Clinical Manifestation of Disease

CASE STUDY-GUIDED QUESTIONS &
CONCEPT MAP

Table of content
INTRODUCTION...........................................................................................................................3
QUESTION 1...................................................................................................................................3
Pathogenesis causing clinical manifestation the patient in case study is presented...............3
QUESTION 2...................................................................................................................................4
High priority nursing strategies to manage the patient...........................................................4
QUESTION 3...................................................................................................................................5
The mechanism of the drugs given to the patient...................................................................5
CONCLUSION................................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Atrial fibrillation is a type of most common chronic cardiac arrhythmia which affects the person in form of heart failure or
stroke (Thihalolipavan and Morin, 2015). The present study is based on a 78-year lady who was admitted in hospital because of severe
breathlessness. After admitting her it was found that she was suffering with atrial fibrillation. Therefore, the report will outline the
pathogenesis which cause clinical manifestation with help of which the lady can be cured. Further, it will discuss two nursing
strategies in managing the lady. In the end, two drugs and mechanism relating to the underlying pathogenesis.
QUESTION 1
Pathogenesis causing clinical manifestation the patient in case study is presented
Atrial fibrillation (AF) refers to the abnormality in heart rhythm which occurs when electrical pulses are generated in
disorganized way. As per the view of Olshansky and et.al., (2015) irregular and rapid heart rate makes the individual more vulnerable
to heart failure, cardiovascular complications and stroke. The heart palpitations, breathing shortness are common symptoms of AF.
When upper chambers of heart witness chaotic electric signals then it causes irregularity in the heart rate. Mrs Brown has medical
history of heart failure thus the patient is more prone to the breathing shortness issues. The blood pressure of the patient was observed
as very high. The patients with history of heart failure and high blood pressure are at more risk of AF progression. The higher blood
pressure of the patient elevates the arterial pressures and thus heart is required to exert more pressure for pumping. It weakens the
heart muscles and normal pumping function of the heart from left side is affected.
As a result of this left ventricle find it difficult or impossible to squeeze during systole. This situation is known as systolic
heart failure or heart failure with reduced ejection fraction. Another possible factor which resulted in the diagnosis of chronic systolic
heart failure of Mrs Brown is the lung diseases. The respiratory rate of the patient was observed as 24 breath per minute which is
higher than the normal respiratory rate. The condition is known as Tachpnea and is one of the possible factor which triggers the onset
of AF. On performing the auscultation of the lungs bilateral basal crackles were heard. These crackling sound is the outcome of lung

infection or the heart failure. Mrs Brown is 78 years old along with cardiac history thus with the growing age the t here is higher risk
factor for the development of systolic heart attack.
According to Ter Maaten and et.al., (2015), body uses aerobic mechanism to maintain stable oxygen saturation level.
However, with Tachpnea and basal crackles the need of oxygen supply may increase SpO2 may experience fluctuations from its ideal
value of 95-100%. The same has been observed in the case of Mrs Brown whose SpO2 was observed as 85% which is very lower
than the normal range. When heart is not able to provide sufficient oxygen to the organs then systemic and pulmonary venous pressure
is increased and it leads to organ congestion. This act as the potential trigger for the systolic abnormalities, valvular disorder, higer
metabolic demand and heart rate along with the rhythm abnormalities. Due to this reduction in the saturated oxygen level oxygen
consumption is limited in metabolically active tissues causing ventricular abnormalities. It acts as fundamental step in development of
systolic heart failure.
Asgar, Mack and Stone, (2015) stated that in heart failure patients cardiac output reserve is also reduced and thus AF acts as
key factor in the progression of systolic heart failure. The presence of sever dyspnoea in Mrs Brown cause exaggerated heart rate in
less diastolic filling time. Hence, cardiac output decreases and irregularity in ventricular response takes place. In response to the
diastolic dysfunction medical history patients are also observed with loss and reduction in atrial contractile function and duration of
left ventricular function. Thus, AF acts as major cause for the tachycardia induced cardiomyopathy whose persistent presence cause
heart failure. The irregular heart rhythm affects the pumping efficiency of the heart which makes it difficult to perform pumping
operations. The breathlessness due to reduce cardiac output also causes myocardial hypertrophy, reconstruction of extracellular matrix
and myocardial cellular loss.

QUESTION 2
High priority nursing strategies to manage the patient
Deriving priority nursing strategy for patient care is essential to manage patient safety and quality care. According to Moore,
2016, nursing intervention are the care strategy practiced by heath care workers to manage effective patient care. In accordance with
medical condition of Mrs. Brown two high priority nursing strategies will be monitor oxygen saturation and Administration of blood
pressure heart rhythm and pulse rate.
Assessment Diagnosis Inference Intervention Rationale Evaluation
Subjective data
Mrs. Brown is facing
difficulty in waking
up and is suffering
from severe
breathlessness.
Objective Data
Severe dyspnoea
Auscultation of lungs
identifies bilateral
basal crackles
Vital signs
 Respiratory
rate of 24
breaths/minute
 Unable to
breathe in
room air
 Decrease in
cardiac
output
 History of
heart
failure
 Atrial
fibrillation
 Monitor
oxygen
saturation
 This is the high
priority because
it provides
information
about the heart’s
ability to perfuse
distal tissues with
oxygenated
blood. According
to Luo, Yang and
Nattel, 2015,
screening oxygen
saturation is
important to
ensure increase in
Reduction in
dyspneic
episodes
Normal
respiratory
status

 SpO2 85%, on
room air
 BP
170/95mmHg
 Pulse rate of
120
beats/minute
 Administra
tion of
blood
pressure
heart
availability for
gas exchange for
alleviating signs
of activity
intolerance.
Patients with
moderate or mild
acute heart
failure show
modest reduction
in oxygen
saturation while
service user with
severe heart
failure undergo
severe oxygen
desaturation.
 This is high
nursing priority
because
Tachycardia is
the condition

rhythm and
pulse rate
Anumonw
o and
Kalifa,
(2016),
which increases
heartbeat. It is
present to
compensate
decreased
ventricular
contractility
(Vera and BSN,
2013). Atrial
fibrillation is
common
dysrhythmias
related to heart
failure.
According to
Moore, 2016,
moderate,
chronic or early
Heart failure
elevates BP
because of
increased SVR.

