Bachelor Nursing Assignment: Heart Failure Pathophysiology

This Bachelor of Nursing assignment examines a case study of a patient, Mrs. Brown, experiencing an acute exacerbation of chronic left-sided heart failure. The assignment analyzes the patient's clinical manifestations, including dyspnea, tachypnea, and reduced oxygen saturation, linking them to the underlying pathophysiology of left-sided heart failure, such as systolic and diastolic dysfunction. It explores the compensatory mechanisms involved and explains the mechanisms behind specific symptoms like shortness of breath and basal crackles. Furthermore, the assignment outlines evidence-based nursing strategies, including supplemental oxygen therapy and the administration of Digoxine. It details the mechanism of action of medications like IV furosemide and sublingual glyceryl trinitrate, relating them to the treatment of heart failure. Finally, it provides crucial nursing implications for these medications, emphasizing patient assessment and monitoring to ensure optimal patient care and safety.

Running head: BACHELOR NURSING ASSIGNMENT
Bachelor Nursing Assignment
Name of the Student:
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Author Note:

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BACHELOR NURSING ASSIGNMENT
Assessment 1: Guided Questions
Answer to Question 1
According to the case study, Mrs. Brown was presented with the clinical manifestations
that included severe dyspnoea, tachypnoea, reduced level of oxygen saturation, hypertension,
and tachycardia among other symptoms. Additionally bilateral basal crackles were detected on
auscultation of lungs. Ultimately a diagnosis of acute exacerbation of chronic left-sided heart
failure was arrived at by virtue of performing an electrocardiogram test that revealed presence of
atrial fibrillation. Under the light of these manifestations, the pathogenesis of the disease related
to left-sided heart failure may be explained. Empirical findings have suggested that systolic
dysfunction may be attributed as the main etiologic factor that leads to left-sided heart failure.
Systolic dysfunction refers to decreased ability to eject blood that in turn may be related to
impaired contractility of the ventricles either due to fibrosis or destruction or abnormal
functioning of the myocytes. Heightened resistance to flow also culminates in increased afterload
which may lead to systolic dysfunction. All these factors account for causing the overstretching
if the ventricles particularly the left ventricle that subsequently leads to decrease in myocardial
contractility because of systolic dysfunction that has been identified as the predominant factor
for heart failure. Diastolic dysfunction may also partially contribute for the onset of heart failure.
Diastolic dysfunction arises because of impaired ventricular relaxation and impaired ventricular
filing as a result of increased stiffness of the ventricular wall. For left-sided heart failure,
impaired ventricular contractility may lead to conditions that encompass transient myocardial
ischemia or myocardial infarction. Moreover mitral or aortic regurgitation might lead to chronic
volume overload (Rosenkranz et al., 2015). Dilated cardiomyopathy is another characteristic

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feature of left-sided heart failure that in turn may be attributed to impaired ventricular
contractility because of systolic dysfunction of the heart. Systemic hypertension of uncontrolled
type together with aortic stenosis also occurs in case of left-sided heart failure because of
increased afterload. Apart from these systemic factors, the pathogenesis of left-sided heart failure
is often linked to the deleterious consequences pertinent to the compensatory mechanisms that
are responsible for maintaining the homeostasis inside the body. Continuous sympathetic
activation, accentuated heart rate, increased circulating volume and preload in conjunction with
increased total peripheral resistance and chronic elevation of angiotensin II enzyme and
aldosterone hormone lead to the causation of left-sided heart failure due to combinatorial effects.
In this connection, the two important symptoms related to the diagnosis of the disease in the
patient that were manifested may be discussed for understanding their underlying mechanisms.
Appearance of symptom related to shortness of breath might have occurred due to increased
pulmonary oncotic pressure due to left-sided regurgitation is capable of extravasation of fluid
into the pulmonary interstitium that in turn is reflected on decreased pulmonary compliance in
addition to increased airway resistance. Further, the presence of bilateral basal crackles on
pulmonary auscultation may be explained. Hydrostatic forces are found to be greatest at the lung
bases whereby prior to inspiration, interstitial edema caused closure of small airways before
opening them again. Higher lung regions represent crackles due to worsening pulmonary edema
(Dupuis & Guazzi, 2015).

