NURBN2023: Pathophysiology and Pharmacology Assignment Answer

Signs and Symptoms of The Disease (Slide 1)

• Some of the clinical symptoms that Mrs. Yelena experienced were dyspnoea, oedematous ankles and high blood pressure
• Other sign and symptoms of heart failure includes fatigue, irregular heart beat, weakness, shortness of breath and chest pain.
• Some patients may also experience wheeziness and a cough that does not goes away (Kurmani & Squire, 2017).

Introduction (Slide 2)

• This presentation aims to analyze the case study 4 related to a patient with diagnosis of heart failure.
• The case scenario is about Mrs. Yelena, a 78 year old woman with a diagnosis of heart failure
• She was experiencing shortness of breath, heavy feet and had a history of hypertension
• The presentations aim to evaluate the pathophysiology behind the condition and understand pathophysiology and individual treatment to promote safety of patients.

Risk Factors Behind the Condition (Slide 3)

Some of the risk factors or causes of heart failure are as follows:

• Diabetes
• Obesity
• High blood pressure
• Coronary artery disease
• Other conditions related to the heart
• Cigarette smoking (Oh & Cho, 2020).

Pathophysiology of Heart Failure and Application to Patient’s Signs (Slide 4)

• Heart failure is a condition associated with the inability of the heart to deliver adequate blood to the body to meet metabolic needs
• It is characterized by typical symptoms such as dyspnoea and ankle swelling and other signs such as pulmonary crackles and peripheral oedema leading to reduced cardiac output.
• Mrs. Yelena was diagnosed with heart failure and the pathophysiology behind it was the structural changes in the heart.
• Some of the factors that initiate structural changes are myocardial infarction, increase in volume overload, hyperventilation and chamber dilatation (Schwinger, 2021).

Pharmacological Intervention for HF (Slide 5)

• According to Pellicori, Kaur and Clark (2015). , diuretics and ACE inhibitors are the mainstay treatment for patient with heart failure.
• Mrs. Yelena has been prescribed Frusemide which is a loop diuretic and used for treatment of edema in patients with heart failure
• Mechanism of action of frusemide : The drug works directly on the cells of the nephron and works to increase the excretion of sodium and water by the kidneys.
• Thus, initially sodium excretion in the urine increases. In patients with extracellular volume expansion, first dose causes significant volume expansion. The onset of diuretic effect is seen in 1-1.5 hours and the drug reaches peach effect by two hours (Khan, Patel & Siddiqui, 2018).

Pharmacological intervention for HF (Slide 6)

• Mrs. Yelena was prescribed digoxin and it is a drug to treat heart failure,
• It is a type of cardiac glycoside class of drug
• The drug acts by inhibiting the action of the sodium-potassium ATPase enzyme, that regulates the quantity of potassium and sodium.
• The drug induces an increase in intracellular calcium thus contributing to an increase in influx of sodium and increase in contractility.
• While giving the drug to Mrs. Yelena, she should be monitored for side-effects such as nausea, vomiting, rashes, headache and weakness (Stucky & Goldberger, 2015).
• Mrs. Yelena was taking Atenolol 50 mg BD as she had a history of hypertension and it was given to treat her high blood pressure

Nursing Considerations to Promote Safety of the Medications (Slide 7)

To promote safety of Mrs. Yelena while initiating pharmacological treatment, the following nursing considerations are important:

• The first important consideration is that digoxin is known to interact with loop diuretics and hence the use of digoxin with frusemide should be reviewed
• There is a possibility of digoxin toscity and increase in serum potassium levels while using digoxin (Stucky & Goldberger, 2015). Hence, the use of digoxin in patients should be considered.
• In addition, the nurse should assess daily weight, BP and urine input and output after admninistering frusemide.
• In addition, nurse should ensure to educate Mrs. Yelena about the side-effects of each drug and the clinical signs that need immediate attention.
• The patient needs to avoid changing position all of a sudden and wear protective clothing due to sensitivity to sunlight (Khan, Patel & Siddiqui, 2018).

Patient Education (Slide 8)

The following areas need to be prioritized during patient education:

• Mrs. Yelena needs to given basic education regarding heart failure, risk factors and cause behind the condition. It will support her to understand the reason behind her current symptoms and not develop anxiety
• In addition, she needs to be educated about the rationale for each drug, the dose regimen and side-effects of the drug. This education can promote drug safety and ensure that she is careful to observe any unwanted adverse effects.
• The patient needs to be educated about the importance of lifestyle change such as making changings in diet, limit salt in food and increasing physical activity (Aggarwal et al., 2018).

Conclusion (Slide 9)

• To conclude, the presentation gave an overview on the pharmacology and pathophysiology of heart failure
• Digoxin and ACE inhibitors were identified as the main pharmacological treatment for HE
• However, to promote safety during the implementation of intervention, it is important to educate patient about different aspects such as side-effects, precautions needed and drug-drug interaction linked to the prescribed drugs for heart failure.

References (Slide 10)

Aggarwal, M., Bozkurt, B., Panjrath, G., Aggarwal, B., Ostfeld, R. J., Barnard, N. D., ... & American College of Cardiology’s Nutrition and Lifestyle Committee of the Prevention of Cardiovascular Disease Council. (2018). Lifestyle modifications for preventing and treating heart failure. Journal of the American College of Cardiology , 72 (19), 2391-2405.

Fogoros, R. (2022). Causes and Risk Factors of Heart Diseases. https://www.verywellhealth.com/assessing-your-risk-of-heart-disease-1745752

Khan, T. M., Patel, R., & Siddiqui, A. H. (2018). Furosemide. https://www.ncbi.nlm.nih.gov/books/NBK499921/

Kırali, K., Özer, T., & Özgür, M. M. (2017). Pathophysiology in heart failure. Cardiomyopaties : types and treatments. Crotia : InTech , 17-38.

Kupper, N., Bonhof, C., Westerhuis, B., Widdershoven, J., & Denollet, J. (2016). Determinants of dyspnea in chronic heart failure. Journal of cardiac failure , 22 (3), 201-209.

Kurmani, S., & Squire, I. (2017). Acute heart failure: definition, classification and epidemiology. Current heart failure reports , 14 , 385-392.

Oh, G. C., & Cho, H. J. (2020). Blood pressure and heart failure. Clinical hypertension , 26 , 1-8.

Ouwerkerk, W., Voors, A. A., Anker, S. D., Cleland, J. G., Dickstein, K., Filippatos, G., ... & Zwinderman, A. H. (2017). Determinants and clinical outcome of uptitration of ACE-inhibitors and beta-blockers in patients with heart failure: a prospective European study. European heart journal , 38 (24), 1883-1890.

Pellicori, P., Kaur, K., & Clark, A. L. (2015). Fluid management in patients with chronic heart failure. Cardiac Failure Review , 1 (2), 90.

Rehman, B., Sanchez, D. P., & Shah, S. (2021). Atenolol. In StatPearls [Internet] . StatPearls Publishing.

Schwinger, R. H. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy , 11 (1), 263.

Stucky, M. A., & Goldberger, Z. D. (2015). Digoxin: its role in contemporary medicine. Postgraduate medical journal , 91 (1079), 514-518.

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