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Nursing Practice 3

Table of Contents

Introduction.

Question 3.

Question 3.

Question 3.

Question 4.

Question 5.

Conclusion.

References.

Introduction

Cardiovascular diseases are much more prevalent worldwide. Among them congestive heart failure, chronic heart damage are very common. Possible risk factors include obesity, stress, smoking, or dietary factors. Primary hypertension is the major cause of cardiac disorder and heart diseases can be hastened or worsened by those above-mentioned contributing factors. Among them about 10 percent are secondary hypertension, which has an identifiable cause. High blood pressure, diabetes, high cholesterol disease- all are mostly lifestyle-related disorders and patients should be given careful advice on managing those, both by using medicine and lifestyle modification. Possible risk factors, pharmacological interventions and non-pharmacological assistance, effect of different drugs have been described and analysed in this report. Various dietary factors are also mentioned here and dietary restrictions also indicated here (Wilkins et al., 2017).

Question 3

Risk factors associated for Russell with developing heart failure: It is very clear from the past medical history of Russell that he has high blood pressure, diabetes and cholesterol- each and every factor is able to cause worsening the condition of heart- leading to heart failure gradually. Hypertension is mostly responsible for hypertensive heart damage [1]. Hypertension causes left ventricular hypertrophy (LVH). Diabetes mellitus is independently involved to increase the risk of developing heart failure [2]. High cholesterol is another reason as they build up in the walls of arteries, and cause artherosclerosis which makes the arteries narrow and blood flow from the whole body to the heart can get blocked and the cardiovascular tissue can be damaged.

As he was a smoker from a very young age, smoking can also cause damage to the blood vessels of the heart. Stress can also be a risk factor for heart damage. Risk is higher as he already had a heart attack 15 years ago. COPD can make the oxygen level low in blood, so creating more pressure on the heart and damaging the muscles. COPD is generally involved with heart failure as it was found that they share the same pathogenetic disorder. Elevated sodium level in blood can cause water retention in the body. It is another important risk factor for hypertension and so for heart failure also (Voelkel, Mizuno, & Cool, 2017).

Question 3

Heart Failure: Heart failure is a condition when our heart stops its normal functioning. There may be several reasons for this. For example high blood pressure diabetes cholesterol hypertension smoking etc. There are different types of heart failure as for example systolic heart failure ,diastolic heart failure, left and right sided heart failure. But in our case study we will be discussing only left and right sided heart failure.

In this article we will explain what are left and right sided heart failure and their possible causes.

Left side heart attack is a condition when our left side ventricle of the heart can’t function properly. The function of our heart is to pump the oxygenated blood throughout our whole body so that oxygenated blood can reach every cell of our body.But if the left side cannot perform its function properly then there will be disturbance in the circulation of blood. As a result our body cell will not get enough blood for performing different types of work. Leading to a fatal condition like heart attack.

When the left side heart can not function properly then it automatically damages the right side of the heart. If the left side of the heart can not function properly then it increases the blood pressure for right side of the heart. The right ventricle of the heart generally accept the deoxygenated blood which is transferred back to the lungs . Due to excessive fluid pressure on the right side of the heart it loses the pumping action. So the deoxygenated blood is not oxygenated properly. This results acute diseases leading to heart failure.

There are several reasons for developing heart failure such as high blood pressure diabetes and cholesterol smoking etc.

In the case of Russell he has many symptoms which are responsible for causing heart failure. As for example Russell has high blood pressure, diabetes and cholesterol each of which are responsible for causing heart failure. Not only this he was a smoker from very young age that is at the age of 18 years. Smoking causes damages in the lungs which also result in the heart failure.Beside that he had a heart attack 15 year ago. So there is a high chance of getting heart attack more than once. He had systolic heart failure. Because of this the left ventricle cannot pump blood properlybecause of its bigger size.Since the size of the left ventricle increases so it cannot contract properly . There is minimum circulation of blood causing left side heart failure of Russell.

Question 3

Acute exacerbations of COPD:

Definition -An acute event characterized by positioning of the patient’s respiratory systems that is beyond normal day-to-day narration and leads to a change in medication. Is also defined as an acute increasing symptoms on normal day to day variation. This is characterized by change in patient baseline dyspnea ,cough or sputum ,etc.

