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A medical case study concerning an elderly man with congestive heart failure

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  1. Introduction
  2. Causes of congestive heart failure
  3. The pathophysiology
  4. Symptoms of congestive heart failure
  5. Effects of congestive heart failure
  6. Conclusion
  7. Reference list

For the purpose of this case study the patient shall be referred to as John to ensure patient privacy and confidentiality in accordance with the Health Information Privacy Code 1994 (Burgess, 1999). John is an 80-year-old European male. He lives with his wife who is a very supportive person. John has a 20 year history of hypertension. He is an ex-smoker having given up 15 years ago. He has a family history of heart disease, hypertension and cancer. John notices feet and ankle swelling. He wakes up in the middle of the night with acute shortness of breath. He feels tired most of the time. John's medical diagnosis is Congestive heart failure. Congestive heart failure is actually a complication of other cardiovascular conditions rather than a disease in itself. John's history of hypertension and his age predispose him to congestive heart failure. Structural changes during aging mainly include some left ventricular wall and septal hypertrophy due to left atrial and ventricle widening, and fibrosis of the cardiac muscle.

[...] Elevating the legs increases venous return rapidly, and can overwhelm the heart in congestive heart failure (Black & Hawkes, 2005). John needs frequent skin care because of edema and peripheral tissue hypoperfusion. Thus it is necessary to turn him often, and moisturize his skin to prevent cracks and fissures. His heels are especially at risk for decreased capillary blood flow; therefore it is important to keep John's heels elevated off the mattress (Black & Hawkes, 2005). At 80 years of age John is more likely to develop pressure ulcers due to age related changes (skin increased fragility with decreased skin thickness and subcutaneous fat for protection) with prolonged bed rest. [...]

[...] Therefore, oxygen demands are not as well met in an older person when compared with a younger person (Shepard, 1997) As mentioned earlier John has longstanding hypertension which is most likely a contributing factor to his congestive heart failure. Hypertension can remain asymptomatic for the first 10-20 years but slowly places more strain on the heart and arteries (Marieb, 2000). The factors which may have contributed to John's hypertension which occurs with aging is increased collagen content, covalent cross linking of collagen, reduced elastin content, elastin fracture, and calcification. [...]

[...] Acute MI: Age-related presentations and treatment options. Geriatrics, 55(2) Nazarko, L. (2000). How age affects fluid intake. NT Plus. 96(31) Nicholas, M. (2004). Heart failure: Pathophysiology, treatment and nursing care. Nursing standard 46-51. Porth, C. (2002). Pathophysiology: concepts of altered health states (6th ed.). Philadelphia: Lippincott Williams & Wilkins. Pinneo, R. (1995). Continuing education in cardio vascular nursing: Congestive heart failure. USA: Prentice-Hall, Inc. Price, S. A., Wilson, L. M. (1997). Pathophysiology: Clinical concepts of disease processes (5th ed.). USA: Mosby. Resnick, B. (2004). Encouraging exercise [...]

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