Introduction to Heart Disease 

Heart disease is a problem because the heart does not pump enough blood for the needs of the body. If the heart cannot fill with enough oxygen, this will happen. It can also occur if the heart is too slow to function correctly. The word insufficiency of the heart doesn't really mean that your heart stops. However, heart disease is a severe medical condition. As per the Centres for Disease Control and Prevention, over six million people in the United States experience heart failure.

Nursing Practice 3: Pathophysiology and Pharmacology Applied to Nursing - Answer 1

Electrocardiogram (ECG OR EKG)

Cardiovascular production per minute is the most important cardiovascular occurrence needed to maintain flow of blood through the body. The heart must maintain a daily cycle of relaxation and contraction, along with the blood flow and contractual power, to accomplish its purpose. This is based upon the use of an instrument called an electrocardiogram for monitoring of a set of difficult electrophysiological events in cardiac tissues. This gadget is called an ECG. My buddy nurse might have suggested ECG in the case of Deep as he is initially having high BP as well as worsening of dyspenia which indicated a heart failure. Therefore, in order to confirm this my buddy nurse might have suggested ECG.

Blood Test

The test for troponin tests your blood level of troponin. Troponin is a protein present generally in a heart's muscles. It is usually not present in blood. The troponin gets into the bloodstream as cardiac muscles are impaired. More troponin is released into the blood as cardiac injury grows.High troponin levels in the blood may mean that a person is having or have recently had a heart disease. When a blood supply to the heart is disrupted, a heart attack occurs. This obstruction can be fatal. But the life could be saved with quick diagnosis and care. Therefore, the procedure is used to detect a heart attack more often. It is also used to monitor angina, which reduces the supply of blood to the heart and induces chest pain. Angina refers to a heart attack occasionally. The buddy nurse suggested this as Deep is feeling discomfort, shotness of breath, fatigue, sweating which could all be the symptom of heart failure (Houstis, 2018).

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 2

Pathophysiology of Heart Failure

Initiation of Heart Failure

A multitude of causes, involving coronary heart disease, asthma and diabetes, cause heart failure. Myocardium is damaged. Cardiomyopathy, valvular disorder, myocarditis, cancers, systemic contaminants, and cardiotoxic medications have become less prevalent etiologies. Patients experience complications of pulmonary dyspnoea and peripheral oedema while experiencing Heart Failure. And if all these corrective factors were initially useful to initial stages of heart disease in a deteriorating progression of heart failure.

Progression of Heart Failure

Heart disease is a long-term recurring illness that gets worse over time. Four phases of heart failure occur (Stage A, B, C and D). These levels range from "high risk of heart failure" to "advanced heart failure."

Stage A

Stage A is a pre-heart defect. It says, whether you have a family history of heart disease or either of these medical disorders, you are at high risk of heart failure:

  • High blood pressure.
  • Artery condition of the coronary artery.
  • Alcohol addiction history.

Stage B

It is deemed an insufficient preheart. This means the ventricular left systolic dysfunction was diagnosed but you never had cardiac defects signs. The majority of patients with stage B cardiac failure have echocardiograms (echo) with a 40 percent or less expulsion fraction (EF).

Step C

Patients with Step C cardiac insufficiency were diagnosed with heart insufficiency with signs and symptoms (currently or before) of the disease.

Stage D and stage E shortened

The advanced signs in patients with stage D HF-rEF are unbeatable. This is the last phase of cardiac failure.

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 3

Interpretation of ECG Rhythm 

The rhythm of the heart, since the P-P and the R-R intervaces not regularly and the ups and downs between the two, can be inferred after examining the ECG. These rhythms are in effect an accelerated or slowed ventricular pulse.

Rate- The atrial rate is shown on the P waves. Almost accurately, during waves of P, five large boxes have an atrial rate of 60 bpm. There are a total of 10 P waves (some of them difficult to see since they are concealed in the QRs intermittently) and 10 x 6 = 60 on the line. The first method is tested. The ventricle rate across each QRS was around 60-75 and consists of four wide boxes. Although there are no more than 11 QRS complexes in this 10-second strip, the actual calculation of the ventricular intensity is 11 x 6 = 66 bpm.

Regularity and P wave presence - Analyzing the ECG, P wave is not confirmed to be regular and is absent at certain locations indicating that the heart's artrics are electrically depolarized (Wu, 2019).

