NURS 6501 CASE STUDY ANALYSIS WEEK 4 Case Study Analysis: Cardiovascular and Respiratory Systems A 76-year-old female patient who presents with symptoms of peripheral edema, abdominal swelling, weight gain, and shortness of breath

 NURS 6501 CASE STUDY ANALYSIS WEEK 4

Case Study Analysis: Cardiovascular and Respiratory Systems

A 76-year-old female patient who presents with symptoms of peripheral edema, abdominal swelling, weight gain, and shortness of breath. The patient has orthopnea (needs to use two pillows in order to get enough air). She has a medical history of congestive heart failure and she is noncompliant to diuretic medication due to its effect on increasing urinary frequency.

Cardiovascular Pathophysiology

Congestive Heart Failure

The patient has a medical history of congestive heart failure (CHF). CHF is a chronic medical condition where there is an abnormality in cardiac structure or function resulting in inability of the heart to fill with or eject blood at a rate that commensurate with the requirements of the metabolizing tissues (Ariyaratnam et al., 2021). It presents with fluid retention, fatigue, and dyspnea. The patient has been noncompliant to diuretic medication. Diuretics are essential medications in CHF since they help relieve the body of excessive fluid. Since the patient does not take the medication due to its effect in increasing urinary frequency, excessive fluid accumulates in the body leading to peripheral edema. Noncompliance to medications further worsens the heart failure.

Fluid Retention and Peripheral Edema

In CHF, the heart’s pumping mechanism is affected leading to reduced cardiac output. The body activates neurohormonal systems such as the renin-angiotensin-aldosterone system (RAAS) and sympathetic nervous system (SNS) which increase reabsorption of sodium and water from the kidneys (Ariyaratnam et al., 2021). The consequence is further increase in fluid overload leading to increased blood volume and aggravate peripheral edema. It is essential for the clinician to enquire about other medications of heart failure. Is the patient taking ACE inhibitors? Medication analysis helps to understand the causation of the symptoms. Abdominal swelling also indicates excessive fluid accumulation in the body. Some fluid accumulates within the abdomen.

Cardiopulmonary Pathophysiology

Pulmonary Congestion

CHF may present with diastolic, systolic, or both dysfunctions. Inefficiency to pump blood from the heart and to fill adequately contributes to blood backing up in the pulmonary circulation. Increased fluids in the pulmonary circulation cause increased pulmonary venous pressure. Elevated pressure in the pulmonary capillaries cause leakage of fluids into the interstitial spaces and alveoli of the lung, leading to pulmonary congestion (Boorsma et al., 2020). Fluid in the lungs impair gaseous exchange and shortness of breath. While lying in recumbence, there is fluid distribution from splanchnic and lower extremities to the lung which in the case of this patient worsens the pulmonary congestion. Orthopnea necessitates this patient to use two pillows to alleviate breathing difficulties.