Nursing Case Study : Accute Heart failure
Answer:
Explain the pathogenesis causing the clinical manifestations with which Mrs. Brown
Presented.
The heart failure mostly occurs when the heart is unable to pump sufficiently the blood in the body to meet its needs. Mrs. Brown was diagnosed with an acute heart failure. The acute heart failure constitutes a clinical syndrome known as heterogeneous, in which the pathophysiology is very complex and it is not completely understood. Nonetheless, based on the diversities of the clinical presentations, there are various types of the pathophysiological mechanisms along with some factors that trigger the circulatory decompensation to be involved. Therefore, acute heart failure can be defined as the heterogeneous syndrome of the various signs and the symptoms, which exhibit on the onset rapidly and then worsen the heart failure, which may entail an urgent therapy. (Valente, Voors, Damman, Veldhuisen, Massie, Connor & Davison, 2014) The acute heart failure often develops in either days or hours that can be life threatening. During the heart failure, there is a drastic drop in the cardiac output. On the case of Mrs. Brown, her case was an exacerbation of a chronic disease. Various conditions that have led to the chronic heart failure include the high blood pressure, inherited heart defects and coronary disease or the inflamed heart. It is important to note that the heart failure and the cardiovascular disease in general can be genetic. Sometimes one of the chronic conditions can lead to an event of acute. (Valente, Voors, Damman, Veldhuisen, Massie, Connor & Davison, 2014) The major causes that may associated with the acute failure are a blood clot in the lungs, an infection; there are severe irregular heartbeats, an allergic reaction and an infection. There are also aspect of the risk factors that can lead to the heart failure and a combination of these factors can increase the heart failure. These are a high blood pressure, having an irregular heartbeat, the sleep apnea which the problem breathing while sleeping. Some of these problem were exhibited by Mrs. Brown like she had arbor normal heart beat, severe dyspnea and her pulse rate was high. (Deedwania, 2012) The pathogenesis causing Mrs. Brown manifestation was systolic failure in which there was a dysfunction on the left ventricle. This was mainly caused by any of the multiple disorders that may damage on the left ventricle on its contractile functions. Some factors that may have caused this condition were insufficient ejection fraction, there was reduced cardiac output on the patient, and there was reduced blood pressure and a fluid retention on the patient. (Valente, Voors, Damman, Veldhuisen, Massie, Connor & Davison, 2014) On the reduced cardiac output, the body is not able to compensate for blood that is pumped for the needs of the body. The cardiac output is caused by the inability of the heart to generating enough output, which may lead to the reduced flow of the blood to the brain, and some of the other vital organs. The symptoms may include fatigue, and the low urine output. She also exhibited dyspnea where she had exertional breathlessness where there is an increased pressure on the left ventricle, which may be due to the nocturnal fluid that has been redistributed and enhanced on the renal reabsorption.
Explain two high priority-nursing strategies to manage on Mrs. Brown case and provide evidence based rationale for the strategies.
One of the strategies the nurse could employ would be an ongoing monitoring and management of the patient. The management of the acute breathlessness can be carried out simultaneously with the diagnosis. When the diagnosis of the acute heart failure are made there should be administering of the diuretic in order to relieve dysponea. Moreover, the dose that is administered should be low to reduce on the fluid congestion and thus balance on the positive action to any of the potential negative effect on the functions of renal. (Gardner, McDonagh & Walker, 2007) There is need for the close monitoring of the renal functions, the output of the urine and the balance of the fluid. The ongoing monitoring of the response to the treatment and the cardiopulmonary status is important by the nurses in order to close monitor on the key parameters of haemodynamic. This would help the patient in that there is no under treatment or prevent the underlying condition do not deteriorate further. A warning score that is allocated to the vital signs is outside the pre-agreed ranges. These point are then summed together to provide a single composite score. If the score increases it would identify the patients that would benefit from escalation of the monitoring or even treatment. (Deedwania, 2012) Nonetheless, the escalation and the alterations in the management are made in accordance with the score. The use of the close monitoring strategy entail provision of a care environment where the nurses have adequate time and provide the expertise to be able to identify and respond to any changes that are exhibited on the physiological data. There is recognition between the adaptation between the competences of the nurses and the quality of the care they have provided. Therefore Mrs. Brown would receive an in patient care on the specialized cardiology ward and she would be cared by a nursing staff that have specific expertise in the management of the needs care. Moreover, the nurse would identify on the exact model to adapt on her conditions
