The patient in the given case study is having cardiac symptoms. He is having multiple comorbidities and has been admitted to the emergency department with the complaint of chest tightness and increased shortness of breath. With the given clinical representation, the patient can be having three main underlying health issues that should be focused upon. These health issues are below-mentioned:
Hypertension- The patient in the given case study is having multiple comorbidities. Patient is having a prior history of idiopathic (non-ischemic) dilated cardiomyopathy, diagnosed two years ago. He is also having a BMI of 29.4kg/m2. He falls in the category of overweight. This adds to the underlying risk factors for the patient (Jian, 2017). Hypertension is also directly associated with decreased cardiac output (Brandt, 2019). This is an additional burden on the patient’s health as the patient is also having an underlying condition of dilated cardiomyopathy. This decrease in cardiac output can lead to the formation of multiple other complications such as increased vascular resistance, myocardial ischemia and with progression of the condition can also lead to ventricular hypertrophy or rigidity (Stewart, 2018). This add to the underlying risk for the patient, having a cardiac condition. Obesity is also an unfavorable factor for the development of hypertension in the patient. This development of obesity in the patient can bring about various cardiovascular complications in the patient. There has been a direct relation observed between the patients having severe obesity and advancement of hypertension. When the person is overweight, the heart has to work a bit harder to pump blood through. This exerts and additional strain on the arteries and thus, adds to the resistance on the blood flow. This leads to rise in blood pressure readings as well as development of multiple cardiovascular conditions in the patient (Carbone, 2019). The condition can life-threatening for the patient given in our case study, as he is already suffering from dilated cardiomyopathy.
Tachycardia- The heart rate readings of the patient observed in the emergency care department was found to be 110 beats per minute. This is reflective of patient having tachycardia. Heart diseases are considered as an underlying risk factor for development of tachycardia in the patient. Tachycardia is generally referred to the heart beat observed faster than the normal pattern. The beat is generally observed as more than 100 beats per minute (Yetkin, 2016). Some of the forms of tachycardia can be life-threatening for the patient. Tachycardia is also characterized by a rapid, inadequate heart rhythm. With an increased heart rate of the patient, there is an added burden on the heart to pump more oxygenated blood to compensate for the circulatory loss. The rapid increase in the heart rate can be life-threatening for the patient as well. It is very difficult to bring back the heart rate of the patient, back to normal easily and might require very aggressive approach to tackle with the same (Aspit, 2019). The parameter of accelerated heart rate is statistically proven to determine the underlying risk for cardiovascular disease development. The mortality rate with high heart rate is also significantly higher in patients having any underlying cardiovascular disease. Tachycardia is an independent risk factor for promoting hypertension in patients, that might require emergent medical management for enabling positive healthcare outcomes from the patient. Thus, tachycardia for the given case study is a major risk factor for the patient.
Increased blood glucose level- The patient is a known case of type-2 diabetes. The reflection of increased blood glucose levels can be a danger for the patient. with an increased blood glucose levels, the patient might develop long-term complications. These include, cardiovascular diseases, neuropathy, damage to the kidney functioning and other joint related issues as well. Both type 1 and type 2 diabetes form the foundational basis for the patient to develop increased risk of dilated cardiomyopathy. As the patient is having diabetes type-2, he might have developed the cardiomyopathy secondary to these symptoms. If the blood glucose levels rise than the normal range there are further complications that can be developed in the patients as well. Diabetic ketoacidosis is one of the complications that might develop secondary to the high blood glucose levels. With a rise in blood glucose levels the body tend to break down the fat for energy deposits (Peters, 2016). This process leads to the increased production of toxins in the body known as ketones. Excessive number of ketones are then accumulated in the blood which are then passed out in the urine. This condition, when left untreated, can cause a diabetic coma in the patient. the condition is also found to be life-threatening for the patient. Another underlying complication that might arise from the situation can be hyperglycemic hyperosmolar state. Condition can be observed when the person might be able to produce insulin but is not able to function as estimated. This might result in an accelerated rise in blood glucose levels, that eventually starts to use up body fat for producing energy (Fayfman, 2017). This eventually leads to increased urination frequency. If and when left untreated the condition can assimilate into a life-threatening dehydration and diabetic coma. The patient in the given case study is having an underlying risk factor for the development of both, to an increased blood glucose level reflected.
The clinical presentation of the patient, represents on the worsening of the symptoms of heart failure. This is marked by evidence of pulmonary hypertension and bilateral lower lobe congestion. The role of nurse in managing care for any patient, can be deemed as vital. In the given case scenario, the below-mentioned role can be reflected by the nurse:
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