Application Of Pathophysiology Of The Patient’s Condition To The Case Study

Chronic heart failure is a complicated and major clinical condition when cardiac contraction or relaxation is impaired (Marwick et al., 2018). Chronic heart failure patients may experience various distressing symptoms. Koshy et al., (2020) state that the symptoms include pain, fatigue, and peripheral oedema. One of the most severe symptoms of chronic heart failure is dyspnoea, or shortness of breath (Koshy et al., 2020). Over time, the heart becomes less functional or weaker, leading to chronic heart failure. Any history of previous heart attack or increased blood pressure is the two possible causes of chronic heart failure. Individuals of all age groups can be affected by chronic heart failure, although the condition is more common in older adults. In Australia, around 1% to 2% of the population is affected by heart failure (Groenewegen et al., 2020). In the case of heart failure, the heart cannot provide sufficient cardiac output to support the body’s metabolic needs and allow a venous return (Balthazar et al., 2021). The diagnosis is made mostly based on the symptoms present. Heart failure is caused by various pathophysiological conditions in which the heart is injured, and as a result, there is an impairment or loss of functional myocardial cells.

When heart failure advances, neurohormonal compensatory mechanisms are activated by the body. Owing to systolic heart failure, blood released from the ventricle decreases. Norepinephrine and epinephrine are released when stimulation of the sympathetic nervous system occurs (Ayada, Toru & Korkut, 2015). Hussain & Awan (2017) stated that renin is released when renal perfusion decreases, stimulating angiotensin I formation. Angiotensin II is formed from angiotensin I by angiotensin-converting enzyme (ACE), which narrows blood vessels and induces the release of aldosterone, leading to fluid and sodium retention (Hussain & Awan, 2017). As the heart’s workload increases, contractility decreases in the heart muscle fibres. For compensating for the extra workload, the heart increases heart muscle thickness. Activating compensatory neurohormonal processes is required to maintain sufficient heart and tissue perfusion. Diastolic or systolic ventricular dysfunction is frequently caused due to cardiac abnormalities. Irregularities in the pericardium, valves or endocardium also cause heart failure (Cassady & Ramani, 2020). For choosing appropriate therapeutic approaches, it is important to identify the pathophysiological mechanism that causes heart failure. the therapeutic options include rhythm disorder treatment, valve repair and medications. Pathophysiology And Nursing Process In Chronic Heart Failure Example Paper

Fluid retention causes swelling, which is clinically termed oedema. One of the initial symptoms of heart failure is oedema. It occurs when the cardiac muscles cannot pump sufficient blood when the fluid is forced to back up into the abdomen or the legs due to increased pressure, or fluid retention is caused due to a malfunctioning heart valve. Reduced ejection fraction or cardiac output causes peripheral venous and pulmonary obstruction, culminating in peripheral and pulmonary oedema (Shoaib et al., 2019). Oedema is symmetric and bilateral. Excessive fluid retention in the body also leads to an increase in weight. Blood cannot empty and fill the heart adequately in case of heart failure. It leads to fluid accumulation in the lungs, and breathing becomes difficult. As the heart becomes weak and cannot pump blood properly, fluids start building up in the body (Ali, 2018). Frequent urination occurs as the kidney tries to eliminate the excess fluid from the body. Sleep disruption occurs due to nocturia, increasing fatigue in heart failure patients. Renal plasma flow is reduced in heart failure patients, and during ambulation, there is an increase in filtration fraction, which is linked to sodium retention (Lane, 2019). Kidney function is improved by lying down, the body can release the fluids easily, and urine production increases.

Compensatory Mechanisms In Heart Failure

Breathlessness in heart failure occurs when an individual is exercising, even at rest or when an individual is sleeping. It makes an individual feel worried and exhausted. For supplying blood to the brain and heart, blood gets diverted from parts like the legs and arms (Putri & Malfasari, 2021). As a result, individuals with heart failure feel tired and face trouble doing everyday activities. Angina or chest pain occurs when blood flow to the heart is decreased. The heart’s pumping efficiency is reduced in heart failure, and as a result, more blood cannot reach the tissues and muscles. As a result, fatigue or tiredness occurs. Tiredness and exercise intolerance are heart failure’s major symptoms. Hypertension is one of the major symptoms of heart failure. Elevated blood pressure damages arteries and reduces oxygen and blood flow to the heart, causing heart disease (Tackling & Borhade, 2021). In heart failure, the heart grows less efficient at pumping blood rich in oxygen through the body, and as a result, the oxygen levels drop. An individual experiences shortness of breath as oxygen levels declines. Thus, decreased oxygen saturation levels result from the heart’s incapability to obtain oxygen-rich blood from the lungs (Abdurrachim & Chairunnisa, 2021). Irregular heartbeats occur when the heart’s ability to pump blood efficiently throughout the body decreases (Kandula, Karthika & Abraham, 2019).