However, in
advanced heart
failure body of
patient is no
longer able to
compensate, and
profound which
can cause
hypotension.
QUESTION 3
The mechanism of the drugs given to the patient
For curing the disease of atrial fibrillation many drugs have been invented and are in use. Some different types of drugs which
can be used in curing and dealing with diseases are as follows-
Furosemide (Lasix)- it is a drug which is potent diuretic that is water pill and its consumption will help the patient in
eliminating water and salt from the body. In accordance with Harada, Van Wagoner and Nattel, (2015), this drug works by blocking
the absorption level of chloride, water and sodium from the fluid which runs in tubules of kidney which causes increase in output of
urine. If this drug is consumed as oral as then administration is within one hour and urine (diuresis) lasts for 6 – 8 hours. On the other
hand, if the drug is injected then it reacts in five minutes and duration if diuresis is about two hours. In the present case the lady is
provided with the drug in oral form as it will help her.
Glyceryl Trinitrate (GTN)- this is yet another pharmacological drug which can be used by nurses and doctors for curing the
disease of atrial fibrillation (Freedman, Potpara and Lip, 2016). It is a sublingual tablet which contains ingredient glyceryl trinitrate

which includes nitrate as a type of ingredient. It is a medication used for curing anal fissures, prevention of chest pain, heart failure,
high blood pressure and many more other diseases.
This medicine is helpful for the lady Mrs Brown in the case study given because this drug helps in widening the heart arteries
which increases the flow of blood and level of oxygen supply to the heart muscle which is beneficial for the lady to recover from
chronic systolic heart failure.
CONCLUSION
With the end of the study it can be concluded that curing atrial fibrillation is very necessary as it can cause cytosolic heart
failure. With the help of case study, it was outlined that the lady had a past history of heart attack and also the lady was admitted for
severe breathlessness. On the study it was outlined that there are many nursing strategy and interventions with the help of which the
nurses can cure the patient of atrial fibrillation. These interventions are monitoring oxygen saturation and administering pulse rate and
heart rhythm. At last, it was outlined that there are also some pharmacological drugs which can be used for curing atrial fibrillation
and systolic heart failure. These drugs are glyceryl trinitrate and furosemide (Lasix) which are helpful in curing the diseases of the
lady.

REFERENCES
Books and Journals
Anumonwo, J. M., & Kalifa, J. (2016). Risk factors and genetics of atrial fibrillation. Heart failure clinics. 12(2). 157-166.
Asgar, A.W., Mack, M.J. and Stone, G.W., 2015. Secondary mitral regurgitation in heart failure: pathophysiology, prognosis, and
therapeutic considerations. Journal of the American College of Cardiology. 65(12). pp.1231-1248.
Floyd, C., & Hayes, D. D. (2017). New-Onset Atrial Fibrillation: What's the Significance?. Home healthcare now. 35(4). 215-220.
Freedman, B., Potpara, T. S., & Lip, G. Y. (2016). Stroke prevention in atrial fibrillation. The Lancet, 388(10046), 806-817.
Harada, M., Van Wagoner, D. R., & Nattel, S. (2015). Role of inflammation in atrial fibrillation pathophysiology and
management. Circulation journal, CJ-15.
Jalife, J., & Kaur, K. (2015). Atrial remodeling, fibrosis, and atrial fibrillation. Trends in cardiovascular medicine. 25(6). 475-484.
Luo, X., Yang, B., & Nattel, S. (2015). MicroRNAs and atrial fibrillation: mechanisms and translational potential. Nature Reviews
Cardiology. 12(2). 80.
Moore, J. A. M. (2016). Evaluation of the efficacy of a nurse practitioner-led home-based congestive heart failure clinical
pathway. Home health care services quarterly. 35(1). 39-51.
Olshansky, B., and et.al., 2015. The parasympathetic nervous system and heart failure: pathophysiology and potential therapeutic
modalities for heart failure. In Pathophysiology and Pharmacotherapy of Cardiovascular Disease (pp. 107-128). Adis, Cham.
Piccini, J. P., & Fauchier, L. (2016). Rhythm control in atrial fibrillation. The Lancet. 388(10046). 829-840.
Ter Maaten, J.M., and et.al., 2015. Diuretic response in acute heart failure—pathophysiology, evaluation, and therapy. Nature Reviews
Cardiology. 12(3). p.184.
Thihalolipavan, S., & Morin, D. P. (2015). Atrial fibrillation and heart failure: update 2015. Progress in cardiovascular
diseases. 58(2). 126-135.
Online

Vera, M. and BSN, R.N. 2013. 13 Heart Failure Nursing Care Plans. [Online]. Available through: < https://nurseslabs.com/heart-
failure-nursing-care-plans/>.