Segment ST-ST shows the intervals around depolarization and repolarization of the ventricles and is observed as usual for all cases (Bragazzi, 2021).

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 4

Difficulty with respirating is caused by different pathways due to different body conditions, commonly known as shortness of breath, breathlessness or dyspnea. In one's lifespan, people can be affected by rare episodes of shortness of breath, such as exhausting or high altitude or warm and cold weather, or by ambient conditions. In Deep’s case it is due to heart failure as the heart failure's shortness of breath is due to a reduction in the cardiac capacity to fill and drain, causing high blood pressure throughout the lung (Rossignol, 2019).

Acute Decompensated Heart Failure : A rapid deterioration of the symptoms and signs of cardiovascular failure, which usually involves trouble breathing (dyspnea), swelling of the leg and foot, and weakness, is an adorable decompensated cardiac failure. ADHF is a variety of processes from patients with moderate lung edoema to cardiogenic shocks that are very well developed. 4 There can be relatively high levels of O2 and fluid pressure for patients with isolated pulmonary odema. With deterioration, the LV activity declines as the sympathetic tone rises, which causes patients to experience extreme hypoxemia and related hypertension in progressive extremis. This group of hypoxemic, critical patients with high heart failure is acute pulmonary oedema (APE)

There are two items which will compound heart failure:

Lasix: Lasix is a medication used to treat fluid retention symptoms for people with heart failure (edoema). And he doesn't take deep because he doesn't like this medicine's adverse effects. It encourages the body to extract salt and water from the urine without any need. This results in a regulated state of blood pressure and pulse rhythm that is safe for the heart and not taking this drug can lead to heart failure (Špinar, 2018).

Hot and Sour: They are not healthy for heart, diabetes and weight loss, since it is full of cornflour, and as a deterrent to weight control, full of calories and carbs like refined sugar. It is a large no for heart and diabetes patients because of its high carb content. And Deep routinely takes it, so it is able to make cardiac insufficiency worse.

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 5

When Deep informed about Viagra, the immediate reaction of the nurses would be to discontinue further dose of glyceryl trinitrate. As both of them react with one another.

Nitric oxide (NO) potently dilates blood vessels by creating a mediator called cGMP. The medications that release NO(NON donor) and are often used in the treatment and prevention of an angina, such as glyceryl trinitrate (GTN). Male penile erectile dysfunction is an efficient cure for Sildenafil that prevents cGMP breakup (Lüscher, 2018). In individuals and patients with cardiovascular disease, this alone leads to small decreases in BP. Co-administration of NO donors with sildenafil in patients with angina, a population at an elevated risk of erectile dysfunction may result in significant reduction in BP with their synergistic activities. It is also advisable to avoid the co-administration of the two medications within 24 hours. Previous studies have identified nitrates as the duration of probable maximum activity 60 min after injection of sildenafil. Therefore, Viagra and nitrates both of them calms the muscles controlling the size of the blood vessels. The arteries increase in diameter as these muscles contract and therefore the blood pressure decreases. In combination of Viagra and nitrates, the results are higher than when one is used alone. The muscles that regulate arteries with a large decrease in blood pressure may be significantly relaxed.

A dramatic decline in blood pressure is adverse in people who have an angina (cardiac pain) in order to fill the heart with blood, a disease that requires a higher blood pressure. Reducing the blood pressure lowers your blood supply to the heart which can cause a heart attack (Szymanski, 2018).

Factors that retain records for patients.

  • The most common reasons for non-disclosure are the lack of judgement or instruction, the failure to consider the harmful and embarrassing nature of such activities.
  • Many people doubt and fear that their physicians are fully transparent and frank. • There may be a psychological risk (Bierrenbach, 2019).

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 6

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 influence of certain chemical compounds, including epinephrine, on blood vessels and the heart. This reduces heart rate, blood pressure and fatigue. This reduces heart rate.

 This compound binds through the chloride conveyor channel and thereby leads to the degradation by the Luminal Na-K-Cl cotransmitter of chloride, sodium and potassium in the urine in the broad upstream belt.

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

· Hypotension or decreased Blood Pressure

· Fatigue.

· Feeling of Cold.

· Slower heart rates.

· Weight gain

· Fast or abnormal heartbeat.

· Stomach cramping

· Urinating less

Nursing considerations (2 major) (1 mark each)

· Blood pressure should be checked regularly to determine response to atenolol.