The impact of COPD exacerbations are reduced lung function, accelerated lung function decline deteriorate quality of life increased mortality etc.

Factors that influence Acute exacerbations of COPD are

  • Right heart failure
  • Pneumonia
  • Cardiac arrhythmia
  • Pulmonary embolism
  • Respiratory tract infection
  • Air pollutants

 Since Russell as a truck driverhe has a greater chance of COPD. Because the factors like air pollutant respiratory tract infection right heart failure etc increases the risk of COPD. As a truck driver he had to move here and there in the air pollution and also he had a heart attack 15 year ago so there is a chance of suffering from COPD (Ko et al., 2016).

Question 4

Generic name

Perindopril

Spironolactone

Budesonide/Fomoterol fumarate dehydrate puffs

Drug group

ACE inhibitor

aldosterone receptor antagonists

long-acting beta agonists

Mechanism of action

The ACE inhibitor group of drugs are characterised with two isoforms which are somatic and testicular. Somatic has two domains C and N. These two domains have some similarities but they play distinct role in physical aspect. ACE inhibitor inhibits and binds these two domains. Perindopril competes ATI to bind them to ACE and inhibits ATI to the ATII. The inhibition of ATII level decreases the patient’s blood pressure.

Spironolactone primarily acts through a certain combination of receptors at the potassium- sodium exchange site which is dependent on aldosterone. It enhances the amounts ofexcretion of water and sodium and retains potassium. By this mechanism it acts as both antihypertensive and diuretic drug.

In its formulation, Symbicorthas two ingredients which are Budesonide and Fomoterol. Budesonideis an corticosteroid to inhale. It reduces and prevents respiratory inflammation. Fomoterol is bronchodilator (LABA). It decreases the counteraction in the airway of respiratory organ. Thus the airflow into the lungs increases.

Complications/side effects

Though this tablet is very helpful forthe heart, butthere are also some several side effects of the patients need to be careful while taking it otherwise it may create complications. Two major side effects of this tablet are:

1.

This tablet may occur breathing problems which include trouble of swallowing and breathing, hoarseness.

2.

It lowers the count of white blood cells which increases the risk of various infections.

This drug has several side effects. Two most complicated among them are:

1.

It increases the potentiality of Hyperkalemiawhich is a high level of potassium. Severe level of Hyperkalemia may cause life risk.

2.

Some symptoms also can be seen similar as flue which include upper abdominal pain, low appetite and so on.

Budesonide/Fomoterol is considered as very useful drug for the patients who are suffering from COPD or asthma. Besides of this positive aspects, Budesonide/Fomoterol also has some side effects which often causes complications in the patient’s body. Two of these complications are:

1.

Budesonide/Fomoterol may cause Bronchospasm which is characterised with tightening of the airways muscles which causes wheezing in the breathing immediately after the patient takes the medication.Possibly it is the sign of the reaction of allergy. If it happens, the patient needs an immediate medical help.

2.

Budesonide/Fomoterol also may cause Angioedema, which is characterised with swelling of throat, tongue, mouth or even face.The patient may feel fainted while facing difficulty in breathing.

Nursing consideration

1.

The first dose of this tablet can cause hypotension. So the nurse need to be careful to ensure that the patient lie down or sit at least 2-4 hours after the first dose.

2.

The nurse should manage the patient’s hypertension following proper guidelines (Poulter et al., 2019).

1.

The nurse should observe the changes in the mental state or the lethargyof the patient and if significant change is found need to report about that change immediately.

2.

The nurse should check the patient’s blood pressure at the intervals of regular therapy (Mleczko-Sanecka et al., 2017).

1.

The patient needs close monitoringof hypercorticismif accompanying doses of CYP3A4 are given.

2.

The patient requires monitoring for the lever disease (Beasley et al., 2019).

