Clinical Reasoning Case Study: Cardiovascular Breakdown and Obesity

This clinical reasoning case study discusses the relationship between cardiovascular breakdown and obesity. It covers the mode of action of Glyceryl Trinitrate, its side effects, and interventions for acute care planning. The case study also includes the evaluation of expected outcomes and the two psychological illnesses associated with the case.

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Question 1
The recurrence of cardiovascular breakdown is expanding; it is one of
the major reasons for death all around the world with a commonness of
roughly 3% in created nations. (Dowaidar, M. (2021) A nearby
connection can be seen between cardiovascular breakdown and
heftiness. As per information from the Framingham Heart Study, the
ascent of BMI by 1 kg/m2 expands the danger of cardiovascular
breakdown by 5% on account of men and 7% on account of ladies.
Stoutness prompts cardiovascular breakdown through a few immediate
and circuitous systems. (Rito and et. al., 2019). Excess weight prompts
haemodynamic changes. A rising in both heart yield and heartbeat has
been seen; an augmentation in BMI of 5 kg/m2 remembered a 5 mmHg
climb for systolic circulatory strain. On one hand, it is related to the
commencement of the renin-angiotensin-aldosterone structure and
afterward once more, to the extended development of the insightful
tangible framework. (Dowaidar, M. (2021) Heftiness increases both the
aldosterone level and the mineralocorticoid receptor explanation, which
advance interstitial cardiovascular fibrosis, platelet assortment, and
endothelial brokenness. The above instruments explain the eventual
outcomes of EMPHASIS-HF fundamental: eplerenone treatment was
more useful for treatment of cardiovascular breakdown with reduced
dispatch division in patients with stomach heaviness (Rito and et. al.,
2019). Extended blood volume works with venous release, which works
on ventricular preload causing extended ventricular divider strain and in
the end inciting ventricular dilatation.
Question 2 (a) The mode of action of Glyceryl Trinitrate is to help in widening of
blood vessels that are artery and veins. It may promote the blood supply
to heart of an individual that helps in attaining more oxygen to the
muscles of heart and helps in minimising chest pain. (Hinder &
Langenickel, 2018).
Question 2(b)
Studies concluded that are numerous of side effects of this drug. Rapid
heartbeat and postural hypotension and in some cases an individual
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might also undergoes redness of the skin. (Hinder & Langenickel,
2018).
Question 2 (c)
 Patients on long-acting or transdermal arrangements regularly
foster resistance and diminished remedial impacts.
 Evaluate remedial reaction.
 Metal-containing tarns-dermal frameworks ought to be
eliminated before cardioversion or diathermy. (Hinder &
Langenickel, 2018).
Question 3
Her arrangement of encounters included hypertension, gastroesophageal
reflux affliction, hyperlipidaemia, and hypothyroidism. Remedies on
show included diltiazem, clopidogrel, losartan, levothyroxine,
furosemide, sertraline, and omeprazole. There was no family foundation
of lung affliction. The patient had worked as a scene originator. Actual
appraisal uncovered a slight woman who appeared fairly dyspneic
exceptionally still. Consistent cardiovascular breakdown can give
crumbling dyspnoea and hypoxemia, and restrictive changes on PFTs
are consistent with CHF. Regardless, recorded and evaluation
disclosures solid of a finish of CHF, including orthopnoea, paroxysmal
evening dyspnoea, jugular venous extension, extra heart sounds, and
periphery purification, were all noticeably absent. Mechanised clubbing
is exceptional in patients with CHF. Alveolar and interstitial attacks
may be seen on radiographs in patients with CHF, yet cardiomegaly and
pleural radiations are customarily present. (Abrams, Pagliuso and
Zhang, 2018).
Question 4 Nicholson showed oxygen can raise myocardial ischemia. Beasley et al.
gave a preventative note on oxygen treatment. Wijesinghe et al. in an
illustrative survey proposed that practicality and security of high stream
oxygen in MI isn't huge, yet the current confirmation suggests that the
standard usage of high stream oxygen in clear MI can cause more