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Answer to Question 2
Considering the situation specific to Mrs. Brown, evidence based nursing strategies must
be implemented to manage her condition and preventing further deterioration of her health status.
The low level of oxygen saturation and increased respiratory rate is particularly alarming for the
patient as these vital signs suggest the deteriorating health condition. Thus, supplemental oxygen
therapy may be ensued for the patient to ensure no further exacerbation of the pulmonary
congestion and hypoxic situation. Administration of adequate oxygen will ensure sufficient
saturation for the patient. Adequate ventilation may be ensured through the utilization of nasal
cannula for oxygen therapy thereby mitigating the sensation related to suffocation that might
arise because of use of oxygen mask. However, precautions must be followed to avoid the risk of
emphysema and hyperinflation of the lungs (Miguel-Montanes et al., 2015). Further her heart
rate was found to be increased, deviating much beyond the normal limit. Therefore, efforts must
be taken so that the cardiovascular functioning may be maintained at a satisfactory level. Hence,
under the guidance and supervision of the attending physician, pharmacologic medications such
as that of Digoxine may be administered. Digoxine is a digitalis that accounts for improving the
contraction and rhythmicity of the heart through enhancing the myocardial contractility and
cardiac output. Therapeutic effects of this drug cause the reduction in the pace of the heart rate
that leads to stabilization of the heart rhythms (Ambrosy et al., 2014). However, the nurse must
observe for any contraindications and any adverse outcomes must be promptly reported to the
concerned physician.

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Answer to Question 3
a. Mechanism of action of drugs and relation to underlying pathogenesis of acute exacerbation
of chronic left-sided heart failure:
IV furosemide:
It is a diuretic that has been indicated for treating edema due to heart failure, hypertension
and other pathological conditions related to renal disorders and hepatic impairment. It acts by
inhibiting the reabsorption of sodium and chloride from the Loop of Henle of the kidney
nephron ad distal renal tubules and cause increased renal excretion of water, sodium,
chloride, magnesium, calcium and potassium. Thus the therapeutic effects are exerted
through dieresis and consequent mobilization of excess fluid thereby reducing edema and
pleural effusions alongside decreasing the blood pressure. Hence management of the left-
sided heart failure is done by this drug (davisplus.fadavis.com., 2017).
sublingual glyceryl trinitrate:
It is considered as an antianginal that has been found to be beneficial in both acute as
well as prophylactic management of angina pectoris besides acting as an adjunct therapy to
treatment of heart failure. Dilation of coronary arteries and improvement of collateral flow to
ischemic regions is acted upon by this drug through increasing the coronary blood flow.
Further, it causes reduction of left ventricular end-diastolic pressure as well as left ventricular
end-diastolic volume thereby acconting fir diminution of the myocardial oxygen
consumption. Thus, the therapeutic effects on the treatment of left-sided heart failure by
means of reliving the symptoms and prevention of heart attack are exerted by this drug.
Reduction of blood pressure and increase of cardiac output is brought about by this drug that

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acts to alleviate the symptoms in case of left-sided heart failure (davisplus.fadavis.com.,
2017).
b. Nursing implications in treatment of patient with acute exacerbation of chronic left-sided
heart failure:
IV furosemide:
Assessment of fluid status apart from monitoring of daily weight, intake and output ratios
apart from location of edema, skin turgor, lung sounds and mucous membranes must be
noted. At the time of administration as well as before that phase, monitoring of blood
pressure must be conducted apart from assessing the falls risks in the elderly patients and
subsequent implementation of fall prevention strategies. Any adverse reactions must be
brought to the notice of the physician for prompt intervention (davisplus.fadavis.com., 2017).
sublingual glyceryl trinitrate:
Evaluation must be carried out with respect to the location, intensity, duration, and precipitating
factors contributing to the patient’s angina pain. Continuous monitoring of the vital parameters
through ECG must be done alongside evaluation of the additional hemodynamic parameters.
Any notable contraindication must be immediately reported to the physician in charge
(davisplus.fadavis.com., 2017).

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References
Ambrosy, A. P., Butler, J., Ahmed, A., Vaduganathan, M., van Veldhuisen, D. J., Colucci, W. S.,
& Gheorghiade, M. (2014). The use of digoxin in patients with worsening chronic heart
failure: reconsidering an old drug to reduce hospital admissions. Journal of the American
College of Cardiology, 63(18), 1823-1832.
Dupuis, J., & Guazzi, M. (2015). Pathophysiology and clinical relevance of pulmonary
remodelling in pulmonary hypertension due to left heart diseases. Canadian Journal of
Cardiology, 31(4), 416-429.
Furosemide. (2017). davisplus.fadavis.com. Retrieved 12 August 2017, from
https://davisplus.fadavis.com/3976/meddeck/pdf/furosemide.pdf
Miguel-Montanes, R., Hajage, D., Messika, J., Bertrand, F., Gaudry, S., Rafat, C., ... & Dreyfuss,
D. (2015). Use of high-flow nasal cannula oxygen therapy to prevent desaturation during
tracheal intubation of intensive care patients with mild-to-moderate hypoxemia. Critical
care medicine, 43(3), 574-583.
Nitroglycerin. (2017). davisplus.fadavis.com. Retrieved 12 August 2017, from
https://davisplus.fadavis.com/3976/meddeck/pdf/nitroglycerin.pdf
Rosenkranz, S., Gibbs, J. S. R., Wachter, R., De Marco, T., Vonk-Noordegraaf, A., & Vachiéry,
J. L. (2015). Left ventricular heart failure and pulmonary hypertension. European heart
journal, 37(12), 942-954.