Concept Map and Guided Question Response-Samples for Students

Questions: 1.Explain the Pathogenesis causing the clinical Manifestations with which Mrs Brown presented. 2.Discuss two high priority nursing strategies to manage Mrs Brown and provide evidence-based rationales for these strategies. 3.Discuss the mechanism of action of these two drugs, and relate to the underlying Pathogenesis of an acute exacerbation of chronic left-sided heart failure. Answers: 1.The case study provided informs that the clinical manifestation in Mrs. Brown was tachycardia, tachypnoea, dyspnoea, hypertension, and decreased level of oxygen saturation. The other things that caused concern in the patient were the lung auscultation reports that showed bilateral basal crackles. By performing the electrocardiogram test, the patients condition was diagnosed as chronic left-sided heart failure. Arterial fibrillation was evident from the electrocardiogram tests performed. Systolic and Diastolic dysfunction The pathogenesis of this clinical condition can be explained on the basis of this manifestation. According to Dupuis, and Guazzi (2015) systolic dysfunction is the main cause of left-sided heart failure. It is known to be the main etiological factor. Systolic dysfunction is the condition characterized by poor capacity to pump out blood. It relates to the poor ventricular contraction. The causative factor underlying this phenomenon may be the impaired functioning of myocytes or fibrosis. When the blood flow is resisted to a level above the threshold, creating afterload and consequently systolic dysfunction. The cumulative effect of this processes is the overstretching of the left ventricle and impaired myocardial contractility. In short, systolic dysfunction is significantly responsible for the heart failure. The onset of heart failure is also initiated by the Diastolic dysfunction to some extent. The hindrance to the ventricular relaxation and filling causes diastolic dysfunction. It is evident from the stiffness of the wall, during this condition. In the patients with the left-sided heart failure, ventricular contractility is impaired. It give rises to the condition like myocardial infarction or ischemic heart (Kraigher-Krainer et al., 2014). During systolic dysfunction and impaired ventricular contractility, the patients also exhibit dilated cardiomyopathy. It is the another feature of left-sided heart failure. The overload can also be contributed by the aortic regurgitation. Overload in this patients causes uncontrolled Systemic hypertension. This may occur together with the aortic stenosis (Craft et al., 2015). Homeostasis In addition to the systemic factors, the deleterious consequences of the left-sided heart failure is also linked to the mechanism that maintains homeostasis in our body. Based on the various clinical examinations it was found that the left-sided heart failure is the outcome of the cascade of events (Adeniran et al., 2015). The factors that are involved in this process are- Continuous sympathetic activation accentuated heart rate increased circulating volume preload in conjunction with increased total peripheral resistance chronic elevation of angiotensin II enzyme aldosterone hormone In the given vase study, the two main symptoms of the diagnosed left-sided heart failure manifested will be focused for understanding the pathophysiology. Shortness of breath The shortness of breath experienced by Mrs. Brown may have occurred because of the pulmonary oncotic pressure. left-sided regurgitation contributes to decreased pulmonary compliance. It occurs because of the extravasation of fluid into the pulmonary interstitium. The increased airway resistance also reflects it. The process leading to the bilateral basal crackles ca ne explained by the worsening pulmonary edema. The lung bases have greater hydrostatic forces and before inspiration, closure of small airways occurs due to interstitial edema. If this condition is serious, crackles are represented by higher lung regions (Rosenkranz et al., 2015). 