The patient in the case study is an Aboriginal woman. As stated in action 5.08 of the National Safety and Quality Health Service (NSQHS) Standards, it is important to confirm the Aboriginal person’s identity so that better risks assessments can be done and culturally competent and complete care can be provided to the patient, and I would act accordingly (NSQHS Standards, 2022). As mentioned in NMBA (2022) standard 1.3 of Registered Nurse Standards for Practice, registered nurses (RN) must respect the Aboriginal culture, so I will keep that in mind and provide care accordingly. Action 5.11 of NSQHS Standards states that clinicians assess the problems and the threats detected in the screening procedure (Standards, 2022). Standard 4.3 in Registered Nurse Standards for Practice states that RN evaluate data and information and present the findings as a practice framework (NMBA, 2022). An integral part of the nursing assessment is collecting data on the patient’s physiological, spiritual, and psychological requirements. I will do that and try to collect information. Information collection includes taking physiological parameters like heart rate, oxygen saturation, temperature, blood pressure, respiration rate and pain level. I will document the results of the clinical and screening procedures as stated in action 5.12 of NSQHS standards (NSQHS, 2022). It is important to note if the patient has a record of any surgeries or significant illnesses, or comorbidities. I will record the patient’s medication history before prescribing new medicines for the patient, as stated in action 4.05 of NSQHS Standards (NSQHS, 2022). Assessing the heart rate is important, as proper heart rate management is linked to improved health outcomes and decreases mortality and hospitalization rates. I will note the heart sounds. Due to persistent heart failure, dysrhythmias cause palpitations, and patients experience rapid heartbeat. The patient in the case study experienced a fast heartbeat, and therefore I will conduct palpitation assessments.

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Symptoms And Causes Of Chronic Heart Failure

Respiratory assessments include examinations for breathing patterns, breath sounds, gasps, and dyspnoea on exertion. As higher systemic vascular resistance elevates blood pressure levels, I will monitor blood pressure levels and monitor urine output. For determining the severity of heart failure, monitoring of oxygen saturation is important, and also it helps in obtaining information about the heart’s capacity to supply oxygenated blood to distal tissues. I will monitor it and measure the patient’s weight as it is very important. As stated by Bravo et al., (2020), some of the tests required to be conducted include blood tests, which help screen for signs of heart disease. I will recommend such tests. X-ray of the chest reveals the status of the heart and lungs. The duration and frequency of the heartbeats are displayed by electrocardiogram, where the heart’s electrical signals are recorded. With the help of sound waves, heart images in motion are created in the echocardiogram. The test reveals the heart’s structure and size, valves, and the amount of blood flowing through the heart. Ejection fraction, which shows the heart’s efficiency in pumping, can be measured with an echocardiogram. Computerized cardiac tomography or CT scan collects pictures of the chest and heart. For identifying blockages in the heart, a coronary angiogram is performed. I will look into the matter that the required tests are conducted timely so that early diagnosis will help me formulation treatment plans for the patient.

The following diagnoses in nursing are significant for chronic heart failure patients based on the information gathered from assessments:

• Decrease in CO is linked to activity intolerance
• Chronic heart failure is linked to an increase in fluid volume
• Inadequate oxygenation causes breathlessness which leads to anxiety
• Lack of understanding is linked to the management of a poor treatment regimen

As stated in NSQHS (2022) action 5.13 of NSQHS Standards, clinicians utilize collaborative decision-making procedures to generate and establish a comprehensive plan for the patient that addresses the complexity and significance of the patient’s health conditions and provide care and treatment accordingly, as stated in standard 5 in Registered Nurse Standards for Practice (NMBA, 2022). A brief plan of care that meets the patient’s requirements includes:

• Enhancing the heart’s pumping function through several nursing interventions
• Preventing and identifying complications and promoting lifestyle improvements by delivering a teaching plan
• For alleviating the fluid overload symptoms, nursing interventions are recommended that minimizes fatigue and promote activity

Some of the nursing interventions that I will undertake for chronic heart failure:

As stated in action 4.02 of NSQHS Standards, it is necessary to apply quality enhancement systems (NSQHS, 2022). A multidisciplinary team involving frontline workers is required to gather information about hurdles to medication management. I will provide oxygen to the patient based on the patient’s oxygen saturation level and symptoms. The patient in the case study had a saturation level of 89%, so oxygen is required as oxygen availability to the myocardium is enhanced by providing supplemental oxygen. It assists in alleviating ischemia, hypoxemia and other associated symptoms. Heart failure causes lung congestion that results in hypoxia. Oxygen is provided based on the pulmonary congestion degree. Pulse oximetry is used for keeping track of the requirement of supplemental oxygen and its effectiveness. It is important to provide an environment for the patient that minimizes stress and promotes sleep and rest, and I will try to do that. By minimizing unnecessary disturbances and manageable stressors, demand for oxygen and cardiac burden can be reduced. Heart failure severity determines the amount of rest required for the patient. As stated in action 1.33 in NSQHS Standards, it is crucial to provide Aboriginals with a culturally appropriate and welcoming environment (NSQHS, 2022). It will help improve my and the patient’s experiences while providing care to the patient and enhancing her health outcomes. For treating nocturia, I will elevate the patient’s legs as it assists in preventing the accumulation of fluid. I will see that the fluid intake is restricted at night as frequent urination causes sleep disruption and the risks of falls increase. Action 5.25 of NSQHS Standards states that healthcare institutions must provide equipment to the patients, so they do not fall and harm themselves (NSQHS, 2022). I will make sure that the surfaces are slip-resistant, and I will provide a bedside commode and appropriate footwear for the patient for minimizing any harm from falls.

