Nursing Case Study: Patho-physiology, Investigations, Pharmacology

Running head: NURSING CASE STUDY
Nursing case study
Name of the student:
Name of the university:
Author note:

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NURSING CASE STUDY
Table of Contents
Patho-physiology:............................................................................................................................2
Investigations:..................................................................................................................................4
Pharmacology:.................................................................................................................................6
References:......................................................................................................................................7

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NURSING CASE STUDY
Patho-physiology:
a.
This case study represents the case of a patient named Robert (Bobby) Holden who is a
62 year old man suffering from various cardiac health adversities which ultimately resulted
into the incidence of an acute pulmonary oedema. There can be various different course of
pathophysiology that can lead to the cardiac complications that has been indicated in the case
study. First and foremost, it has to be mentioned that acute pulmonary oedema is associated
with fluid accumulation in the lung parenchyma and alveoli that leads to chronic and frequent
episodes of shortness of breath and impaired gas exchange; enhancing the chances of
mortality of the patient (Vital, Ladeira & Atallah, 2013). Now, the preliminary diagnosis of
the buddy nurse attending the patient under consideration indicated at acute pulmonary
oedema and the most plausible reason behind the diagnosis can be congestive heart failure.
The underlying pathophysiology behind the manifestation of acute pulmonary oedema is
centered on the excessive fluid backup. According to the Norhammar, Johansson,
Thrainsdottir and Rydén (2017), one of the prime contributors of congestive heart failure is
the inability of the left ventricle to pump enough blood satisfy the need for fresh oxygenated
blood to reach the entire body, which leads to oxygen deficiency. In such conditions the heart
is not able to remove the pulmonary circulation out at a sufficient rate which causes blood
back up (Huh et al., 2012). This phenomenon enhances the wedge pressure effectively, and
facilitated by the cumulative impact of left ventricular failure, fluid overload in the kidney
and arrhythmia, it leads directly to pulmonary oedema. On a more elaborative note, it has to
be mentioned that the ability of the lymphatic system to remove the fluid from the interstitial

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NURSING CASE STUDY
space depends critically on the systemic venous pressure. In case of the congestive heart
failure, the decreased cardiac output and deficiency of oxygenated blood contributes to the
pulmonary congestion and acutely increased after-load, indirectly facilitating pulmonary
oedema (Al Deeb, Barbic, Featherstone, Dankoff & Barbic, 2014).
In this case scenario, the patient had been a active smoker for 44 years and also
had a habit of drinking two bottles of VB every night. Hence these two factors can have a
significant impact on the respiratory apparatus and the cardiac muscles, enhancing the
vulnerability of the patent going through the resent clinical manifestations. Along with that
the patient had been slightly obese and had been diagnosed with diabetes as well, both of
which enhance the risk of congestive heart failure due to excessive blood sugar and
cholesterol deposition leading to blockages (Caudrillier et al., 2012). The patient had the
symptoms of cool to touch extremities and distended jugular veins; both of which is a clear
indication of a oxygen deficiency leading to congestive heart failure and pulmonary
embolism. It has to be mentioned that in congestive heart failure the lack of proper
oxygenated blood flow to the vital organs result into blood being pulled off from the
accessory organs like the extremities causing it to appear cool to touch; and it enhances the
central nervous pressure. Hence the most plausible reason behind the acute pulmonary
oedema is the congestive heart failure and its deterioration (Davison, Terek & Chawla,
2012).
The first symptom that the patient under case study which can relate excellently to
the congestive heart failure, is the shortness of breath. It has to be mentioned that systolic
heart failure, the left ventricle is unable to pump enough oxygenated blood to satisfy the need
of the entire body. Due to the inefficiency of the heart to pump and remove the blood from