NUM2306: Adult Health Care - Assessment Answer

Introduction

The essay is about a patient Sandra who faces the condition of heart failure. Heart failure causes fluid to build up in the body and limits the capacity to drink and salt. Heart failure is a long-term condition that is developing very slowly and suddenly leads to a heart attack (Rossignol et al., 2019). It will make the extremities get less blood and the body feel cold. The essay will identify the nature of the condition and apply it to the case study. It will help in finding out the suitable interventions and management strategies for the heart failure condition. With the sake of insight into the condition and applying it to the case study, the scope of practices can be understood.

Pathophysiology of Ventricular Remodelling and Heart Failure

Presentation of a patient Sandra, 72 years old who presented in the emergency department with shortness of breath that lasted for 3-4 days. It is noticed that she has not been passing urine as normal and coughing up frothy sputum. She also has a history of hypertension and is an ex-smoker. After getting 85% of the blockage in the right coronary artery she quit the habit of smoking (Tomasoni et al., 2019). Cardiac remodelling is defined as a group of molecular, cellular and interstitial changes that is manifesting in the changes of masses, geometry and function of the heart after any injury or surgery. The results will be seen in terms of association with the dysfunctioning of ventricular and malignant arrhythmias. The process of remodelling will trigger the expression of fatal genes that comprise an increase in alpha and decrease in beta myosin heavy chains and an increased in the expression of GLUT-1 (Tromp et al., 2019).

The increase in the markers will lead to the dysfunction of the cardiac which is the main consequence of remodelling of the cardiac. The impacts will be seen on the onset and progression of dysfunction of ventricular chambers. The cellular and molecular changes will make the progressive loss of the function of ventricular regions that is evolving as the first signs of heart failure (Edelmann et al., 2018). Cardiac catheterization and PTCA will lead to the blood flow in the myocardium that is originating as the cause of remodelling of the heart. In the case of Sandara, undergoing such surgery and procedure will result in the remodelling of the cells and making her face follow signs and symptoms. Following are the four clinical manifestations of heart failure that are shortness of breath and difficulty in lying down. Accumulation of fluids in the lungs leads to the experience of orthopnea and shortness of breath (Bahit et al., 2018). It will make an individual lie down and make them wake up with wheezing and gasping air which is referred to as nocturnal dyspnea. Second is swelling in the legs, arms and feet which is edema that is making the blood flow at a slow rate and will back up in the veins in the legs. Edema is noted in the case of Sandra which is further confirmed by CXR. Third is an irregular and rapid heartbeat that makes the heart fasten up and compensates for the failing ability of the heart to pump blood (Metra et al., 2019). Lastly, the inability to urinate is due to the blockage in the urinary system and nerve damage. The rationale for selecting the clinical manifestation that is traced in the case study.

Immediate Nursing Management in the Treatment of Heart Failure

Measurement of objective data for severity of dyspnoea that consists of respiratory rate, tolerance to lying prone and effect of breathing and level of oxygen saturation. It is a hallmark of chronic congestive heart failure that impairs functional capacity and contributes to the severity of diseases. Objective data of Sandra shows that crackle on chest auscultation, and chest X-ray confirm the pulmonary edema that is leading to difficulty in lying down (Rice et al., 2018). The haemodynamic status is the measurement of systolic and diastolic blood pressure. Measuring blood pressure will estimate heart failure progression and development. It is a potential factor that determines the structural cardiac changes and dysfunction of ventricular structure. If the blood pressure range is more than>160/100 values, then it indicates the risk of heart failure. Hemodynamic status monitoring will lead to the estimation of the rhythm of the heart and beats per minute that define the chances of heart failure. It is a crucial one in the case of Sandra as she is facing issues with breathing and is unable to urinate (Awoke et al., 2019). Hemodynamic status monitoring makes control the situation and provides the opportunity to rescue heart failure. In addition, Sandra also seems to be having a medical history of hypertension that needs to be considered in the immediate nursing assessment. Lastly, clinical examination for signs of congestion comprises the assessment of the pulmonary rate, edema, and jugular venous pressure. It helps in the restoration of breathing rate and helps the practitioner estimate what are nursing interventions required.

