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. [...]
[...] Within a few hours of heart failure the kidneys secrete an increased amount of renin. Renin acts upon angiotensin to produce angiotensin I which then is converted by angiotensin-converting enzyme, to angiotensin II. Angiotensin II causes arterial vasoconstriction, which increases peripheral vascular resistance and maintains blood pressure. Angiotensin II also stimulates secretion of aldosterone from the adrenal gland. Aldosterone promotes reabsorption of sodium and chloride in the kidney. Retention of sodium and water produces expansion of the blood volume. The stretch of the myocardial fibers is increased to improve contractility. [...]
[...] Congestive heart failure is a chronic medical problem commonly found in older adults. Nurses must be aware of the structural changes that occur in the body systems of the elderly. However it is important to implement effective nursing assessment and intervention to ensure patient safety. Reference list: Black, J. M. & Hawks, J. H. (2005). Medical-Surgical nursing: Clinical management for positive outcomes (7th ed.). USA: Elsevier Saunders. Brashers, V. L. (2002). Clinical applications of pathophysiology (2nd ed.). USA: Mosby. Burgess, M.E., (1999). [...]
[...] Coronary heart disease risk in older people 65 years of age and older. Progress in Cardiovascular Nursing, 138-140. Kennedy-Malone, L., Ftetcher, K. R., & Plank, L. M. (2000). Working with older adults (2nd ed.). Philadelphia: Davis Company. Lewis, S., Heitkemper, M., & Dirksen, S. (2004). Medical-surgical nursing: Assessment and management of clinical problems (6th ed.). Missouri: Mosby. Lippincott Williams & Wilkins. (2003). Elder care strategies: expert care plans for older adults. Philadelphia: Lippincott Williams & Wilkins. Marieb, E. (2003). Essentials of Human Anatomy and Physiology (7th ed.). [...]
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