Nursing Practice 3: Pathophysiology and Pharmacology Applied to Nursing

Introduction to Cardiovascular System

A cardiovascular system cannot supply an adequate amount of oxygen to the tissue's body is due to heart failure. This is because of a wave of changes, which ultimately leads to intense exhaustion, breathing and death. Over the last four decades, the knowledge of molecular and cellular processes that lead to effective treatments and lead to heart disease has progressed greatly. However, chronic heart failure is a major cause of illness and death. And with an increased generation, the number of people affected is rising with the increasingly global population.

The limitation of this disorder, aimed at cellular and organ-wider diseases, is needed in new treatments to avoid and restore. Cardioactive myocytes or cardiac interstitial diseases and not just cardiac fatigue or disruptions are induced by the dynamical interplay of autoimmune, genomic, biochemical, and neurohormonal alterations.

Rationale for ECG/EKG

The EKG is a non-invasively recorded electronic mapping of the heart from the epidermis. The EKG is a cardiogram of electricity. ECG is a non-invasive screening procedure that affects the cardiovascular severity significantly clinically. ECG is being used frequently as a pre-operative part to screen and test individuals in high-ranking and sports careers in antiarrhythmic patients and other drugs. Cardiovascular disease (CVD) is the number one cause of death and stresses how professionals of health should gain knowledge and knowledge in the understanding of ECGs to promptly provide the proper treatment. For many healthcare facilities the advanced ECG analysis is a complex task. Errors in analysis can lead to diagnostic errors and to a delay in adequate treatment. For deep buddy nurse, thus, ECG should have indicated that if Deep has a heart attack, it could be confirmed that

Blood Test

Troponin is a complex of 3 units of T-, I and C protein involved in the contractile system of the skeleton and heart muscles. Both the cardiac muscles and the skeletal muscles express troponin C, while troponin T and I are more cardiac. Cardiomyocytes release heart troponin into the blood when a heart attack occurs (from ischemia or other causes). In 3 to 4 hours after the injury, two troponin levels increase and rise for 4 to 7 days or 10 to 14 days (troponin T). Yet healthy people's blood without evidence of a cardiac attack also has very limited heart troponin levels. Clinically, the troponin evaluation is particularly helpful in the identification of potential patients with acute coronary disease (ACS). ACS is characterised by an insufficient supply of oxygen to the coronary artery of the myocardial system as a range of conditions.

Since the determination of cardiovascular disease involves both blood and ECG. Therefore, the buddy nurse would have prescribed all of these examinations to confirmed that Deep is in heart attack.

Diagnosis of Heart Failure

Heart failure is a pathological disorder in which the heart cannot cause sufficient blood pressure to achieve digestion or systemic venous reversal. Heart loss is ventricular dysfunction (HF). Left ventricular collapse causes shortness of breath and fatigue, right ventricular failure leads to accumulation of peripheral and ventricular fluids. In heart failure, the coronary blood cannot provide mitochondrial tissue, and heart pressure increases can lead to obstruction of the organ. It can be caused by systemic, diastolic or any of these abnormalities. While the composition of the cardiomyocyte is different as a key anomaly, the rotation of the artery collagen often shifts (National Institute for Health and Care Excellence, 2020). Cardio-vascular abnormalities can also lead to heart disease (e.g. congenital, valvular, rhythmic and high metabolism requirements (e.g. persistently high cardiac) (e.g., because of thyro-toxicology).

Causes

If one or more of the coronary arteries are crossed, there will be a heart attack. A growth of fatty deposits, like cholesterol, is over time responsible for forming substances called plaques that can restrict the arteries (atherosclerosis). The most common cause of this illness is coronary artery disorder.

Plaques will break and spill cholesterol and other materials into the bloodstream during a cardiac attack. At the site of the rupture there is a blood clot. If the coagulation is high, it will obstruct coronary artery blood supply, starving the oxygen and nutrient core (ischemia).

Interpretation of ECG

The QRS Complex

The QRS represents the depolarized ventricles (activated). QRS is always called but it is not always possible to represent all three waves. As the electric vector of the left ventricle is many times bigger than the left one, QRS actually represents the depolarisation of the left ventricle. QRS is the difference in time between QRS start and finish.

ST Section

The ST area is the extent of activity of the plateau (phase 2). Although the segment ST is changed in different cases, it must always be carefully examined. Many of these conditions cause some common changes to the ST section. Active myocardial ischemia is particularly important in the ST region as ischemia causes variations in the ST segment (ST segment deviation) (Serhani et al., 2020).