The drugs help in relaxing the blood vessels and improve the flow of blood and decrease the strains in the heart. For example Epaned and captopril. Receptors blocker benefits the same as ACE inhibitor (Cheng, 2018). Beta-blockers, which is a medication class, is used for slowing the heart rate and lowering blood pressure which further reduces the symptoms of heart failure. The class of medication will help in living longer and work in a better manner for the heart. Last are diuretics that make the system able to urinate and help the system to clear the fluid. Reducing the fluid retention in lungs facilitates the breathing in an individual. Apart from pharmacological interventions, the non-pharmacological intervention will consist of restricting the dietary intake of fluids and dietary sodium which is causative for retention in the system (Brennan, 2018). Providing the schedule for physical activity and weight measurement that is helping in the making system activity and improving the breathing rate.

Three Medications That Are Used in the Treatment of Sandra

Angiotensin-converting enzyme (ACE) inhibitors, it is a class of medication that prevents enzymes in the body from producing angiotensin II. The action of medication involves restricting the release of a hormone that is leading to the narrowing of blood vessels causing high blood pressure and forcing the heart to work hard. The role of medication is to control high blood pressure (Heckman et al., 2018). ACE inhibitors are given via oral administration except for one of the drugs that are enalapril which is given intravenously. Side effects of the drug will involve dry cough, dizziness from blood pressure and fatigue. Nursing care will consist of providing potassium supplements and diuretics that is avoiding the retention of salts and increase the efficiency of drugs.

Beta-blockers show the mechanism of action that involves blocking the effects of the hormone epinephrine. It causes the heart to beat slowly with less force. Reduction in the force will widen the veins and arteries to improve the flow of blood. The route of administration of drugs is dependent on the severity of the condition (Marti et al., 2019). It can be given by oral, intravenously, and ophthalmic. Side effects of the drugs will involve feeling tired, dizzy and difficulty sleeping and feeling sick and cold fingers and toes (Leong et al., 2019). Nursing care consideration will involve caution with the patient who will be having any coexisting condition of asthma and respiratory condition. As the drug will cause bronchoconstriction that impacts respiration. In the case of Sandra, providing the drug with caution is important to facilitate her breathing rate (Bhat et al., 2018).

Diuretics' mechanism of action acts as diminishing reabsorption of sodium at different sites at the nephron. It is increasing the urinary sodium and loss of water. It will also act in another manner that is inhibiting water reabsorption by creating a blockage in the vasopressin receptors along with the connecting tubule and ducts (Kapelios et al., 2018). The mode of administration is the oral route which is a usual route for the drug. In case of advanced heart failure can be given intravenously to attain the maximum potency. One of the side effects of the drug is hypotension and oliguria (Joseph et al., 2019). For nursing care, monitoring the blood pressure, fluid states and serum electrolytes attain the goals of medication.

Conclusion

Heart failure is a condition in which the heart is no longer able to pump oxygen-rich blood to the rest of the body efficiently. GLUT-1, SERCA2a causes the remodelling of the heart which leads to dysfunctioning. Medical management of heart failure is as follows: a combination of medication in which Angiotensin-converting enzyme (ACE) inhibitors, beta blockers and diuretics is provided. For nursing care, monitoring the blood pressure, fluid states and serum electrolytes attain the goals of medication. In conclusion, it will manage the vital signs and condition of the patient Sandra.

