Pathophysiology

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INTRODUCTION

Congestive heart failure is defined as “the state in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits”. There are two categories of congestive heart failure: systolic and diastolic. In the systolic type of the disease, blood coming into the heart from the lungs may be regurgitated so that fluid accumulates in the lungs (pulmonary congestion). In the diastolic type, the heart muscle becomes stiff and cannot relax, leading to an accumulation of fluid in the feet, ankles, legs, and abdomen.

Congestive heart failure is in itself not a diagnosis. Rather it is the physiological result of damage to the heart caused by some underlying condition. Cardiomyopathy is a condition in which the heart muscle is damaged and no longer functions properly. It is divided into three categories: dilated, hypertrophic, and restricted. The most common underlying cause for congestive heart failure is hypertension. The Framingham Heart Study recently reported that high blood pressure increased the risk of developing heart failure about 2 times for men and 3 times for women. A second important risk factor for the disease is diabetes mellitus. The incidence of heart failure among diabetics is three to eight times greater than in the normal population.

Currently, congestive heart failure or heart failure continues to be a major public health problem worldwide. Nearly 300,000 patients die from heart failure yearly. In the Philippines, cardiovascular diseases are the most common causes of mortality. According to the Department of Health (2005), about 77,060 in a 100, 000 populations have died in the Philippines due to diseases of the heart. The prevention of heart failure is an urgent public health need with national and global implications.

This case study is about a 58 year old Filipino male patient, a known-hypertensive and diabetic, diagnosed with congestive heart failure secondary to Dilated Cardiomyopathy.

OBJECTIVES

After the study, nurses are expected to:

* Know the patient’s profile and other information that would be essential for the case; * Identify causes that led to the diagnosis of the disease; * Distinguish organs involved, understanding its anatomy and physiology; * Analyze and understand the pathophysiologic explanation of the disease; * Analyze laboratory and diagnostic results;

* Provide a plan of care understanding its precautions.

PATIENT PROFILE:
NAME: Patient DRV
AGE: 58 years old
GENDER: Male
NATIONALITY:Filipino
DATE OF BIRTH: September 21, 1953
CIVIL STATUS: Married
RELIGION: Catholic
OCCUPATION:Cashier at the office of DENR
ADDRESS: DENR – PENRO, Capitol Road, Mamburao, Occidental Mindoro DATE OF ADMISSION: 20 August, 2012
CHIEF COMPLAINT: difficulty of breathing
ATTENDING PHYSICIAN: Dr. Romulo Rosita
ADMITTING DIAGNOSIS: Congestive Heart Failure secondary to Dilated Cardiomyopathy (CHF 2° to DCM)

CLINICAL APPRAISAL

The primary source of information is patient DRV’s wife since the patient was asleep and should be undisturbed during the time of our visit.

FAMILY HISTORY

According to his wife, patient DRV is the second child among the nine children of his parents. Patient DRV’s parents are both deceased and died of old age as his wife stated though hypertension is present in both of them. Three of his siblings also have elevated blood pressure. Hypertension is the only condition the wife can recognize as similar to what her husband has.

PERSONAL HISTORY / LIFESTYLE

Patient DRV, as what his wife told us, does not smoke any kind of tobacco or cigarette. She stated that her husband drinks large amount of alcoholic beverages before when he was not yet diagnosed of having such diseases but reduced his alcohol consumption after experiencing symptoms that led to his present condition.

According to the patient’s...
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