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.