Case Study of Mrs Sharon McKenzie-Free-Samples-Myassignmenthelp.com

Questions: 1. Causes, incidence and risk factors of identified condition and its impact on the patient and family. 2. List five common signs of the selected diseases and for each provide the link to the underlying pathophysiology. 3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body. 4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient. Answers: 1.Mrs. Sharon McKenzie is a 77 year female patient, who came to the emergency department with symptom of shortness of breath, swollen ankles, mild nausea and dizziness. Based on his vital sign observation and presenting symptoms, congestive cardiac failure (CCF) is the identified condition in Mrs. Sharon. CCF is a progressive and chronic clinical condition that affects the hearts ability to pump blood at normal rate. This results in symptoms of tachycardia, fatigue, weakness, wheezing and rapid pulse (Teerlink et al., 2013). Many abnormalities like pressure and volume overload affects the myocardial contractility and the ability to maintain arterial pressure of vital organs. In case of heart failure, the adaptive mechanism involved in maintaining the contractility of heart becomes maladaptive. This results in poor cardiac output and activation of three major compensatory mechanisms such as adrenergic system, rennin-angiotensin-aldosterone system and ventricular hypertrophy. The adren ergic mechanism enhances sympathetic activity and increases level of cathecholamines contributing peripheral vasoconstriction. Hence, the compensatory mechanism increases the venous return and lead to alterations in heart rate, preload, afterload and contractility (Kemp Conte, 2012).. CCF is a global pandemic affecting about 26 million people worldwide and its incidence is increasing data by day due to poor lifestyle and behavioral risk factors. It is a significant public health problem as CCF is associated with significant mortality, morbidity and health care expenditure (Roger, 2013). The review of heart disease statistics of Australia reveals that it is a significant health issue in Australia too as heart disease affects around 1.2 million Australians and it is the single leading cause of death in the country (The Heart Foundation, 2018). Hence, major preventive care activities needs to focus on addressing the behavioral risk factor of the disease. There are many common cause of CCF such as coronary heart disease, hypertension and alcohol consumption. Apart from this, poorly controlled diabetes, smoking, high cholesterol and family history of heart diseases are common risk factors that lead to CCF. Evidence has shown that diabetes amplifies the risk of CCF and many other comorbid conditions like obesity, hypertension and coronary heart disease contributes to high rate of CCF. Insulin resistance and hyperglycemia is directly linked to cardiac dysfunction due to its effect on cardiac metabolism and the rennin-angiotensin system (Nasir Aguilar, 2012). The diagnosis of CCF is associated with great physical and psychological impact on patient and their family member. They struggle to cope with the comorbidities of the condition and many psychosocial issues like depression and lack of social support further increases hospital admission rates in patient. In case of family members, emotional distress and care giving burden increases. Negative situations arising from care worsens their quality life, increases level of stress and increase care giving burden for family members (Lacerda et al. 2017). Hence, certain interventions should be implemented for family members to help them cope with psychological burden of the disease. 2.In case of Mrs. Sharon McKenzie, she was identified to be suffering from CCF due to presence of symptoms like shortness of breath, mild nausea, dizziness and swollen ankles and high respiratory rate. All the four symptoms along with palpitations are are common signs of CCF and they are linked to the pathophysiology of the disease. Edema is seen in patients with CCF due to the activation of humoral and neurohumoral mechanism that promotes reabsorption of sodium and water by the kidneys. Apart from this, CCF leads to abnormal Starling forces thus increasing venous capillary pressure and fluid extravasation. Such mechanism increases the likelihood of edema in patients with CCF (Arrigo et al. 2016). Shortness of breath is the most common symptom seen in CCF patient due to pulmonary edema. Pulmonary edema may be caused by narrow of the arteries, kidney failure of effect of medications. During CCF, the hearts ability to pump blood at a normal rate is affected and this leads to accumulation of blood in the veins that take blood through the lungs. The increase in pressure in the blood vessels pushes fluid into the alveoli and disrupts normal oxygen exchange through the lungs. All these factors together causes shortness of breath in patient (Dub, Agostoni Laveneziana, 2016). Many patients with CCF experience symptoms of dizziness. Irregular heart beat also results in decreases blood pressure which leads to dizziness in patient. Dizziness is caused by the effect of medications too. In addition, the symptom of nausea is seen due to the build-up of fluid around liver and guts. The complex interaction between central nervous system, autonomic nervous system and endocrine nervous system results in nausea. Histamines and dopamines act as stimuli that give rise to nausea (Singh, Yoon Kuo 2016). The fifth symptom of CCF is palpitation and it is associated with very rapid or irregular heart beat in patient. This symptom in seen during CCF due to the effect of the disease on hears muscle contractility. Patients like McKenzie may feel that their heart is racing or pounding at a rapid rate. This may be caused by the onset of compensatory mechanism. Cardiac arrhythmias also results in high heart rate and it the condition affects the normal heart rhythm. The pathophysiology behind such condition is the onset of three mechanisms like enhanced automaticity, triggered activity or re-entry. The enhancement of automaticity results in multiple arrhythymia and symptom of palpitation in CCF patient (Raviele et al., 2011). It can be concluded that several mechanism like contraction of the heart rate and cardiac arrhythmias results in symptoms of palpitation in patient. 