Case Study: Congestive Heart Failure (CHF) Essay Example

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Case Study: Congestive Heart Failure (CHF)

Case Study: Congestive Heart Failure (CHF)

Heart failure (HF) that is normally referred to in many cases as Congestive Heart Failure (CHF) refers to the inability of one’s heart to supply sufficient blood flow to meet the needs of the body (McMurray & Pfeffer, 2005). This is normally characterized with shortness of breath, swelling of legs and extreme cases of exercise intolerance. Research has shown that Congestive Heart Failure is a condition that is both costly and deadly because of many inabilities that it renders on the victim. In developed countries for example, statistics indicate that about 2% of all adults suffer from Congestive Heart Failure while the same percentage increases for those who are above the age of 65 years (McMurray & Pfeffer, 2005). Bearing in mind all these negative consequences, there is need to ensure that proper diagnosis is carried out on patients who report this condition. However, for this to be achieved, there is need to ensure that cardiovascular assessments that precede diagnosis are carried out holistically and in a proper manner so that detailed information is provided for diagnosis (McMurray & Pfeffer, 2005). The main purpose of this paper is to critically discuss the nursing responsibilities in undertaking an initial cardio-respiratory assessment. This will be done through the use of a selected case study.


The main objectives of this paper are:

  1. To critically discuss the nursing responsibilities in undertaking an initial cardio-respiratory assessment including health history taking and physical examination of specific present conditions of a CHF patient by use of a case study.

  2. To discuss the assessment approach and techniques that a nurse needs to utilize for a CHF patient with special attention to communication skills required and proper approach that is required.

  1. To demonstrate how a planned and organized approach in conducting a holistic nursing assessment that includes relevant aspects of subjective and objective data to be gathered need to be designed.

  2. To demonstrate how any developmental, psychosocial, cultural, spiritual and/or mental health considerations should be noted when undertaking the health assessment.

Case study

Mr. Sartaj Manjari is a 50 year old married man of Indian descends who has three teenage children. Mr. Manjari has been living in Australia for nearly 20 years and owns a popular Indian restraunt and recently arrived at a medical ward with Congested Heart Failure (CHF). While conducting a holistic nursing assessment on admission, the nurse is aware that certain aspects of cardiovascular, peripheral vascular, integumentary and respiratory assessments are a priority responsibility in performing an episodic or problem-centered database approach on this patient.


In this assessment, it is important to understand that proper communication between the nurse and Mr. Manjiri is fundamental for a holistic analysis. The first understanding is that communication in nursing is the sharing of health related information between the patient and the nurse of which both parties are participants through receiving and providing information (McMurray & Pfeffer, 2005). In addition, information for a holistic assessment in this case may be verbal or non verbal, written or spoken, personal or impersonal and issue specific or relationship oriented. The power of carrying out an effective and holistic assessment of the patient in this study can only be achieved through a combination of good nursing skills and excellent communication ones. To be specific, Mr. Manjari will share his story, symptoms and concerns about Congestive Heart Failure through spoken word and body language and words and actions of the nurse will do much in putting Mr. Manjari at ease, setting up a productive relationship and subsequent intervention of his case. Since good communication skills are fundamental in carrying out an assessment in nursing, the following are some of the nursing responsibilities that are required when it comes to undertaking an initial cardio respiratory in this case study.

Holistic initial assessment

This is the first stage in this case study that will involve a complete and holistic assessment of Mr. Manjari regardless of the actual disease. The main purpose of this stage is to asses the nursing problem of Mr. Manjari and should be expressed as either actual or potential ones. Components of this nursing process include:

Nursing history

This case study will require a nurse to carry out an assessment of the nursing history of Mr. Manjari so as to establish a proper rapport between him and his family. Elements of the nursing history in this case will involve Mr. Manjari’s overall health status, the course of his present congestive heart failure problem including symptoms and current management of the condition. Also included in this assessment is Mr. Manjari’s medical history including family health history and his perception of Congested Heart Failure (Raphael et al., 2007).

Psychological and social assessment

The main areas that need to be considered in this section of assessment of Mr. Manjari’s health status are his intellectual and emotional health. The nurse in this case is therefore required to check for hallucinations and delusions on the part of Mr. Manjari, measure his concentration level, his hobbies and interests including his popular Indian restaurant. To wholly understand the emotional health of this patient, the nurse will be required to inquire about how the patient feels and the response he gives to the feelings (Raphael et al., 2007). Perception is also important in this section of assessment because the religion and beliefs of Mr. Manjari are important parts to be considered.

Physical examination

A holistic nursing assessment also includes a physical assessment of the patient involved (Rang, 2003). This section involves assessing things that are observable like outward symptoms such as nausea. Skills that can be used in assessing Mr. Manjari physically include inspection, palpitation and percussion. However, physical examination of Mr. Manjari’s body temperature, blood pressure and respiratory rate are important in ensuring that the initial assessment is complete.

Communication skills in a nursing assessment

As earlier discussed, assessment of above aspects of Mr. Manjari’s condition can only be successful where the nurse is equipped with good communication skills. The Nurse’s communication skills when it comes to carrying out a holistic assessment of this patient are critical because it is the sole cause of many healthcare issues. The following are parts of communication skills that need to be considered as being vital when it comes to this assessment.

The facts

There is need to understand that nursing is collaborative in nature and therefore nurses and other medical staff must communicate effectively so as to attain their objectives (Rang, 2003). To provide the appropriate treatment and medical care for Mr. Manjiri, the nurse will need to ensure that he or she creates a high level of satisfaction in the patient so as to gather facts that are required for the diagnosis of the problem. This will serve to ensure that there is excellent two way communication between the Mr. Manjiri and the nurse so as to provide the appropriate channel for fact gathering.