NUR2204 CLINICAL REASONING CASE STUDY TEMPLATE
conspicuous infarct size and possibly increase the risk of mortality.
(Abrams, Pagliuso and Zhang, 2018). In Cochrane crucial review by
Cabello et al., did not track down any decisive proof from randomized
controlled preliminaries (four equal plan, randomized controlled
preliminaries revealed somewhere in the range of 2012 and 2019) to
help the standard utilization of breathed in oxygen in patients with
intense AMI. In any case, low quality of the included examinations and
improperly estimated infarct size in a subset of the investigation
populace, the danger of inclination was high for the results. An enough
fuelled, conclusive randomized controlled preliminary is prudent to
attract firm suggestions for its utilization clinical practice rules.
American Heart Association Guidelines for Cardiopulmonary
Resuscitation (CPR) and Emergency Cardiovascular Care suggests
oxygen in patients with dyspnoea, hypoxemic, or with indications of
cardiovascular breakdown and shock, in light of checking of
oxyhemoglobin immersion. (Abrams, Pagliuso & Zhang, 2018).
Question 5 The two intervention that are set in the case Mrs. Hovey are acute care
planning are psychotherapy and crisis counselling. It can be beneficial
for her, as it may release stress and able to promote the recovery of an
individual.
Question 6 S- Counselling session should be taken for an individual that may
demonstrate the importance of quality of life. Psychotherapies may
include numerous of interventions that are behavioural and cognitive
theories that can applied for effective result in the progression of
recovery.
M- The evaluation ways that can be concluded that are taken direct
communication with Mr. Hovey and ensuring her demonstration
seriousness of complication which is suffering from her.
A- the scope which is expected is to promote the recovery from illness
and also prevention from other illness.
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R- As the interventions which are taken are revenant for her, as it can
helpful in administration of illness and helpful for an individual to cut
out side effects such as rapid heartbeat and so on.
T- Time taken by this procedure that is pre assumed as it can take
around 6 months to 1 years to reflect the promotion of recovery.
Question 7 Through the intervention it has been assessed that expected outcomes
that are expected through this implementation are recovery from chronic
illness, elimination of use of substance (smoking), control in blood
sugar level and also prevention of psychic illness.
Question 8 The two mental or psychological illness in this case are depression and
hypertension (Cuspidi and et. al., 2018) These psychological illnesses
are also associated with numerous illness such as hypertension may
promote the fluctuation of blood sugar level, and also Hypertension is a
fundamental risk factor for cardiovascular contamination, including
stroke, coronary scene, cardiovascular breakdown, and aneurysm
(Cuspidi and et. al., 2018). Observing heartbeat is fundamental for
protecting prosperity and diminishing the risk of these dangerous
conditions. (Brandt and et.al., 2019). Consideration, hot showers, yoga,
and essentially going on long walks are loosening up strategies that can
help with soothing pressing factor. People should make an effort not to
eat up alcohol, brandishing medicines, tobacco, and poor sustenance to
adjust to pressure, as these can add to raised heartbeat and the
ensnarement’s of hypertension. Smoking can fabricate beat. Avoiding or
halting smoking decreases the risk of hypertension, certifiable heart
conditions, and other clinical issues (Cuspidi and et. al., 2018). Another
mental distress is depression that is observed in the chosen case. It has
been concluded that dealing with numerous chronic illness might
become stressful for an individual to manage at one point. (Brandt and
et.al., 2019). Depression is a mental disorder that is interconnected with
other mental disorders and also it can induce suicidal tendencies in an
individual (Cuspidi and et. al., 2018). Depression or Discouragement

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can be in excess of a consistent mindset of misery or feeling "blue."
Significant discouragement can cause an assortment of side effects.
Some influence your temperament, and others influence your body. Side
effects may likewise be progressing, or travel every which way.
(Andrews and et. al., 2018) The side effects of sorrow can be capable
contrastingly among men, ladies, and kids in an unexpected way. Ladies
might encounter side effects identified with their: state of mind, like
peevishness passionate prosperity, for example, feeling pitiful or vacant,
restless or miserable conduct, like loss of interest in exercises, pulling
out from social commitment, musings of self-destruction psychological
capacities, for example, thinking or talking all the more leisurely rest
designs, for example, trouble staying asleep for the entire evening,
waking early, dozing excessively. The management of depression may
include the social support and moral support of an individual (Andrews
and et. al., 2018). Also, the willingness to get better of their self may
help an individual to cope and heal. At present, the health care
professionals also prescribe psychic drugs to recover and prevent.
(Brandt and et.al., 2019).
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