Patient Education strategy
The hospital is also an ideal time for provide education in regards to the heart failure¸ the monitoring and the management. In some hospitals on admission are preventable if the heart failure worsening is detected early enough. Some patient’s families wish to get involved in the self-care in order to monitor on their conditions. There should be introduction of these concepts during the stay in the hospital of the patients. In most of the case there can be a mismatch that exists between ta patients understanding on their management of the heart failure and the information, which is often provided by a health professional. In a survey done it showed that the patients only recalled approximately 45% of advice given on self-care. The study also elaborated that the adherence to the medication was majorly associated with the beliefs of the patient on their medication. (Deedwania, 2012)The ability of the patient to learn and be able to retain the information may be reduced while at the hospital due to the high levels of anxieties and the cognitive dysfunction. It is important for the nurses to use the admission of the hospital to provide the patient with the verbal information, which is supported by material that are written. The nurse on the case of Mrs. Brown can use teach back technique where they may ask her to repeat using their own words the information they have provided them. This help to confirm on their understanding and helps the nurse to reparse the information they have not understood. The time spent between the nurse and the patient provide benefits in regards to knowledge retention rate and may be much useful when interacting with individuals who have low education level or the health literacy.
3 a). Effects of IV furosemide and glyceryl trinitrate drugs in relation to the underlying pathogenesis
The glyceryl trinitrate drug provides a rapid and a steady therapeutic concentration of the nitrates during the continuous infusion. This drug caused the venodilation when given in low doses, but when given on high doses it dilates both the arteries and the veins. The hemodynamic effect of the drug is to decrease the blood pressure in the preload- this is on the left ventricle when it is filling the pressure. It also determines afterload and decreases the oxygen demand in the myocardial.
The IV furosemide drug is an anthranillic acid derivate that is often used as a diuretic. The drug is used to treat the excessive accumulation of the fluid, which may be caused by congestive heart failure. The drug is used to control the hypertension and some of the side effect of the drug are thirst, urination. The dosage is essentially determined by the physician depends to how much fluid is there are how fast it should be removed. These two drugs were used on Mrs. Brown because she had acute heart failure.
b) Discuss how to monitor for the respond of the adverse effects of these drugs
The physician carefully determines the level of the administration of these drugs. The doctors use the therapeutic monitoring method, which they use to check the effectiveness of the drugs taken the individuals with the heart failure. (Gardner, McDonagh & Walker, 2007) Monitoring entails looking at the side effects on the drug like severe vomiting, dizziness, the blood pressure level. The doctors are able to keep the record of the patients in regards to the drugs the patients is taking the side effects and if the medication is working effectively. They also need to get the right balance of the drug and control the side effect of the drug and if they are severe change the medication.
C) How to evaluate on the therapeutic effect of the drugs
The best diagnostic evaluation of the side effects is to carry a complete history of the symptoms that are exhibited. (Gardner, McDonagh & Walker, 2007) It is important for a physician to know when they started, how long they have lasted, how severe they have become and whether the patient had them as before. Moreover, the doctor should ask about the history of the patient on the family member history. The treatment outcome of the side effects depends on the evaluation that is done. The therapeutic doses of these drugs will tend to reduce the systolic, diastolic and arteries pressure. The concentration of these drugs should not be mixed to the other drugs.
References
Deedwania, P. C. (2012). Heart failure. Philadelphia, PA: Saunders
Gardner, R. S., McDonagh, T. A., & Walker, N. L. (2007). Heart failure. Oxford: Oxford University Press
McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.
Nieminen, M. S., Böhm, M., Cowie, M. R., Drexler, H., Filippatos, G. S., Jondeau, G., ... & Rhodes, A. (2005). Executive summary of the guidelines on the diagnosis and treatment of acute heart failure. European heart journal, 26(4), 384-416.
Selby, V. N., & Teerlink, J. R. (2013). What’s new in the treatment of acute heart failure?. Current cardiology reports, 15(9), 1-9.
Valente, M. A., Voors, A. A., Damman, K., Van Veldhuisen, D. J., Massie, B. M., O'Connor, C. M., ... & Davison, B. (2014). Diuretic response in acute heart failure: clinical characteristics and prognostic significance. European heart journal, 35(19), 1284- 1293.
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