Good listener

To effectively and holistically gather information about congestive heart failure, the nurse carrying out assessment on Mr. Manjiri needs to be a good listener. He or she should be able to listen carefully and report all information in an accurate and efficient manner (Auble, Hsieh, McCausland, & Yealy, 2007). In addition to that, a nurse plays a vital role of perceiving interpersonal relationship. For example in this case, a nurse who is able to properly carry out social consideration will be able to accurately perceive the relationship between Mr. Manjiri’s current state of health and his social lifestyle. Effective communication that coupled with good listening in nursing will serve to satisfy Mr. Manjiri’s initial assessment and also serves to empower the nurse in obtaining accurate information form the patient under assessment.

Assessment approach and techniques

The role of a nurse in this case study will be that of an instructor, a teacher and an interviewer. He will need to be an effective listener and ask the right questions at the right time and in the right manner concerning congestive heart failure. On the other hand, the nurse will also have to play the role of an instructor in ensuring that Mr. Manjari receives the right information and uses it in the right manner. In so doing, skills of the nurse who relays information to this patient need to be effective and easy to understand on his part (Stewart et al., 2002).

Since Nursing uses clinical judgment to find out the balance between knowledge through personal interpretation and available evidence from research, critical thinking on the approach that should be taken by the nurse in this case may play an important role in understanding the case of Mr. Manjari and therefore help define the course of action. To collect both objective and subjective information about this patient, the nurse might apply the nursing framework that was developed by Marjory Gordon dubbed the functional health patterns. When this model is applied, it provides an opportunity for more comprehensive assessment of the patient. Questions in this framework are structured in away that they cover all aspects of a patient while at the same time remaining within the guidelines that govern a nursing assessment. The pattern that is followed when analyzing the patient involved in this case study is important because it ensures organized collection of information (Juenger et al., 2002).

Data collection tools and techniques

Once an initial assessment has been carried out in this case study, the next step that a nurse needs to do is to organize the collected data from Mr. Manjiri’s situation. This applies varies data collection tools and techniques to transform all these into meaningful information. This will involve subjects with extraneous variables that were identified concerning the Mr. Manjari’s condition and the subject. Proper organization of data that has been collected from an initial assessment is useful when it comes to deciding on what should actually be done to diagnose the condition and take good care of the patient. The following is a design of how a holistic assessment that includes developmental, psychosocial, cultural, spiritual and/or mental health can be carried out with respect to the case of Mr. Manjiri.

Health perception and management

This section serves to provide subjective data about Mr. Manjiri’s health history and management skills that he has been able to apply on his current congested heart failure condition. Questions may range from those that seek to understand his past activities such as drug involvement. The section deals with the general day to day activities of Mr. Manjiri.

Nutritional metabolic

This is also a section that deals with subjective data about the patient. Questions in this section are aimed at understanding daily food intake of Mr. Manjiri, whether he applies any food supplements in his diet and the overall skin quality assessment is carried out.

Activity exercise

This section of the assessment is normally centered on the activity level, exercise schedule and leisure level of the patient (Juenger et al., 2002). The nurse will therefore be able to note that Mr. Manjiri runs a popular restraunt in the city and this could be having an indirect relationship with his current condition.

Self perception

An important part of a holistic clinical assessment that is used to measure the understanding of a patient’s self. This can assist when it comes to self interpretation of the patient’s condition bearing in mind his religious and cultural background (Juenger et al., 2002).

Role relationship

This involves assessing the family structure, problem or difficulty when it comes to relating it to the main problem. In the case of Mr. Manjiri, he is a married man with children and also from an Indian lineage. All these factors are intertwined and are important in addressing his condition.

Value belief pattern

What the patient values and beliefs in are also important in this case of diagnosis because they provide a background to the whole assessment and upon which conclusions can be drawn from. The section also centers on religion and its importance on the patient and this has to be factored in also because the patient under assessment is not a native to this country and has his religious basis somewhere else.


In conclusion, nursing responsibilities can be sometimes too demanding for the nurse especially carrying out an initial assessment on a patient. This requires keen listening that is accompanied by good communication skills that can enhance a two way communication between the nurse and the patient (Juenger et al., 2002). This is important if at all the goal of conducting a holistic study on the patient should be achieved. The case of Mr. Manjiri who recently arrived at a medical center to receive nursing attention is a typical example of how a holistic assessment of a patient needs to be carried out plus all the skills that are involved.


Auble, T. E., Hsieh, M., McCausland, J. B. & Yealy, D. M., 2007. Comparison of four clinical prediction rules for estimating risk in heart failure. Annals of emergency medicine, 50 (2), pp. 127–35.

Juenger, J., Schellberg, D. & Kraemer, S. et al., 2002. Health related quality of life in patients with congestive heart failure: Comparison with other chronic diseases and relation to functional variables. Heart,
87 (3), pp. 235–41.

McMurray, J. J. & Pfeffer, M. A., 2005. Heart failure. Lancet,
365 (9474), pp. 1877–89.

Raphael, C., Briscoe, C. & Davies, J. et al., 2007. Limitations of the New York Heart Association functional classification system and self-reported walking distances in chronic heart failure. Heart, 93 (4), pp. 476–82.

Rang, H. P., 2003. Pharmacology. Edinburgh: Churchill Livingstone.

Stewart, S., Jenkins, A., Buchan, S., McGuire, A., Capewell, S. & McMurray, J. J., 2002. The current cost of heart failure to the National Health Service in the UK. Eur. J. Heart Fail, 4 (3), pp. 361–71.