I.

INTRODUCTION

INTRODUCTION

A. Overview of the disease

Heart failure is a physiologic state in which the heart cannot pump enough

blood to meet the metabolic needs of the body (determined as oxygen consumption).

Heart failure results from changes in systolic or diastolic function of the left

ventricle. The heart fails when, because of intrinsic disease or structural defects, it

cannot handle a normal blood volume or, I the absence of disease, cannot tolerate a

sudden expansion in blood volume (e.g. during exercise).

Heart failure is not a disease itself; instead, the term refers to a clinical

syndrome characterized by manifestations of volume overload, inadequate tissue

perfusion, and poor exercise tolerance. Whatever the cause, pump failure results in

hypoperfusion of tissue, followed by pulmonary and systemic venous congestion.

Because, heart failure causes vascular congestion, it is often called congestive heart

failure, although most cardiac specialists no longer use this term.

Heart failure signs and symptoms may include:

Shortness of breath (dyspnea) when you exert yourself or when you lie down

 Fatigue and weakness

 Swelling (edema) in your legs, ankles and feet

 Rapid or irregular heartbeat

 Reduced ability to exercise

 Persistent cough or wheezing with white or pink blood-tinged phlegm

 Increased need to urinate at night

 Swelling of your abdomen (ascites)

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I. INTRODUCTION

 Very rapid weight gain from fluid retention

 Lack of appetite and nausea

 Difficulty concentrating or decreased alertness

 Sudden, severe shortness of breath and coughing up pink, foamy mucus

 Chest pain if your heart failure is caused by a heart attack

Causes

Heart failure often develops after other conditions have damaged or

weakened the heart. However, the heart doesn't need to be weakened to cause heart

failure. It can also occur if the heart becomes too stiff.

In heart failure, the main pumping chambers of the heart (the ventricles)

may become stiff and not fill properly between beats. In some cases of heart failure,

heart muscle may become damaged and weakened, and the ventricles stretch

(dilate) to the point that the heart can't pump blood efficiently throughout the body.

Over time, the heart can no longer keep up with the normal demands placed on it to

pump blood to the rest of the body.

Heart failure can involve the left side (left ventricle), right side (right

ventricle) or both sides of your heart. Generally, heart failure begins with the left

side, specifically the left ventricle — the heart's main pumping chamber.

Risk Factors

 High blood pressure

 Coronary artery disease

 Heart attack

 Diabetes

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I. INTRODUCTION

 Valvular heart disease

 Alcohol uses

 Tobacco use

 Obesity

 Irregular heartbeats

Chronic Kidney Disease (CKD) is progressive, irreversible loss of kidney

function. It is defined as either presence of kidney damage or glomerular filtration

rate (GFR) <60 ml/min for 3 months or longer. (Normal GFR is about 125ml/min

and is reflected by urine creatinine clearance measurements). Disease staging is

based on the decreasing glomerular filtration rate which is shown below.

Stages Description Glomerular filtration

rate (ml/min/1.73 m²)

Stage 1 Kidney damage with ≥ 90

normal or increase GFR

Stage 2 Kidney damage with 60-89

mild decrease GFR

Stage 3 Moderate decrease GFR 30-59

Stage 4 Severe decrease GFR 15-29

Stage 5 Kidney Failure < 15 (or dialysis)

CKD can cause other problems such as heart failure or sometimes called

Congestive Heart Failure. In some studies, a damage kidney which has a diminished

ability to excrete excess water and waste material in the blood, can cause CHF

because excess volume of fluids in the body will stress the pumping mechanism of

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I. INTRODUCTION

the heart. As renal function progressively deteriorates, every system also becomes

affected especially the heart.

A. Reference: Medical-Surgical Nursing 7th edition of 2008 Volume by Lewis,

Heitkemper , Dirksen, O’Brie and Bucher Chapter 47 Acute Renal Failure and

hroic Kidney Disease Page 1204-1216

B. Statistical Data

Local

Congestive heart failure is found in about one-quarter of cases of chronic

kidney disease. The most common causes of congestive heart failure is ischemic

heart disease. The prevalence of congestive heart failure increases greatly as the

patient’s renal function deteriorates, and, at end-stage renal disease, can reach 65-

70%. There is mounting evidence that chronic kidney disease itself is a major

contributor to severe cardiac damage.

