her mother died at the age of 65 years because of CVA. Type 2 diabetes is a major risk factor for coronary heart disease and stroke and obesity is also important which also leads to cardiovascular diseases (Kayser and, 2016). Thus, looking towards the present condition of MG, it can be said that her condition is highly critical as she is having several major issues related to cardiovascular disease. Further, the issue of stroke is also increasing since MG is getting older.

What other complications does MG present with and why have these occurred

Along with Cardiovascular disease, MG is also having problems because her pulse rate is irregular, BP level is also down and respiratory rate is also 24 that means she is having fast breathe continuously (Lee and, 2016). At the same time, it is also identified that her legs is getting big; thus such factors could generate other risk associated aspects for MG. On the basis of past history, the risk of heart attacks are higher because of hypertension and type 2 diabetes. Thus, proper medical support and treatment is required to be given to MG else she might get other issues along with cardiovascular disease. Since, she has type 2 diabetes; therefore MG has the risk of high blood sugar and insulin resistance (LaBella and, 2016). This clearly states that because of high blood pressure, there is a risk of heart failure which can also lead to evaluated blood sugars.

The life of MG is highly risky as she is not following proper dietary chart and she also consumes unhealthy products most often. At the same time, she is not performing any sort of physical activity; hence this also leads to obesity and fatigue (Mohammedi and, 2016). The problem of cholesterol is also increasing and that brings improper pumping of heart that also blocks the blood vessels. Thus, considering the present situation, it is clear that there are various risk factors for MG. These complications have occurred because MG was asked to follow various things and restrictions were also there in the consumption of fluid and salt. However, she did not follow that and because of that her weight is increasing. She is also not following proper medication chart and as a result, other health issues are arising consequently.

Using the Clinical Reasoning Cycle, identify three priorities nursing diagnoses

In the present research study, three major priorities which needs proper nursing diagnosis are stated as under:

  • Cardiovascular disease
  • Type 2 diabetes
  • Hypertension

Thus, according to the defined problems, these are the major priorities which needs immediate nursing diagnosis so that suitable care can be delivered to MG. This is also useful so that she can recover her health condition as early as possible (Moore, Bobo, Rock & Wise, 2016). At the same time, it is also vital for the nurses to adopt numerous interventions to give suitable care to MG.

State the goal of care, specific nursing intervention and their corresponding rationale

Thus, as per the above discussion it is clear that in the present case of MG, nurses are required to develop a nursing plan so that specific care can be delivered accordingly. Nurses in this case must also make use of specific intervention as per the health problem.

Hence, in terms of reflecting about my own experience, I can say that I have prepared this study will all relevant and accurate materials which has contributed in enhancing my knowledge and capabilities. Further, I can also say that I now get to know about the nursing interventions that are available for different health diseases. However, in the present case, MG is having several health problems; thus proper treatment is required to be given to her according changing health aspects. Stating about my role in this care provision, I can say that I have acquired knowledge on various aspects which can help me in performing all my roles in suitable manner.

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The study seems to be useful since it helped in analysing the effectiveness of nursing intervention for different health problems. The study has also helped in realizing the ways through which cardiovascular problems can be managed inappropriate manner.


  • Abrahams-Gessel, S. and, (2016). Challenges facing successful scaling up of effective screening for cardiovascular disease by community health workers in Mexico and South Africa: Policy implications. Health systems and policy research. 3(1).
  • Connolly, S. B. and, (2017). Outcomes of an integrated community-based nurse-led cardiovascular disease prevention programme. Heart.
  • Ding, S. and, (2017). Knowledge and practice in cardiovascular disease prevention among hospital registered nurses: a crosssectional study. Journal of clinical nursing.
  • Faithfull, S. and, (2017). Mitigating risk of cardiovascular disease in people living with and beyond cancer. Cancer Nursing Practice. 16(1). pp.18-23.
  • Hockenberry, M. J., Wilson, D., & Rodgers, C. C. (2016). Wong's essentials of pediatric nursing. Elsevier Health Sciences.
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