NURBN2023 Pathophysiology and Pharmacology Applied to Person-Centred Nursing Assessment Answer

Pathophysiology

Heart failure refers to a condition of the heart in which it does not have the capability of pumping blood in sufficient amounts which can suit the requirements of the body. There are several risk factors that contribute to this condition which include age, obesity, hypertension, smoking and diabetes (Schwinger, 2021). The potential factors or causes which are responsible for the occurrence of heart failure are usually associated conditions of the heart like ischemic heart disease, cardiomyopathy, valvular heart disease and arrhythmias. The pathological changes which can arise due to this condition involve the enlargement and weakening of the heart along with the accumulation of fluid due to the ineffective pumping of blood in the body. This can result in detrimental effects on the functioning of various organs such as the liver and kidney(Neidenbach et al., 2018). In addition, this can also result in increase in the risk of infection by comprimising the immunity of the body. Lastly, there are a variety of signs and symptoms that are associated with heart failure which include swelling in ankles, shortness of breath, persistent coughing, weakness or fatigue, sudden gain or loss in weight and loss of appetite(Groenewegen et al., 2020).

Application

In the following case, firstly, Mrs Yelena Kozlov has a history of hypertension which is a major risk factor that can lead to the development of heart failure. Her condition of high blood pressure can gradually be detrimental to the heart muscle, increasing the risk. Moreover, she also has other symptoms like shortness of breath and oedema in the ankle indicating heart failure (Bai et al., 2020). Secondly, her vitals indicate hypertension and hypoxia and her ECG result also showed that she has a weak heart and suffered from heart failure. In addition to this, the medications given to her i.e. frusemide and digoxin deal with the symptoms and effects of heart failure (Tasew et al., 2020). Lastly, Mrs Yelena’s old age and her sedentary lifestyle also contribute towards her development of the condition of heart failure (Francula-Zaninovic & Nola, 2018).

Pharmacology Treatment

In this case, Mrs Yelana Kozlov has been administered furosemide and digoxin for the management of her situation of heart failure. Monitoring her fluid intake and output, heart rate, electrolyte levels and potassium levels is important during the course of her medication as diuretics like frusemide work towards the increase in urine output and reduction of the buildup of fluid in the body. In addition to this, digoxin helps in the improvement of the contractions of the heart by increasing its strength of the heart (Tasew et al., 2020). It is also essential to monitor and report any type of side effects shown by Mrs Kozlov such as vomiting, nausea or dizziness, or any other continuing symptoms. Keeping a check on her weight and reporting any changes observed is important. Teaching could be provided regarding her sitting or standing habits and weight management along with encouraging daily exercise (Moholdt et al., 2018). In addition to this, it is also vital to avoid the consumption of any medication without a prescription and to report changes in the rate or rhythm of the heart while she is on the prescribed medications. She could be given beta blockers which can help in the reduction of the load on the heart and improve its pumping ability (Singara et al., 2020).

Education

Firstly, Mrs Yelena should be educated on the condition so that she develops an understanding of heart failure. This will enable her to identify symptoms and take action accordingly. Secondly, she should have knowledge about the importance, mechanism and side effects of the medications prescribed to her. Thirdly, Mrs Yelena should be educated about the importance of a healthy lifestyle which would involve consuming healthy food items and not indulging in activities like drinking and smoking, and how these changes can play a role in the improvement of her condition (Massouh et al., 2020). Furthermore, she should be taught about methods of using which she can practice self-monitoring. This can include keeping a regular check on her weight and recognizing symptoms associated with her condition such as swelling in her ankles or shortness of breath. Through this, identification of symptoms that indicate a worsening of the condition and seeking appropriate medical help would become easier for her. Lastly, since Mrs Yelena’s children reside far from her, it is essential to make sure that sufficient support from her caregiver is provided to her. This can comprise check-ins from caregivers in a timely and regular fashion in addition to providing their numbers as contact information to be contacted in case of any emergency situation (Sun et al., 2019).

References

Bai, M. F., & Wang, X. (2020). Risk factors associated with coronary heart disease in women: A systematic review. Herz , 45 , 52-57. https://doi.org/10.1007/s00059-019-4835-2

Francula-Zaninovic, S., & Nola, I. A. (2018). Management of measurable variable cardiovascular disease'risk factors. Current Cardiology Reviews , 14 (3), 153-163. https://doi.org/10.2174/1573403X14666180222102312

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. European Journal of Heart Failure , 22 (8), 1342-1356. https://doi.org/10.1002/ejhf.1858

Massouh, A., Skouri, H., Cook, P., Huijer, H. A. S., Khoury, M., & Meek, P. (2020). Self-care confidence mediates self-care maintenance and management in patients with heart failure. Heart & Lung , 49 (1), 30-35. https://doi.org/10.1016/j.hrtlng.2019.07.008

Moholdt, T., Lavie, C. J., & Nauman, J. (2018). Sustained physical activity, not weight loss, associated with improved survival in coronary heart disease. Journal of the American College of Cardiology , 71 (10), 1094-1101. https://www.jacc.org/doi/abs/10.1016/j.jacc.2018.01.011

Neidenbach, R., Niwa, K., Oto, O., Oechslin, E., Aboulhosn, J., Celermajer, D., & Kaemmerer, H. (2018). Improving medical care and prevention in adults with congenital heart disease—reflections on a global problem—part I: Development of congenital cardiology, epidemiology, clinical aspects, heart failure, cardiac arrhythmia. Cardiovascular diagnosis and therapy , 8 (6), 705. https://doi.org/10.21037/cdt.2018.10.15

Schwinger, R. H. (2021). Pathophysiology of heart failure. Cardiovascular Diagnosis and Therapy , 11 (1), 263. https://doi.org/10.21037/cdt-20-302

Sinagra, G., Corrà, U., Contini, M., Magrì, D., Paolillo, S., Filardi, P. P., & Agostoni, P. (2020). Choosing among β-blockers in heart failure patients according to β-receptors’ location and functions in the cardiopulmonary system. Pharmacological Research , 156 , 104785. https://doi.org/10.1016/j.phrs.2020.104785

Sun, J., Zhang, Z. W., Ma, Y. X., Liu, W., & Wang, C. Y. (2019). Application of self-care based on full-course individualized health education in patients with chronic heart failure and its influencing factors. World Journal of Clinical Cases , 7 (16), 2165. https://doi.org/10.12998/wjcc.v7.i16.2165

 Tasew, M., Aklilu, T. M., & Abdissa, S. G. (2020). Diuretic resistance in patients with heart failure: Clinical characteristics and predictors of outcome. Journal of Clinical Sciences , 17 (3), 66. https://doi.org/10.4103/jcls.jcls_1_20

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