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Guided questions:Question 1 Explain the pathogenesis causing the clinical manifestations with which Mrs. Brown presented.Heart failure typically describes the condition of inability of the heart to function to provide thenecessary normal amount of blood to the organs . Due to the characteristic inability of adequatefunctionality of the heart, the primary functions of the human system are disarrayed . Therefore,failure of the heart collectively refers to a syndrome that leads to the weakness of the heart [1, 2]. Heartfailure may either affect the right or the left side of the heart [1, 2]. Failure of the left heart is a commonoccurrence across the world [1, 2]. Oxygenated blood is pumped into the left side of the heart and thisblood is pumped to all the organs of the body [1, 2]. In left heart disease, the ability of the heart topump blood to all the organs is reduced [1, 2]. Due to the compromised capacity of the heart to pumpblood to all the body, the patient experiences severe fatigue [1, 2]. Mrs. Brown has been reported toexperience a severe case of dyspnoea or difficulty in breathing [1, 2]. This is primarily due to the lack ofoxygenated blood reaching the lungs from the left side of the heart [1, 2]. Mrs. Brown has been found tohave atrial fibrillation. Pulmonary hypertension is one of the most frequently occurring conditions in theleft heart disease [3, 4]. Pulmonary hypertension in left heart disease is a complex and partially-understood phenomenon [3, 4]. It is regarded as being a heterogeneous phenomenon and is resultedfrom the transmission of the filling pressure on the left side of the heart [3, 4]. The transmission is of apassive nature and occurs in the backward direction [3, 4]. The filling pressures on the left side of theheart are caused due to the dysfunction of systolic and diastolic pressures in the system in the leftventricle [3, 4]. The left arterial pressure and the pulmonary arterial pressure are increased due to thefunctional mitral regurgitation [3, 4]. The patient thus experiences this during exercise [3, 4]. In thepathophysiology of left heart disease, a major event is the increase in the size of the left artery [3, 4].
The size of the left artery is a pathological marker for the morbidity of the disease along with indicatingthe mortality index [3, 4]. Additionally, the pathological events include impairment of the contractilityand compliance of the left artery and stiffness in left artery [3, 4]. These events lead to severalpathological modifications in the right side of the heart and the pulmonary artery [3, 4]. The cardiacfilling and the output are affected by these pathological modifications in the properties of the leftarterial systolic and diastolic pressures [3, 4]. There is a sudden elevation in the left arterial pressure anda failure of the alveolar-capillary stress. This results in oedema of the alveolar and the interstitial system[3, 4]. The occurrence of severe dyspnoea, compromised in the rate of respiration, pulse, and heart rateare all reduced [3, 4]. Chronic heart failure has high aetiology and the symptoms of disease andrespiratory system and exertional dyspnoea with poor prognosis leading to compromised functionalityin the activities of daily life, similar to the case of Mrs. Brown. The pathology of dyspnoea is mainlycaused due to cardiovascular factors. Additionally, dyspnoea depends on complex interactions in thepulmonary and cardiac system [3, 4]. There is an abnormal increase in the restrictions on the expansionof the tidal volume, ventilation, and critical cardiac output leading to dyspnoea [3, 4].Question 2 Discuss two high priority nursing strategies to manage Mrs Brown and provide evidence-basedrationales for these strategies. The symptoms of dyspnoea and limitations in breathing lead to several variations in the patientsymptoms [5, 6]. The primary method of determination of the link between the occurrence of dyspnoeaand left-sided heart disease is echocardiography [5, 6]. The intervention of the nurse is one of the mostessential aspects in providing medical care to patients, especially the elderly, for heart disease, chronicheart failure, and connected pulmonary hypertension and respiratory compromise [5, 6]. The primaryobjective of the nursing intervention and clinical manifestation is to maintain the stability of the clinical
presentations of the patient with left-sided heart disease and to improve the quality of life and aid themin the performance of activities of daily life [5, 6]. The nursing strategies that are of high importanceinclude: (i) The provision of education to the patients and to provide prognosis to the patient; the symptoms ofischemia, hypertension, and atrial fibrillation are common amongst patients [5, 6]. The importanttreatment option for dyspnoea is the use of diuretics; however, it does not improve the prognosis of thepatient [5, 6]. Tachycardia is resulted from serious injury to the heart and myocardial infarction [5, 6].Exercise increases tachycardia and nurses are required to take care that patients remain at rest [5, 6].(ii) The second nursing intervention involves the care given to patients of chronic left-sided heart failurewho are on diuretic medication, in order to maintain the state of rest and accomplish activities of dailylife [7, 8]. The shortness of breath and dyspnoea is mainly caused by congestion of the pulmonaryvenocapillary. Nurses need to ensure that the patients remain in the sitting position while sleeping [5, 6].The strategies of nursing are predominantly dependent on the care for patients based on the rationaleof compromised daily activity. Research evidence suggests that nursing interventions that aim tocontrol/restrict activity in the patient, enhance the mechanics of respiration, function of the peripheralmuscle, and exercise capacity [5, 6]. Thus, the rationale for providing nursing care to the heart failurepopulation is to control pulmonary hypertensive and respiratory impairment and to improve the qualityof life of the patient. Question 3Two of the drugs that were given to Mrs Brown were IV furosemide and sublingual glyceryl trinitrate.a. Discuss the mechanism of action of these two drugs, and relate to the underlying pathogenesis ofan acute exacerbation of chronic left-sided heart failure.
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