Duties of a Nurse

Running head: DUTIES OF A NURSE
DUTIES OF A NURSE
Name of Student
Name of University
Author note

1DUTIES OF A NURSE
Table of Contents
CASE STUDY 1........................................................................................................................2
Response to Question 1a:.......................................................................................................2
Response to Question 1b:.......................................................................................................3
Response to Question 1c:.......................................................................................................4
CASE STUDY 2........................................................................................................................4
Response to Question 2a:.......................................................................................................4
Response to Question 2b........................................................................................................5
Response to Question 2c:.......................................................................................................6
CASE STUDY 3........................................................................................................................7
Response to Question 3a:.......................................................................................................7
Response to Question 3b:.......................................................................................................8
Response to Question 3c:.......................................................................................................9
CASE STUDY 4........................................................................................................................9
Response to Question 4a:.......................................................................................................9
Response to Question 4b:.....................................................................................................10
Response to Question 4c:.....................................................................................................11
References:...............................................................................................................................12

2DUTIES OF A NURSE
CASE STUDY 1
Response to Question 1a:
Dyspnea is the most severe issue which should be prioritized above anything. Patients
suffering with cardiac insufficiency develop pulmonary edema. Edema impairs gaseous
exchange and increases the work of breathing, contributing much to the development of
dyspnea. A ‘conscious awareness’ between the respiratory motor impulse to working
respiratory muscles worsens dyspnea. This respiratory motor output results from a corollary
discharge. The discharge happens from brainstem’s Nucleus Tractus Solitarious (respiratory
neurons), to the higher sensory cortex during the process of automatic ‘reflex breathing’. The
discharge can also occur from motor centers of cortex to sensory cortex again during the
process of ‘voluntary respiratory efforts’. Uncontrolled dyspnea can lead to cyanosis which
results when deoxygenated blood flows very directly to heart without ever properly flowing
through the structures of alveoli and without proper oxygen uptake. Severe uncontrolled
dyspnea causes extreme fatigue of respiratory muscles and worsened bronchospasms which
can lead to respiratory failure and which is why, it needs to be managed imperatively
Tachycardia, which is a state of elevated heart beat levels beyond the physiological
normal range – needs to put into priority care right after dyspnea. Tachycardia-induced
cardiomyopathy gradually develops and appears very much reversible with improvement in
left ventricular ejection fraction (LVEF) but occurrence of recurrent tachycardia declines left
ventricular function rapidly that lead to heart failure, causing a possible sudden death. Heart
rate measurement during stress conditions like de-compensation heart failure, is related to the
sympathetic activation and sensitivity, density of beta-adrenergic receptors (Bristow, 2011).
Presence of exertional dyspnea and tachycardia is suggestive of left sided heart failure
in William. In NYHA class IV heart failure, a patient is unable to carry out any physical

3DUTIES OF A NURSE
activities without discomfort and hence, the subject is bed ridden mostly. With symptoms like
orthopnea present at rest, it should be taken care as a priority too. Orthopnea is actually
caused by the act of pulmonary congestion in recumbency. In a horizontal position, blood
volume is redistributed from lower extremities as well as splanchnic beds upwards towards
the lungs. It has a minimal effect in healthy individuals but there is a significant reduction in
vital capacity along with pulmonary compliance and resultant dyspnea in patients is different
situation all together. This happens in patients because additional volume is not pumped by
left ventricle due to pathology. Congestive heart failure patients manifests marked overload
in pulmonary circulation with edema fluid reabsorption from dependent body parts.
Response to Question 1b:
Interventions to treat dyspnea include maintaining a clear airway, suction and chest
mobilization which helps in mobilization of secretions centrally and upwards (Sutton, 2013).
Elevating the head and help change the position that may ease expectoration of secretions.
Nebulizing with mucolytics help open constricted airways and liquefy secretions
(Masoompour, Anushiravani & Norouz, 2015). Providing oxygen supplement help
maximizing oxygen uptake.
Tachycardia is over- excitatory symptoms and is suggestive of many severities.
Interventions must include promoting relaxation, stress reduction and sleep because
transmission of excitatory neuro-hormones and neurotransmitters are considerably reduced
under relaxation and stages of sleep. Administration of nitroglycerin is to reduce oxygen
demand in myocardium through vasodilatation (Ferreira & Mochly-Rosen, 2011)
Orthopnea can be treated by sitting (Panchabhai et al., 2016). Pulmonary congestion
decreases on assuming a comparatively erect position which is accompanied by proper
perfusion of oxygen to distant parts, causing improvement of symptoms.