· Drug must be given after meals if gastrointestinal upset occurs and pulse rate must be monitored.

· Monitor and review blood sugar levels, which could be temporarily increased after beginning this medicine in patients with diabetes.

Fluid state evaluation. Monitoring daily edoema, lung noises, skin turgor and membrane levels, weight gain and production ratios, quantity and position.

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing - Answer 7

Unfortunately, non-compliance with medication, particularly in patients with chronic illness, is fairly normal because they do not treat their medication according to their prescription (Linthout, 2017).

Two grounds reasons:

Fear:

Possible side effects can scare patients. You may also have prior side effects of the same or related drug. Moreover, patients complain that they have not taken their prescription, since a friend or family member who took the same and related medication may have had adverse effects. For anyone else's side effects had been observed, they may have believed that the medicine induced them.

Cost:

The cost of a patient's prescription medication is also a significant deterrent to adherence. The high cost could lead to patients not first of all filling their medicines. You can also ration what you do to expand the stock.

Deep may feel fear while taking medicines as he is already feared due to the intake of Viagra and now taking so many medicines might cause a reaction. I will make him understand how this is not going to cause any reaction (Ashraf, 2020).

Conclusion on Nursing Practice

Heart failure has very high diagnosis accuracy in patients with acute dyspnea and hypertension. There are a number of treatments that could and could be used to improve the result of heart failure and mount proof. Heart disease is a world leading disease and death factor. Where appropriate, biopathic markers and cardiovascular imaging techniques can incorporate signs of and signals for cardiac insufficiency diagnostics. The improved control of cardiovascular disease through the possible decrease in diastolic blood pressure in heart disease risk patients could decrease cardiovascular risk factors such as hypertension. In patients at risk for heart disease and in diabetic conditions where empagliflozin has reduced cardiovascular risk factors such as hypertension, may be lowered by increasing cardiovascular disease control by theoretically lowering diastoular blood pressure levels.

References for Nursing Practice

Ashraf, H., & Rosenthal, J. L. (2020). Right Heart Failure: Causes and Clinical Epidemiology. Cardiology clinics38(2), 175-183.

Bierrenbach, A. L., Alencar, G. P., Martinez, C., Souza, M. D. F. M. D., Policena, G. M., & França, E. B. (2019). Redistribution of heart failure deaths using two methods: linkage of hospital records with death certificate data and multiple causes of death data. Cadernos de saude publica35, e00135617.

Bragazzi, N. L., Zhong, W., Shu, J., Abu Much, A., Lotan, D., Grupper, A., ... & Dai, H. (2021). Burden of heart failure and underlying causes in 195 countries and territories from 1990 to 2017. European Journal of Preventive Cardiology.

Houstis, N. E., Eisman, A. S., Pappagianopoulos, P. P., Wooster, L., Bailey, C. S., Wagner, P. D., & Lewis, G. D. (2018). Exercise intolerance in heart failure with preserved ejection fraction: diagnosing and ranking its causes using personalized O2 pathway analysis. Circulation137(2), 148-161.

Lüscher, T. F. (2018). Heart failure and its causes: high blood pressure, atrial fibrillation, radiotherapy, and chemotherapy.

Rossignol, P., Hernandez, A. F., Solomon, S. D., & Zannad, F. (2019). Heart failure drug treatment. The Lancet393(10175), 1034-1044.

Špinar, J., Špinarová, L., & Vítovec, J. (2018). Pathophysiology, causes and epidemiology of chronic heart failure. Vnitrni lekarstvi64(9), 834-838.

Szymanski, P. Z., Badri, M., & Mayosi, B. M. (2018). Clinical characteristics and causes of heart failure, adherence to treatment guidelines, and mortality of patients with acute heart failure: Experience at Groote Schuur Hospital, Cape Town, South Africa. South African Medical Journal108(2), 94-98.

Van Linthout, S., & Tschöpe, C. (2017). Inflammation–cause or consequence of heart failure or both?. Current heart failure reports14(4), 251-265.

Wu, D., Jian, C., Peng, Q., Hou, T., Wu, K., Shang, B., ... & Zhao, L. (2020). Prohibitin 2 deficiency impairs cardiac fatty acid oxidation and causes heart failure. Cell Death & Disease11(3), 1-14.

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