2.The prevailing condition of Mrs. Brown can be treated by evidence based nursing strategies. The patients health condition is deteriorating with increased respiratory rate and low level of oxygen saturation. In this situation, oxygen therapy is the effective way to prevent the pulmonary congestion and hypoxia (Miguel-Montanes et al., 2015). It will improve the oxygen saturation. Nurses must monitor the patent under this action plan to ascertain the intervention. The nurse must ensure adequate ventilation by using the nasal cannula. The oxygen mask may create temporary suffocation must be mitigated by the nurses. Nurse actions under this strategy involves taking preventive steps fr probable occurrence of emphysema and hyperinflation of the lungs (McMurray et al., 2012). Mrs. Browns heart rate was elevated above the normal limit. It is necessary in this stage to maintain the satisfactory cardiovascular functioning. Under the supervision of the physician, nurse can administer Digoxine as prescribed. Thus medication improves the contraction and rhythmicity of the heart. It improves the cardiac output by enhancing the myocardial contractility. It will lead to stabilization of the heart rhythms (Ambrosy et al., 2014). The role of the nurse is to monitor and report to the physician in case of contraindications or adverse outcomes. In addition to the pharmacological intervention, the non-pharmacological interventions for the nurses can be emphasizing on self-care programs for the patient. The urinary output can be measured as part of the diuretic therapy (Lilley et al., 2014). Mechanism of action of IV furosemide and sublingual glyceryl trinitrate This section deals with the mechanism of the drugs and relation to the acute exacerbation of the chronic condition. IV furosemide: This drug is diuretic and functions to block the reabsorption of sodium, chloride, and water from kidney. It is effective to treat oedema as it eliminated fluid from the body by increasing urine output. Oedema is decreased by diuresis and pleural effusions, thereby lowering the blood pressure. It is usually administered for the management of left-sided heart failure (davisplus.fadavis.com., 2017). Sublingual glyceryl trinitrate: Thus drug is used for prophylactic management of angina pectoris. It is also used in acute conditions. It is known as adjunct therapy to treat heart failure. This drug acts to dilate the coronary arteries. It improves the collateral flow to ischemic regions. Upon administration of this drug the coronary blood flow increases. This drug decreases the myocardial oxygen consumption. Thus, it is administered to relive the symptoms of heart failure by reducing the blood pressure and increasing cardiac output (davisplus.fadavis.com., 2017). Nursing implication of the drugs administered Nurse must report the physician in case of adverse outcomes. Timely assessment of fluid status is necessary in addition to regular check of vital signs and location of edema, lung sounds, skin turgor, and mucous membrane. Fall risk assessment should be conducted as Mrs Brown is an elderly patient. The patient must be educated about the fall prevention strategies, and the side effects of IV furosemide. It includes dzziness, nausea, muscle cramps, and abdominal pain. Increased heartbeat, allergic reactions and tongue ulcers are the side effects of sublingual glyceryl trinitrate. Nurses must carry out evaluation of the contributing factors of angina pain in Mrs Brown. The patient must be checked for three level of consciousness (Aitken et al., 2016). References Adeniran, I., MacIver, D. H., Hancox, J. C., Zhang, H. (2015). Abnormal calcium homeostasis in heart failure with preserved ejection fraction is related to both reduced contractile function and incomplete relaxation: an electromechanically detailed biophysical modeling study.Frontiers in physiology,6. Aitken, L., Marshall, A., Chaboyer, W. (2016).Acccn's Critical Care Nursing. Elsevier Health Sciences. Craft, J., Gordon, C., Huether, S. E., McCance, K. L., Brashers, V. L. (2015).Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences. Dupuis, J., Guazzi, M. (2015). Pathophysiology and clinical relevance of pulmonary remodelling in pulmonary hypertension due to left heart diseases.Canadian Journal of Cardiology,31(4), 416-429. Furosemide. (2017).davisplus.fadavis.com. Retrieved 12 August 2017, from https://davisplus.fadavis.com/3976/meddeck/pdf/furosemide.pdf. Kraigher-Krainer, E., Shah, A. M., Gupta, D. K., Santos, A., Claggett, B., Pieske, B., ... McMurray, J. J. (2014). Impaired systolic function by strain imaging in heart failure with preserved ejection fraction.Journal of the American College of Cardiology,63(5), 447-456. Lilley, L. L., Collins, S. R., Snyder, J. S. (2014).Pharmacology and the Nursing Process-E-Book. Elsevier Health Sciences. McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Bhm, 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. Rosenkranz, S., Gibbs, J. S. R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., Vachiry, J. L. (2015). Left ventricular heart failure and pulmonary hypertension.European heart journal,37(12), 942-954.