Question 5

Non-pharmacological recommendations for heart failure: The patient should be given vital information about the disease so that he can follow self help strategies. Most importantly to reduce the risk of heart failure weight should be noticed, weight gain must be prevented and for that regular balanced diet should be maintained. Dietary measurement is extremely essential. Dietary sodium and fluid restriction should be followed. Adequate general nutrition should be ensured. Salt content needs to be reduced in daily diet. High sodium can cause fluid retention in patients with heart failure and for that reason high salt-diet must be avoided. Physical activity in moderation can also help. Alcohol can cause cardiomyopathy so it is better to avoid alcohol consumption.

To prevent exacerbation of COPD: To prevent COPD flare-ups it is important to avoid common cold, flu and other infectious diseases. Eating the right diet and getting enough sleep. Nutritional status should be correctly maintained to cope with the sudden severity of symptoms. If COPD flares up frequently distance should be maintained from any sick people affected with flu. Influenza vaccines can also be taken as a preventive measure. Pulmonary rehabilitation can improve this condition.

To prevent pneumonia: Any type of infection in lungs can irritate the inner wall and cause flare-ups so it is needed to be careful, to stay away from the common cold and cough and to maintain clean hygiene. Pneumonia vaccine can be taken but obviously after consulting with a regular physician or a pulmonologist.

To reduce his high cholesterol level: Apart from the medicines, dietary modifications are needed. The diet should be rich in unsaturated fat and soluble fiber and low in saturated fat as much as possible. It should be helpful if the diet is rich in omega-3 fatty acid because it does not increase LDL which is bad cholesterol. Trans fat in food should be strictly avoided. Green vegetables, fruits, avocado, fish oil, almonds and nuts are very effective in managing bad cholesterol levels in the body [3]. Dietary interventions are always important for controlling any kind of heart damage. Smoking is obviously another harmful thing so it should be completely fought shy of because smoking generally reduces the overall cardiac output, especially when the patient has a past history of heart attack. Smoking and high blood pressure both are significant risk factors for hyperlipidemia so blood pressure should be controlled.

Conclusion

Nursing is a crucial part of the total medical set up inside a health care centre. The responsibility of a nurse should be totally focused on the patient's health condition. Nursing a patient with heart disease along with the problem of COPD is very tough. The nurse should handle all of the patient's problems with adequate knowledge and patience. The physicians and the specialists prescribe the life saving drugs and the additional care while the patient is admitted in the health care centre. The nurse should follow the chart accordingly and take good care of the patient. All the efforts of the nurse helps the patient to overcome the disease and survive (American Diabetes Association, 2016).

References

Wilkins, E., Wilson, L., Wickramasinghe, K., Bhatnagar, P., Leal, J., Luengo-Fernandez, R., ... & Townsend, N. (2017). European cardiovascular disease statistics 2017.

American Diabetes Association. (2016). 8. Cardiovascular disease and risk management. Diabetes care, 39(Supplement 1), S60-S71.

Voelkel, N. F., Mizuno, S., & Cool, C. D. (2017). The Spectrum of Pulmonary Disease in COPD. In COPD (pp. 195-207). Springer, Berlin, Heidelberg.

Ko, F. W., Chan, K. P., Hui, D. S., Goddard, J. R., Shaw, J. G., Reid, D. W., & Yang, I. A. (2016). Acute exacerbation of COPD. Respirology, 21(7), 1152-1165.

Poulter, N. R., Dolan, E., Gupta, A. K., O’Brien, E., Whitehouse, A., & Sever, P. S. (2019). Efficacy and Safety of Incremental Dosing of a New Single-Pill Formulation of Perindopril and Amlodipine in the Management of Hypertension. American Journal of Cardiovascular Drugs, 19(3), 313-323.

Mleczko-Sanecka, K., da Silva, A. R., Call, D., Neves, J., Schmeer, N., Damm, G., ... & Muckenthaler, M. U. (2017). Imatinib and spironolactone suppress hepcidin expression. Haematologica102(7), 1173-1184.

 Beasley, R., Holliday, M., Reddel, H. K., Braithwaite, I., Ebmeier, S., Hancox, R. J., ... & Pavord, I. D. (2019). Controlled trial of budesonide–formoterol as needed for mild asthma. New England Journal of Medicine, 380(21), 2020-2030.

Remember, at the center of any academic work, lies clarity and evidence. Should you need further assistance, do look up to our Nursing Assignment Help

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