Kidney diseases, especially End Stage Renal Disease (ESRD), are already

the 7th leading cause of death among the Filipinos. One Filipino develops chronic

renal failure every hour or about 120 Filipinos per million population per year. More

than 5,000 Filipino patients are presently undergoing dialysis and approximately

1.1 million people worldwide are on renal replacement therapy. Reliable estimates

reveal that the number of these patients will double in 2010.

Reference: http://www.nkti.gov.ph/index.php/patients-and-visitors/kidney-health-plus

International

Each year in the United States, more than 100,000 people are

diagnosed with kidney failure, a serious condition in which the kidneys fail to rid

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I. INTRODUCTION

the body of wastes. Kidney failure is the final stage of chronic kidney disease

(CKD).

The number of adults living with heart failure increased from about 5.7

million (2009-2012) to about 6.5 million (2011-2014), according to the American

Heart Association's 2017 Heart Disease and Stroke Statistics Update.

Based on the latest statistics, the number of people diagnosed with heart

failure, which means the heart is too weak to pump blood throughout the body, is

projected to rise by 46 percent by 2030, resulting in more than 8 million people

adults with heart failure. According to experts, there are several reasons for the rise

in heart failure, that can be attributed to medical advances, because more people are

surviving heart attacks which means they face higher heart failure risk afterward,

said Paul Muntner, Ph.D., a member of the statistical update's writing panel and a

professor and vice chair in the Department of Epidemiology at the University of

Alabama at Birmingham. But the aging of America and other health problems are

also major contributors.

References:https://medicalxpress.com/news/2017-01-latest-statistics-heart-failure-

cardiovascular.html

C. Scope and Limitation

The patient was confined last October 24, 2018 due to Chest pain, shortness

of breath and edema on the lower extremities. On the 4th day of confinement, it was

Saturday, the student nurses from LSPU-SCC handled the patient at 6-2 shift in

Medical Ward of Laguna Medical Center under the supervision of Mrs. Gloria N.

Ramos, Ph.D, RN.

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I. INTRODUCTION

The coverage of the duty includes the Nurse-Patient-Interaction/interview,

cephalocaudal assessment, IV regulation, monitoring and recording of patient’s

vital signs, monitoring and recording of intake and output, drug administration by

oral route and other independent nursing interventions and documentation.

The student nurses received their patient lying on bed with oxygen

administration via nasal cannula. He was complaining of having difficulty of

breathing. During the duty, the student nurses had a hard time in talking to the

patient, since the patient is experiencing difficulty of breathing. Fortunately, the

student nurses were able to finish the interview through the help of the patient’s

relatives.

D. Background of the Study

This study aims to identify patient’s problems and health needs in order to

promote general health of the patient by providing proper interventions through the

application of nursing process.

This case was chosen by the student nurses in order for them to enhance

their critical thinking in analysing such case, also to practice their skills in

formulating and implementing a nursing care plan. Lastly, this study help them to

develop their sense of teamwork as they perform their case presentation with the

concepts in fundamentals of Nursing Care Management, Medical-Surgical Nursing

course, and Human Anatomy and Physiology.

E. GENERAL OBJECTIVES

At the end of the case presentation, nursing students from BSN IV-A will

be able to gain extensive knowledge and comprehend their case even more, and also

to further understand everything from the case that will be presented.

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I. INTRODUCTION

SPECIFIC OBJECTIVES

 Understand the pathophysiology and etiology of Chronic Kidney Disease

and Congestive Heart Failure

 Recognize the contributing risk factors associated with CHF and CKD

 Will be able to enumerate the predisposing and precipitating factors that

contribute to the case.

 Will be able to provide a thorough assessment and data gathering that could

help in formulating nursing care plan.

 Will be able to state and identify the appropriate nursing diagnosis and make

interventions.

 Provide specific and suitable health teachings to promote wellness.

 Will be able to implement plant of care.

 Will be able to formulate nursing care plan.

 Provide health teaching.

 Determine the effectiveness of every plan and interventions.

 Learn about management and rehabilitation factors that optimize health.