T-wave

The T-wave reflects the rapid repolarization (phase 3) of contractile cells and T-wave changes take place in a wide range of different conditions. T-wave changes are often ignored in clinical practise and tested during the following discussion. The ST-to-T-wave segment transformation should be easy (and not abrupt). The normal T-Wave has a slightly asymmetrical descent track. The CG interpretation usually starts with the P-wave assessment. The P-Wave is a smooth, building wave.

The atria form a thin muscle mass comparatively. If the rhythm is sinus rhythm (i.e., in normal circumstances), the P-speed vector is either directed downwards or to the left on the frontal plane. The P-wave is still optimistic in lead II at sinus rhythm (Kaplan Berkaya et al., 2018). The lead is positioned opposite the P-wave vector and the discovery of the electrode is next to the P-wave vector, which is really intuitive.

In Deep’s Case:

Rhythm — rhythm is irregular, since intervals P-P and R-R are not regular, and when the ECG is analysed they have parallel ups and downs between them. In reality, the rhythms of tachycardia are highly ventricular or tricky.

The auricular rate is shown by the waves rate-P. At 60 bpm atrial frequencies, almost precisely five main boxes are available between P waves. There are 10 P waves in total (some of them difficult to see because the crossover is hidden) and 10 x 6 = sixty waves on the track. The first procedure is tested. The ventricular incidence was just over 4 major cases between 60 and 75. Whereas on this 10-second strip a maximum of 11 QRS complexes exist, the real ventricular measurement rate is 11 x 6 = 66 ppm.

Waves of P Regularity and presence – P-waves in some fields suggesting a depolarization of the arteries of the heart are not declared to be regular and missing by analysing the ECG. ST – ST segments show the intervals between ventricular depolarization and repolarization and are usually considered as specific cases (Chamley et al., 2019).

Shortness of Breath

Excessive dyspnoea is one of the prevalent symptoms of chronic heart dysfunction which continues to worsen as the disorder decreases functionality and daily conduct. For the successful management of this disabled symptom, a better knowledge of their underlying physiology is needed. Cardiovascular disorders are believed to play an important part in dyspnoea patients with heart disease. However, unlike the pharmacology, the exercise dyspnoea is a concern of patients with heart dysfunction, such as vast dilators or inotropes that enhance central haemodynamic. The signs of Chronic Heart Insufficient (CHF), explained by patients with exhaustion and breathlessness, rely on the way a reduction of cardiac rates during workouts contributes to impairment of the skeleton's blood flow and, therefore, to fatigue; (Narcisse et al., 2021).

Two Things that would increase the heart rate of the patient:

Lasix: Furosemide is used to reduce excess body fluid (edoemia) due to heart, liver and kidney disease. Therefore, symptoms such as breathing and swelling will decline in the back, legs and abdomen. The drug is also used for the treatment of high blood pressure. Since then, Deep has confessed to avoiding Lasix because he faced problems including having to go to the toilet several times. Lasix may therefore have helped him prevent heart failure.

Hot and sour soup: it is not safe for heart disease, diabetes and weight loss since it does contain maize flour, and since it is full of calories and carbohydrates including processed sugar, it is also deterrent for weight management. For heart patients and patients with diabetes with a high carb product, this is a perfect no. And Deep regularly takes it and may therefore contribute to heart disease (Ahmed et al., 2020).

Two factors for patients keeping the information to himself

The first proposal is to avoid the supplementary dosage of the Glyceryl Trinitrate, because Deep suggests it has taken a Viagra, and the patient is asked if the doctors and nurses retain any other doses.

Viagra and Glyceryl Trinitrate attach and lead to fast decreases in blood pressure and cardiovascular insufficiency. This is why the medication is halitng. Blood arteries are expanded by the release of a cGMP mediator, nitrc oixide (NO). Nitrogen such as trinitrate of glyceryl (GTN) has been used widely in the treatment of angina and avoidance with the application of NO-causing drugs (non-dontingent). Male erectile dysfunction that prevents the cGMP failure is treated effectively with sildhenafil

This alone causes minor reductions in BP for more healthy adults and cardiovascular patients. The combination of sildenafil with NO donors leads to an increase in the prevalence of erectile dysfunction in groups, leading to an overall decrease of BP in patients with Angina. It is therefore recommended not to co-administer all prescriptions within 24 hours. Earlier tests have shown that nitrate has a maximum contact time of 60 minutes following sildenafil administration (Su et al., 2012).

Patient data retaining factors.The most common explanations that these actions cannot be assessed or learned are not to realise that they are damaging and humiliating. Many people are concerned and doubtful that their physicians will be as transparent and stubborn as they are mentally dangerous. The consequence is that doctors often do not provide reliable, appropriate diagnostic records, which may have an impact on the care and guidance of patients.

