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001293G - Assignment on Bachelor of Nursing

   

Added on  2020-03-04

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Running head: BACHELOR NURSING ASSIGNMENTBachelor Nursing AssignmentName of the Student:Name of the University:Author Note:

1BACHELOR NURSING ASSIGNMENTAssessment 1: Guided QuestionsAnswer to Question 1According to the case study, Mrs. Brown was presented with the clinical manifestationsthat included severe dyspnoea, tachypnoea, reduced level of oxygen saturation, hypertension,and tachycardia among other symptoms. Additionally bilateral basal crackles were detected onauscultation of lungs. Ultimately a diagnosis of acute exacerbation of chronic left-sided heartfailure was arrived at by virtue of performing an electrocardiogram test that revealed presence ofatrial fibrillation. Under the light of these manifestations, the pathogenesis of the disease relatedto left-sided heart failure may be explained. Empirical findings have suggested that systolicdysfunction may be attributed as the main etiologic factor that leads to left-sided heart failure.Systolic dysfunction refers to decreased ability to eject blood that in turn may be related toimpaired contractility of the ventricles either due to fibrosis or destruction or abnormalfunctioning of the myocytes. Heightened resistance to flow also culminates in increased afterloadwhich may lead to systolic dysfunction. All these factors account for causing the overstretchingif the ventricles particularly the left ventricle that subsequently leads to decrease in myocardialcontractility because of systolic dysfunction that has been identified as the predominant factorfor heart failure. Diastolic dysfunction may also partially contribute for the onset of heart failure.Diastolic dysfunction arises because of impaired ventricular relaxation and impaired ventricularfiling as a result of increased stiffness of the ventricular wall. For left-sided heart failure,impaired ventricular contractility may lead to conditions that encompass transient myocardialischemia or myocardial infarction. Moreover mitral or aortic regurgitation might lead to chronicvolume overload (Rosenkranz et al., 2015). Dilated cardiomyopathy is another characteristic

2BACHELOR NURSING ASSIGNMENTfeature of left-sided heart failure that in turn may be attributed to impaired ventricularcontractility because of systolic dysfunction of the heart. Systemic hypertension of uncontrolledtype together with aortic stenosis also occurs in case of left-sided heart failure because ofincreased afterload. Apart from these systemic factors, the pathogenesis of left-sided heart failureis often linked to the deleterious consequences pertinent to the compensatory mechanisms thatare responsible for maintaining the homeostasis inside the body. Continuous sympatheticactivation, accentuated heart rate, increased circulating volume and preload in conjunction withincreased total peripheral resistance and chronic elevation of angiotensin II enzyme andaldosterone hormone lead to the causation of left-sided heart failure due to combinatorial effects.In this connection, the two important symptoms related to the diagnosis of the disease in thepatient that were manifested may be discussed for understanding their underlying mechanisms.Appearance of symptom related to shortness of breath might have occurred due to increasedpulmonary oncotic pressure due to left-sided regurgitation is capable of extravasation of fluidinto the pulmonary interstitium that in turn is reflected on decreased pulmonary compliance inaddition to increased airway resistance. Further, the presence of bilateral basal crackles onpulmonary auscultation may be explained. Hydrostatic forces are found to be greatest at the lungbases whereby prior to inspiration, interstitial edema caused closure of small airways beforeopening them again. Higher lung regions represent crackles due to worsening pulmonary edema(Dupuis & Guazzi, 2015).

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