Assignment On The Respiratory

Running head: NURSING
Nursing
Name of the Student
Name of University
Author’s note

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Answer 1
The respiratory manifestation of Mrs Brown include hypoxia (SpO2: 85%), bi-basal
crackles, tachypnoea, dyspnoea The cardiac manifestations include hypertension (170/95), atrial
fibrillation and tachycardia.
Mrs Brown has a previous history of heart failure and she was admitted to the hospital
with increased respiratory rate (24 breaths per minute; normal: 16 to 20 beats per minute) and
pulse rate (120 beats per minute; normal up to 100 beats per minute). Her high blood pressure
might be attributed due to her poor oxygen saturation (Mentz&O'connor, 2016).These
parameters indicate that Mrs Brown is having low cardiac output (stroke volume X heart rate).
Under low cardiac output, neurohormonal compensatory mechanisms activate to increase cardiac
output. For example, sympathetic system increase the cardiac output by increasing the heart rate,
myocardial contractility, and peripheral vasoconstriction (Mentz&O'connor, 2016). Renin-
angiotensin-aldosterone system (RAAS) causes vasoconstriction (angiotensin) followed by an
increase in blood volume, and retention of salt and water (aldosterone). Activation of RAAS
increases the secretion of renin, plasma angiotensin II (ATII), and aldosterone. ATII is a potent
vaso-constrictor for efferent arterioles and thus increasing the peripheral vascular resistance and
and increasing the cardiac output. Peripheral vascular resistance used to create blood pressure in
the circulatory system, by the process of vasoconstriction (Reddy, Melenovsky, Redfield,
Nishimura & Borlaug, 2016). Rossi, Mascolo and Mollace (2017) stated that activation of RAAS
under sustained sympathetic stimulation leads to increased preload and after load of heart. RAAS
also increases plasma noradrenaline concentrations along with progressive retention of salt and
water leading to the formation of oedema. RAAS causes systemic hypertension and heart failure

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along with the development of atrial fibrillation (AF) (Nair, Nery, Redpath & Birnie, 2014). AF
is evident in case of Mrs Brown as reported in her ECG report. It leads to decreased left
ventricular compliance along with thromboembolism (Marrouche et al., 2018). The blood clot of
thromboembolism results in the generation of heart failure. AF also increases the upper or the
systolic blood pressure as the heart now takes more efforts in pumping blood (vaso-constriction)
and thus providing justification regarding the high systolic blood pressure of Mrs Brown
(Atherton et al., 2018). Moreover, the BP of Mrs brown showed high systolic pressure. This
indicated disequilibrium in the end diastolic volume of Mrs Brown (volume of load in the right
and left ventricle at the end of diastole) and thus increased pressure over the cardiac muscles and
development of heart failure (Kerkhof, 2015). Heart failure occurs when heart is unable to pump
enough blood to different parts of body. It can occur due to narrowing of the arteries and
veins like artherosclerosis. Narrowing of arteries and veins give promotes ventricular re-
modelling. Ventricular re-modelling diminishes shape and size of heart along in decreased
contractility of the heart (systolic). This increases pressure over the blood vessels leading to
high systolic blood pressure as in case of Mrs Brown (Galli & Lombardi, 2016).
The backward failure of the decreased stroke volume as in case of systolic heart failure
results in the formation of congestion in the lungs. Congestion in the lungs along with renal
hypofunction causes pulmonary oedema. Pulmonary oedema results in the formation of hypoxia,
decrease oxygen saturation within the body (SpO2 of Mrs Brown is 85%)(Dunham-Snary et al.,
2017). Pulmonary oedema results in accumulation of fluid in the pulmonary cavity and this
causes failure of the pulmonary muscles to inflate properly and resulting in formation bi-basal
crackles mainly during the time of inhalation (Sellarés et al., 2016). The auscultation of lungs of
Mrs Brown identifies the presence of bi basal crackles. Sellarés et al. (2016) stated that older