Analysis of Drugs

Generic name

Atenolol

Furosemide oral

Drug group (1 mark)

Selective β1 receptor antagonist

Loop diuretic medication

Mechanism of action (3 marks)

It works by blocking the action of certain chemicals, such as epinephrine, on the blood vessels and heart. This reduces heart rate, blood pressure and heart tension.

This medication acts by connecting to the transmission channel of chloride, which causes the lumineous Na-K-Cl co-sender in the wide ascending belt of Henle's loop to deplete chloride, sodium and potassium in the urine.

Complications/side effects (2 major) (1 mark each)

· Slower heart rates

· Feeling of Cold.

· Fatigue.

· Hypotension or decreased Blood Pressure

· Urinating less

· Weight gain

· Stomach cramping

· Fast or abnormal heartbeat.

Nursing considerations (2 major) (1 mark each)

• Blood pressure to assess the reaction to atenolol should be routinely monitored.

• Drugs should be used after meals in the event of gastrointestinal upheaval and heart rate monitoring

· • Monitor blood glucose levels which may be elevated temporarily in patients with diabetes after this medicine has begun.

· • Assessment of fluid state. Regular edoemas, pulmonary sounds, skin turgor levels and membrane levels, output gains, quantity and location monitoring.

Reasons behind Medicines Non-Adherence

Sadly, non-compliance with medications, particularly in chronic patients, is very common when patients do not take their medication as advised. If so, it is needed to understand that people don't take medication for physicians and other health care providers? (Wei et al., 2017). This encourages teams to identify patients and enhance their medications compliance.

Understanding

There will be no continuity if the patient doesn't know if the medicine is needed, how long it takes to check outcomes and the side effects. This is particularly true for those with chronic illnesses take every day medications in order to alleviate unpleasantness.

May not experience symptoms

As discussed above, if signals are absent, non-compliance can occur. No need should be applied after beginning or halting treatment in patients who don't feel differently. Furthermore, after a patient's wellbeing is examined, he or she may feel the problem has been healed and may avoid the medication. You must inform your patient that your prescription can take a long time (Usherwood, 2017).

References for Pathophysiology and Pharmacology Applied to Nursing

Ahmed, A. A. A., Al-Shami, A. M., Jamshed, S., Nahas, A. R. F., & Ibrahim, M. I. M. (2020). Public awareness of and action towards heart attack symptoms: An exploratory study. International Journal of Environmental Research and Public Health. https://doi.org/10.3390/ijerph17238982

Chamley, R. R., Holdsworth, D. A., Rajappan, K., & Nicol, E. D. (2019). ECG interpretation. European Heart Journal. https://doi.org/10.1093/eurheartj/ehz559

Groenewegen, A., Rutten, F. H., Mosterd, A., & Hoes, A. W. (2020). Epidemiology of heart failure. In European Journal of Heart Failure. https://doi.org/10.1002/ejhf.1858

Kaplan Berkaya, S., Uysal, A. K., Sora Gunal, E., Ergin, S., Gunal, S., & Gulmezoglu, M. B. (2018). A survey on ECG analysis. In Biomedical Signal Processing and Control. https://doi.org/10.1016/j.bspc.2018.03.003

Narcisse, M. R., Rowland, B., Long, C. R., Felix, H., & McElfish, P. A. (2021). Heart Attack and Stroke Symptoms Knowledge of Native Hawaiians and Pacific Islanders in the United States: Findings From the National Health Interview Survey. Health Promotion Practice. https://doi.org/10.1177/1524839919845669

National Institute for Health and Care Excellence. (2020). Acute heart failure diagnosis and management. National Institute for Health and Care Excellence.

Serhani, M. A., El Kassabi, H. T., Ismail, H., & Navaz, A. N. (2020). ECG monitoring systems: Review, architecture, processes, and key challenges. In Sensors (Switzerland). https://doi.org/10.3390/s20061796

Su, L., Huang, J., Yang, W., Li, H., Shen, Y., & Xu, Y. (2012). Ethics, patient rights and staff attitudes in Shanghai’s psychiatric hospitals. BMC Medical Ethics. https://doi.org/10.1186/1472-6939-13-8

Usherwood, T. (2017). Encouraging adherence to long-term medication. Australian Prescriber. https://doi.org/10.18773/austprescr.2017.050

Wei, L., Champman, S., Li, X., Li, X., Li, S., Chen, R., Bo, N., Chater, A., & Horne, R. (2017). Beliefs about medicines and non-adherence in patients with stroke, diabetes mellitus and rheumatoid arthritis: A cross-sectional study in China. BMJ Open. https://doi.org/10.1136/bmjopen-2017-017293

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