The Assignment on Nursing Introduction

NURSING
Introduction
The following assignment is based on the case study of Russell who is a truck driver
(age: 68 years) and has encountered heart failure. He has previous case history of heart attack
(15 years before). Russell used to smoker 20 cigarettes per day and has high level of
cholesterol. The following assignment will be structured in questions and answer format
covering the reasons underlying the heart failure, the pathophysiology of exacerbation of
COPD and heart failure. This will be followed by mode of actions of the medications and
nursing interventions for improving the health outcome for Russell.
Answer 1
The prime factor that led to the development of heart failure in case of Russell is high
concentration of low-density lipo-protein in blood [Low density lipoprotein (LDL) 5.0
mmol/L [2.0 mmol/L]. LPL is bad cholesterol and it increases the chance of heart attack
(Weldam et al., 2017). Second reason includes previous reported cases of heart attack (15
years ago) that was treated with stent. Another reason that leads to the development of heart
failure includes presence of Chronic Obstructive Pulmonary Disease (COPD) for the past 30
years (Weldam et al., 2017). Tham, Bernardo, Ooi, Weeks & McMullen (2015) stated that the
presence of COPD leads to the development of right sided heart failure. COPD decreases the
level of oxygen supply in the corners of the body. Decrease in the oxygen saturation increase
the level of blood pressure in the pulmonary arteries (pulmonary hypertension) leading to
heart failure. The presence of pulmonary hypertension is reflected in the chest x-ray. Chest x-
ray revealed the presence of cardiophrenic and costophrenic angles that indicates pulmonary
oedema. Lack of proper supply of oxygen in the pulmonary arteries increase the pressure
over the arteries and thus leakage of the extracellular lining of the arteries and leakage of the

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extra-cellular fluid inside the cell and formation of pulmonary oedema. Another reason
behind the development of heart attack includes diabetes and high level of cholesterol.
Diabetes and unmanaged blood glucose level for a prolong period of time cause macro and
micro-vascular complications of diabetes. Higher level of cholesterol is a type of micro-
vascular complication. This micro-vascular complication decreases the overall diameter of
the arteries by increase the deposition of extra cholesterol over the arteries. Increase in the
level of cholesterol disposition hampers the overall process of blood flow and thus increasing
the cardiac output and development of heart attack (Tham et al., 2015). The presence of
severe diabetes for the prolong period of time is also reflected by the presence of peripheral
oedema in both the legs. Russell was suffering from dyspnoea or breathlessness. This
indicates lack of proper oxygen supply in the body and thus increasing the cardiac output and
development of heart attack (Tham et al., 2015).
Answer 2
Pathophysiology of left-sided heart failure
There are two types of left-sided heart failure, first one is the heart failure occurring
due to reduced ejection fraction (systolic failure) and failure occurring due to preserved
ejection fraction (diastolic failure) (Bosch et al., 2017). In systolic failure the left ventricule
looses the ability to contract leading to black-age of blood transfusion and subsequent
development of heart failure. In diastolic heart failure, the normal relaxation power of the left
ventricle is lost due to stiffness of muscles leading to heart failure (Bosch et al., 2017). The
clinical manifestations of the left-sided heart failure include awakening at night or shortness
of breath, chronic wheezing or coughing.

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Pathophysiology of right-sided heart failure
Right sided heart failure mainly as a result of the left sided failure (Bosch et al.,
2017). The failure of the left ventricles increases the fluid pressure and the same pressure is
transferred into the lungs and this ultimately damages the veins and the arteries of the right
side of the heart. This damage leads to pumping or flow of the blood into the vein. This
backward pumping leads to swelling and congestion in the peripheral regions of the body like
foot, ankles and swelling win the gastro-intestinal tract and liver (Bosch et al., 2017). The
formation of the right sided heart failure is common among the patients who are suffering
from primary pulmonary arterial hypertension and secondary pulmonary hypertension.
Congenital heart disease also increases the chance of right sided heart failure. Russell used to
suffer from COPD and thus increasing the tendency of heart failure however, in this case,
Russell has encountered left-sided heart failure. However, peripheral oedema indicates that
he is has vulnerability to develop right-sided heat failure.
Figure: Right, Left and Congestive Heart Failure

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(Source: American Heart Association, 2019)
The left ventricle or left chamber of the heart provides the significant power to the
cardiac cells of the heart. Thus during the left sided heart failure, the heart is unable to pump
adequate blood to different parts of the body, resulting in the formation of dilated heart. This
same condition is indicated in the chest X-ray of Russell as he showed increased
cardiothoracic ratio (dilated heart). During the right sided heart failure, the right chamber of
the heart looses it capability to pump blood. This signifies that the heart is unable to fill
adequate blood in order to backup the veins leading to the swelling of the ankles, belly and
legs (Konstam et al., 2018).
Answer 3
An acute exacerbation of chronic obstructive pulmonary disease (COPD) is regarded
as sudden worsening of COPD condition including shortness of breath and color and
viscosity of phlegm. This typically lasts for more than week. This is mainly triggered under
the action of the environmental pollutants, viruses and bacteria (Crisafulli, Barbeta, Ielpo &
Torres, 2018). According to Torres, Crisafulli, Barbeta and Ielpo (2018), COPD is mainly
characterized by reversible obstruction in the airflow along with abnormal inflammatory
response present in the lungs. Under Exacerbation of COPD there occurs amplified response
towards mucous hyper-secretion (chronic bronchitis) along with the destruction of the tissues
(emphysema) and subsequent disruption of the optimal defense mechanism of the pulmonary
arteries resulting in the formation fibrosis and inflammation in the small airway. These
pathological changes in the airway increase the overall resistance of the airflow and thereby
increasing the resistance of the airflow in the small conducting airways. Exacerbations o COP
also leads to the increased compliance of the lungs along with air trapping and progressive
obstruction in the overall airflow of the lung (Crisafulli, Barbeta, Ielpo & Torres, 2018).