References

Awoke, M. S., Baptiste, D. L., Davidson, P., Roberts, A., & Dennison-Himmelfarb, C. (2019). A quasi-experimental study examining a nurse-led education program to improve knowledge, and self-care, and reduce readmission for individuals with heart failure. Contemporary nurse, 55(1), 15-26.https://doi.org/10.1080/10376178.2019.1568198

Bahit, M. C., Kochar, A., & Granger, C. B. (2018). Post-myocardial infarction heart failure. JACC: Heart failure, 6(3), 179-186.https://www.jacc.org/doi/abs/10.1016/j.jchf.2017.09.015

Bhat, S., Kansal, M., Kondos, G. T., & Groo, V. (2018). Outcomes of a pharmacist-managed heart failure medication titration assistance clinic. Annals of Pharmacotherapy, 52(8), 724-732.https://doi.org/10.1177/1060028018760568

Brennan, E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688.https://doi.org/10.12968/bjon.2018.27.12.681

Cheng, J. W. (2018). Current perspectives on the role of the pharmacist in heart failure management. Integrated Pharmacy Research and Practice, 1-11.https://www.tandfonline.com/doi/full/10.2147/IPRP.S137882

Edelmann, F., Knosalla, C., Mörike, K., Muth, C., Prien, P., Störk, S., ... & Group, H. F. D. (2018). Chronic heart failure. Deutsches Ärzteblatt International, 115(8), 124.https://doi.org/10.3238%2Farztebl.2018.0124

Heckman, G. A., Shamji, A. K., Ladha, R., Stapleton, J., Boscart, V., Boxer, R. S., ... & McKelvie, R. S. (2018). Heart failure management in nursing homes: a scoping literature review. Canadian Journal of Cardiology, 34(7), 871-880.https://doi.org/10.1016/j.cjca.2018.04.006

Joseph, P., Swedberg, K., Leong, D. P., & Yusuf, S. (2019). The evolution of β-blockers in coronary artery disease and heart failure (part 1/5). Journal of the American College of Cardiology, 74(5), 672-682.https://doi.org/10.1016/j.jacc.2019.04.067

Kapelios, C. J., Malliaras, K., Kaldara, E., Vakrou, S., & Nanas, J. N. (2018). Loop diuretics for chronic heart failure: a foe in disguise of a friend?. European Heart Journal–Cardiovascular Pharmacotherapy, 4(1), 54-63.https://doi.org/10.1093/ehjcvp/pvx020

Leong, D. P., McMurray, J. J., Joseph, P. G., & Yusuf, S. (2019). From ACE inhibitors/ARBs to ARNIs in coronary artery disease and heart failure (part 2/5). Journal of the American College of Cardiology, 74(5), 683-698.https://doi.org/10.1016/j.jacc.2019.04.068

Marti, C. N., Fonarow, G. C., Anker, S. D., Yancy, C., Vaduganathan, M., Greene, S. J., ... & Butler, J. (2019). Medication dosing for heart failure with reduced ejection fraction—opportunities and challenges. European journal of heart failure, 21(3), 286-296.https://doi.org/10.1002/ejhf.1351

Metra, M., Dinatolo, E., & Dasseni, N. (2019). The new heart failure association definition of advanced heart failure. Cardiac Failure Review, 5(1), 5.https://doi.org/10.15420%2Fcfr.2018.43.1

Rice, H., Say, R., & Betihavas, V. (2018). The effect of nurse-led education on hospitalisation, readmission, quality of life and cost in adults with heart failure. A systematic review. Patient Education and Counseling, 101(3), 363-374.https://doi.org/10.1016/j.pec.2017.10.002

Rossignol, P., Hernandez, A. F., Solomon, S. D., & Zannad, F. (2019). Heart failure drug treatment. The Lancet, 393(10175), 1034-1044.https://doi.org/10.1016/S0140-6736(18)31808-7

Tomasoni, D., Adamo, M., Lombardi, C. M., & Metra, M. (2019). Highlights in heart failure. ESC heart failure, 6(6), 1105-1127.https://doi.org/10.1002/ehf2.12555

Tromp, J., Ferreira, J. P., Janwanishstaporn, S., Shah, M., Greenberg, B., Zannad, F., & Lam, C. S. (2019). Heart failure around the world. European journal of heart failure, 21(10), 1187-1196.https://doi.org/10.1002/ejhf.1585

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