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adults who haves previous history of cardiac failure are more likely to develop bi-basal crackles.
The presence of hypoxia in turn further leads to the generation of shortness of breath and
laboured breathing (dyspnoea along with tachypnoea respectively). Dyspnoea is defined as a
hallmark of heart failure. During shortness of breath or decreased oxygen supply, there occurs an
increase in the ventilatory demands along with the generation of abnormal constraints in the tidal
volume of the heart. Chemo-receptors respond to decrease in oxygen saturation this leads to
increase in respiratory rate for increase supply of oxygen throughout the body. Increased
respiratory rate activates chemo-receptors that respond to changes by increasing blood
pressure. This disequilibrium in functioning of the heart and the lungs lead to the generation of
heart failure body (Dunham-Snary et al., 2017).
Answer 2
Increase in the oxygen saturation of Mrs. Brown
The oxygen saturation of Mrs Brown SpO2 is 85% on room air, while normal oxygen
saturation is 95 to 97%. The main priority of care is to increase the oxygen saturation of the body
because increase in the oxygen saturation will help to reduce the symptoms like shortness of
breath (dyspnoea) and tachypnoea. The increase in the oxygen saturation in the body will be
done by giving external supply of oxygen(Atherton et al., 2018). The external supply of oxygen
will be given with the help of oxygen mask (venturi mask). Oxygen mask helps to delivery
oxygen that can be inhaled through nose and mouth. It is advantageous than nasal cannula
because it eliminates direct contact of the nostrils of the patients. The use ventilation approach
through nasal mask venturi mask) also helps to reduce unwanted loss of oxygen(Rizk, Essawy,
Ali, El-Gazzar& Mahmoud, 2018). The oxygen will be administered in high Fowler’s position

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(30 to 45 degree). The semi-fowler helps in maximum chest expansion (diaphragm) while
relaxing the tension of abdominal muscles and thus in faster increase in the oxygen saturation
within the body. It would be the duty of the nursing professional to raise the hinge of the bed in
order to maintain the semi-Fowler’s position. The outcome will be monitored based on the SPO2
value as displayed in pulse oxymerty (Rizk et al., 2018).
Monitoring the vital signs of Mrs Brown
The vital signs of Mrs Brown are unstable like high blood pressure, poor oxygen
saturation within the body, high pulse rate and respiratory rate. Thus nursing interventions will
involve effective monitoring of the vital signs of Mrs Brown by shifting her in the acute
area/resus room. The monitoring will be done round the clock with the help of pulse oxymetry
along with period check of the condition of the electrical impulses of the heart through ECG
(Rogers & Bush, 2015). Effective monitoring goes as per the Nursing and Midwifery Board of
Australia (2018) Professional Code of Conduct. The code of conduct states that it is the duty of a
nursing professional to document the patients’ health records for avoiding errors in the process of
medication management and therapy plan. For Mrs Brown, special attention must be given to the
blood pressure. Sudden increase and decrease in blood pressure should be addressed through
medical emergency team (MET) for avoiding any future chances of further cardiac complications
(Lujak, Billhardt&Ossowski, 2016).
Answer 3
Furosemide (Lasix) is a diuretic and is used for the treatment of edema assisted heart
failure and hypertension. The medication works through inhibiting the water reabsorption in the
nephrons via blocking the sodium-potassium-chloride cotransporter (NKCC2) present in e loop

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of Henle under the action of competitive inhibition. Competitive inhibition occurs at the chloride
binding site present on the co-transporter and thus preventing the transport of sodium ions in the
basolaterla side. This leads to excretion of dilute urine and helping to decrease edema and blood
pressure(Adams & Urban, 2015). This will help to reduce increased respiratory rate and pulse
rate of Mrs. Brown. The changes will be monitored based on decrease in water retention in the
body, the amount or urine output and decrease in blood pressure. However, dieresis might lead to
excessive dehydration and electrolyte depletion(Atherton et al., 2018).
Sublingual GlycerylTrinitrateis used for the treatment of heart failure and is
nitroglycerine in nature. It works by activating second messenger cyclic GMP causing relaxation
of smooth muscles and thus helping to dilate the coronary arteries. The dilation of arteries help to
improve oxygen supply in the myocardium and helping in reducing preload, and after loadfor
Mrs Brown. The patients’ improvement status will be monitored through the ECG report and by
checking the blood pressure. Nitroglycerine is associated with side-effects like weakness and
nausea and thus proper care must be given for preventing accidental fall (Atherton et al., 2018).