Therapeutic Approaches For Heart Failure

Patients must be alert about their previous weight in which they were in a stable condition. Regular monitoring of weight is required as gain in weight indicates fluid retention. I will reposition the patient at frequent intervals, as prolonged immobility is associated with an increased risk of pressure ulcers, which is extremely harmful to patients with oedema. Some physical exercises are recommended for chronic heart failure patients, and I will encourage such physical activity, as exercising makes the cardiovascular system and the heart stronger. Drug therapy in chronic heart failure aims to stabilize the patient and control the progression of the disease. It also helps enhance haemodynamic function and enhances the survival of the patient. Based on co-existing medical conditions, some medications are recommended as add-on therapy. Vasodilators help patients with chronic heart failure by improving cardiac output, lowering systemic vascular resistance, and lowering circulation volume. It ultimately leads to a reduction in ventricular burden. ACE inhibitors, beta-blockers, aldosterone antagonists, hydralazine plus nitrate, and many more have enhanced the patient’s survival (Aronow, 2016). The majority of the medications are taken in combination so that the therapeutic outcomes are good.

As a nurse, my primary responsibility is providing safe treatment to the patient. Throughout my shift, I will gather and analyze patient data and ensure that the patient’s requirements are met. I will make sure that the medicines are administered quickly and assess the patient’s response. I will try to address the patient’s anxiety by delivering clear information regarding the disease to the patient and her family. As stated in standard 7 of Registered Nurse Standards for Practice, it is important to evaluate the results for informing nursing practice (NMBA, 2022). I will assess and monitor the progress towards the anticipated aims and results. Based on the evaluation, I will revise the care plan.

References

Abdurrachim, R., & Chairunnisa, N. (2021). The role of sodium intake and liquid balance to overcoming breathing based on respiration rate (RR) on congestive heart failure (CHF) patients. Jurnal Gizi dan Dietetik Indonesia (Indonesian Journal of Nutrition and Dietetics), 8(2), 93-100. https://ejournal.almaata.ac.id/index.php/IJND/article/view/1287

Ali, R. A. M. (2018). Diagnostic Accuracy of Brain Natriuretic Peptide (pro BNP) in Diagnosis of Heart Failure in Khartoum State (Doctoral dissertation, Sudan University of Science & Technology).

https://repository.sustech.edu/handle/123456789/22386

Aronow, W. S. (2016). Current treatment of heart failure with reduction of left ventricular ejection fraction. Expert Review of Clinical Pharmacology, 9(12), 1619-1631. https://doi.org/10.1080/17512433.2016.1242067

Ayada, C., Toru, Ü., & Korkut, Y. (2015). The relationship of stress and blood pressure effectors. Hippokratia, 19(2), 99. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4938117/

Balthazar, T., Vandenbriele, C., Verbrugge, F. H., Den Uil, C., Engström, A., Janssens, S., … & Adriaenssens, T. (2021). Managing patients with short-term mechanical circulatory support: JACC review topic of the week. Journal of the American College of Cardiology, 77(9), 1243-1256. https://www.jacc.org/doi/abs/10.1016/j.jacc.2020.12.054

Bravo, M. J. B., Pereda, D. C., Vega, D. S., del Prado Díaz, S., Ruiz, J. M. M., Gómez, J. L. Z., & Salinas, G. L. A. (2020). Heart failure in the time of COVID-19. Cardiology, 145(8), 481-484. https://doi.org/10.1159/000509181

Cassady, S. J., & Ramani, G. V. (2020). Right heart failure in pulmonary hypertension. Cardiology clinics, 38(2), 243-255. https://doi.org/10.1016/j.ccl.2020.02.001

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

Hussain, M., & Awan, F. R. (2018). Hypertension regulating angiotensin peptides in the pathobiology of cardiovascular disease. Clinical and experimental hypertension, 40(4), 344-352. https://doi.org/10.1080/10641963.2017.1377218

Kandula, M., Karthika, P., & Abraham, R. (2019). Nurses Action towards Cardio Vascular Emergencies. Asian Journal of Nursing Education and Research, 9(1), 121-126.

Koshy, A. O., Gallivan, E. R., McGinlay, M., Straw, S., Drozd, M., Toms, A. G., … & Witte, K. K. (2020). Prioritizing symptom management in the treatment of chronic heart failure. ESC Heart Failure, 7(5), 2193-2207.  Pathophysiology And Nursing Process In Chronic Heart Failure Example Paper