3.The two common classes of drugs that are used for patients with CCF include the ACE (Angiotensin-converting enzyme) inhibitors and the beta-blockers. Drugs like beta blockers are given to patient when there is a need to slow down heart rate and for this reason it is suitable for use in CCF patient as the condition mainly leads to rapid heart rate. Some examples of beta blockers include Metoprolol and Acebutolol and their physiological effect on the body is seen due to its role in blocking the effect of epinephrine hormone. Beta blockers are able to block the effect of the function of norepinephrine and epinephrine by binding to the beta-adrenorecptors where norepinephrine binds. Such action of the drugs results in inhibition of sympathetic effect. They are also known as partial agonist as during the process of binding, they activate the receptors too. Sympathetic influence are the reason for heart rate, contractility and electrical condition and betablockers reduce such sympathetic influence thus leading to a decreases in heart rate, contractility, conduction and relaxation rate. Due to such physiological effect of beta-blockers, this drug is most commonly given to CCF patient (Kotecha et al., 2017). ACE inhibitors are most common drug used for the management of heart failure. The main rational for its use is that it works to relax the blood vessels and reduces blood pressure. This eventually leads to improved work flow and improvement in the hearts ability to pump blood to different parts of the body. The physiological mechanism of ACE inhibitor is seen due to their role in preventing the enzyme to produce angiotensin II. The effect of angiotensin is to the narrow the blood vessels thus contributing to high blood pressure. Such conditions make it harder for heart muscles to pump blood. However, the ACE inhibitors diminish the activity of rennin-angiotensin-aldosterone system that controls blood pressure fluctuation in the body. Angiotensin II is an activated form of protein that stimulates release of aldosterone, however the conversion of angiotensin I to angiotensin II is blocked by ACE inhibitors. This results in increased secretion of sodium and increase in cardiac output (La rson, Symons Jalili, 2012). For this reason, the drug is found to be useful for treatment of patients with CCF. 4.The review of Mrs. McKenzies vital sign observations revealed that she had blood pressure of 170/110 mm Hg, heart rate of 54 bpm, SpO2 at 92% and respiratory rate of 30 bpm per minutes. All the vital signs are above the normal range and hence the first nursing care priority is to address the abnormal vital sign of patient. The normal blood pressure is 120/80 however Mrs. McKenzie blood pressure observation shows that she is hypertensive. Implementing appropriate nursing intervention to increase blood pressure is necessary because hypertension increases risk of complication in patient. Hence, it will be necessary for nurse to consult physician to provided appropriate antihypertensive drugs that reduces blood pressure of Mrs. Sharon. Drugs like beta-blockers, ACE inhibitors and nitrates are most effective in decreasing blood pressure and management of adverse symptoms in patient with CCF. Hypertension increases cardiac work and taking action against hypertension is the most effective strategy to provide relief to patient. Mrs. Sharons heart rate and respiratory rate was also abnormally high. Leaving this symptom untreated may lead to respiratory stress in patient. Hence, the nursing care plan for addressing these symptoms includes providing oxygenation to patient and providing appropriate body position alignment to patient. Oxygen therapy is also necessary to bring the SpO 2 value of Sharon to normal limits of 95-100%. The advantage of oxygen therapy for patients with CCF is that it reduces cardiac output and heart rate thus providing relied to patient (Larson, Symons Jalili, 2012). However, the rate of oxygen administered to patient must be carefully monitored as excessive supplemental oxygen may also deteriorate cardiac function of patient. To provide relief to patient, another care plan is to elevate head of bed of patient. The ABG value of patient will be monitored too to prevent adverse symptom in patient. This care plan can enhance comfort level of Sharaon (Pool et al. 2015). The second nursing care priority for management of Sharons condition is to take action for edema (swollen feet). The Symptom of edema is a sign that patient has high cardiac output. Hence, to provide appropriate care to patient, the nursing care plan is to evaluate fluid status of patient and identify fluid restrictions that are necessary for patient. Fluid restriction will help to maintain fluid volume for patient. Fluid intake and output measurements needs to be monitored at regular intervals too. In addition, diuretics may also be provided to Sharon to maintain fluid volume imbalances (Ter Maaten et al, 2015). The third care priority for the recovery of Sharon is to address symptom of hypothermia in patient. Review of Sharons condition revealed that her finger was cool to touch and she always used to wear bed socks for her cool feet. To maintain the body temperature of patient, it will be necessary to monitor fluid loss in patient and control the temperature of the room. Evidence has shown that targeted temperature management protocols are effective in addressing temperature changes in patient (Lundbye et al., 2017). Mrs. Sharons potassium level was 2.5 mmol/L. The normal level is 3.5-5.0 thus indicating that patient has hyperkalemia. This condition arise due to side effects of medications like diuretics and the care plan to address electrolyte imbalance is necessary to prevent further discomfort to patient (Urso, Brucculeri Caimi, 2015) References: Arrigo, M., Parissis, J. T., Akiyama, E., Mebazaa, A. (2016). Understanding acute heart failure: pathophysiology and diagnosis.European Heart Journal Supplements,18(suppl_G), G11-G18. Dub, B. P., Agostoni, P., Laveneziana, P. (2016). Exertional dyspnoea in chronic heart failure: the role of the lung and respiratory mechanical factors.European Respiratory Review,25(141), 317-332. Kemp, C. D., Conte, J. V. (2012). The pathophysiology of heart failure.Cardiovascular Pathology,21(5), 365-371. 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