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References
Adams, M. P., & Urban, C. (2015). Pharmacology: Connection to Nursing. Pearson
Education.NewYork, USA.
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ... &
Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of
Australia and New Zealand: Australian clinical guidelines for the management of heart
failure 2018. Medical Journal of Australia, 209(8), 363-369. Retrieved from:
https://www.ncbi.nlm.nih.gov/pubmed/30067937
Dunham-Snary, K. J., Wu, D., Sykes, E. A., Thakrar, A., Parlow, L. R., Mewburn, J. D., ... &
Archer, S. L. (2017). Hypoxic pulmonary vasoconstriction: from molecular mechanisms
to medicine. Chest, 151(1), 181-192.
1045675zhttps://doi.org/10.1016/j.chest.2016.09.001
Galli, A., & Lombardi, F. (2016). Postinfarct left ventricular remodelling: a prevailing
cause of heart failure. Cardiology research and practice, 2016.
Kerkhof, P. L. (2015). Characterizing heart failure in the ventricular volume domain. Clinical
Medicine Insights: Cardiology, 9, CMC-S18744. doi: 10.4137/CMC.S18744
Lujak, M., Billhardt, H., &Ossowski, S. (2016). Distributed coordination of emergency medical
service for angioplasty patients. Annals of Mathematics and Artificial Intelligence, 78(1),
73-100.

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Marrouche, N. F., Brachmann, J., Andresen, D., Siebels, J., Boersma, L., Jordaens,
L., ...&Schunkert, H. (2018). Catheter ablation for atrial fibrillation with heart
failure. New England Journal of Medicine, 378(5), 417-427. DOI:
10.1056/NEJMoa1707855
Mentz, R. J., &O'connor, C. M. (2016).Pathophysiology and clinical evaluation of acute heart
failure. Nature Reviews Cardiology, 13(1),
28.https://www.nature.com/articles/nrcardio.2015.134
Nair, G. M., Nery, P. B., Redpath, C. J., &Birnie, D. H. (2014).The role of renin angiotensin
system in atrial fibrillation. Journal of atrial fibrillation, 6(6).doi: 10.4022/jafib.972
Nursing and Midwifery Board of Australia (2018).Professional Code of Conduct. Access date:
13th August. Retrieved from: https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards.aspx
Reddy, Y. N., Melenovsky, V., Redfield, M. M., Nishimura, R. A., & Borlaug, B. A. (2016).
High-output heart failure: a 15-year experience. Journal of the American College of
Cardiology, 68(5), 473-482. DOI: 10.1016/j.jacc.2016.05.043
Rizk, Y. E. S., Essawy, T. S., Ali, A. H. A. E., El-Gazzar, M. A., & Mahmoud, A. F. (2018).
Effect of Oxygen Therapy by Venturi Mask versus Non Invasive Ventillation on the
Outcome of Patients Who Devolope Hypoxia after Open Heart Surgery. Open Journal of
Anesthesiology, 8(09), 241. DOI: 10.4236/ojanes.2018.89025

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Rogers, C., & Bush, N. (2015). Heart failure: pathophysiology, diagnosis, medical treatment
guidelines, and nursing management. Nursing Clinics, 50(4), 787-799.
DOI: https://doi.org/10.1016/j.cnur.2015.07.012
Rossi, F., Mascolo, A., &Mollace, V. (2017).The pathophysiological role of natriuretic peptide-
RAAS cross talk in heart failure. International journal of cardiology, 226, 121-
125.https://doi.org/10.1016/j.ijcard.2016.03.080
Sellarés, J., Hernández-González, F., Lucena, C. M., Paradela, M., Brito-Zerón, P., Prieto-
González, S., ...& Sánchez, M. (2016). Auscultation of Velcro crackles is associated with
usual interstitial pneumonia. Medicine, 95(5).doi: 10.1097/MD.0000000000002573