Nursing Practice 3: Pathophysiology and Pharmacology Applied to Nursing

Table of Contents

Introduction.

Risk factors developing heart failure.

Path physiology of right and left-sided heart failure using a clinical presentation and examination findings of Russell

Explain the term ‘acute exacerbation of COPD’ and the factors that put patients like Russell at high risk for exacerbations of COPD..

Table for the use of drugs.

Non-pharmacological recommendations for Russell

Prevent heart failure.

Prevent exacerbation of COPD..

Prevent pneumonia.

To reduce his high cholesterol level

Conclusion.

References.

Introduction to Cardiovascular Diseases

The cardiovascular diseases are related to the heart and the blood vessels of the human body. It occurs due to the blood clot or atherosclerosis. Cardiovascular diseases include stroke, coronary heart diseases, and peripheral arterial diseases. The risk factors of these diseases are poor diet, high blood cholesterol, and blood pressure problems, insufficient exercise, overweight, diabetics, hypertension, drinking excessive alcohol. The coronary artery diseases happen due to the blockage of supplying the blood in the heart. Stroke is caused due to disturbance in blood supply into the brain. The peripheral arterial diseases or peripheral vascular diseases occur due to the blockage of blood circulation to the limbs. In this report, we have described the reasons for cardiovascular diseases, pharmacological and non-pharmacological treatments, the usage of drugs-related these diseases, and the job role of a nurse during the treatment. We have also mentioned different types of dietary factors and restrictions in this report (Morris et. Al., 2016).

Risk Factors Developing Heart Failure

The main reason for heart failure is when the pumping chambers become rigid inside the heart and for that reason; these cannot be adequately filled between the heartbeats. In some cases, it can be seen that the hearts cannot pump efficiently to supply the blood which is required for the human body because the muscle of the heart becomes damaged, and ventricles stretch inside the muscles ( Edelmann et. al.,2018).

Some common risk factors that include developing heart failure acute are:-

  1. The person can suffer from dyspnoea or shortness of breath. It can be generally worse at the time of exercising or falling asleep. Sometimes, the patient can wake up from bed at night. From the case study, Russell is suffering from dyspnoea from the last three months due to shortness of breath. Besides, he feels comfortable to sleep on three pillows. He has COPD from the last 30 years.
  2. The person can suffer from swelling or edema on the legs and the feet. This problem occurs due to inflammation and lack of fluids. Russell has the mild edema on his both legs.
  3. The person can suffer from other symptoms like high blood pressure, lack of appetite, rapid heartbeat, wheezing with pink foamy mucus, previous myocardial infarction, atrial fibrillation, excessive weakness, coronary artery disease, valvular diseases. Russell has a high BP and cholesterol. Besides, he faced a heart attack already 15 years back that was systolic heart failure. Therefore, he has a high chance of developing heart failure again. 
  4. The person can suffer from high diabetics that can increase coronary artery disease. Russell has diabetic Mellitus for many years.
  5. Smoking is another risk factor for heart failure because it affects the airways of the lungs. Russell smoked from the age of 18 years. Besides, he drinks alcohol also (Fang et. al., 2019). 

Path Physiology of Right and Left-Sided Heart Failure Using a Clinical Presentation and Examination Findings of Russell

Normally the heart failure has two types and the reasons are explained below-

Left-sided heart failure:- This occurs for the congested blood inside the lungs and lack of proper supply of oxygenated blood. It happens when the muscles from the left side of the heart can not contract. As a result, the pumps cannot function properly. The main source of pumping is the left ventricle and when it becomes weak the heart cannot pump oxygenated blood to the left atrium, the functions become harder. Respiratory symptoms that can happen are shortness of breath, pulmonary edema (Francis & Tang, 2019). 

It has two types:-

  1. Systolic heart failure: Because of blood pumping problems of the left ventricle
  2. Diastolic heart failure: Because of blood filling problems of the left ventricle 

Right-sided heart failure:- It occurs due to the backup of the fluids into the abdomen. The right-sided heart failure mainly occurs for the pulmonary circulations and the failure of the right ventricles, which accepts the deoxygenated blood. The deoxygenated blood cannot be oxygenated due to the fluid pressure on the pumping section. The results are the swelling, liver and spleen enlargement, ascites, nocturia, coagulopathy. 

From the case study of Russell, we come to know that he has high blood pressure, diabetic Mellitus, and blood cholesterol. Besides, he has been suffering from COPD for the last thirty years and that’s why he always feels the shortness of breath. He has mild edema on both legs. Russell was smoking from the age of 18 years and he also drinks alcohol. The Echocardiogram report of Russell shows that he has a dilated left ventricle with the symptoms of severe systolic dysfunctions and this is the reason the left ventricle cannot pump the blood appropriately. Russell was suffering from systolic heart failure 15 years ago. These symptoms show the development of the heart failure of Russell. 

‘Acute Exacerbation of COPD’ and Factors

A person who is suffering from COPD feels breathing problems and coughing with the production of sputum for a long time. The exacerbation of COPD triggers the inflammatory of the lungs and it narrows the airways. This is the deterioration of the lung tissues. The reasons for COPD are pneumonia, smoking, flu, a seasonal allergen. COPD is diagnosed by the spirometry test and in this test, the physicians measure how intensely the patient is breathing and how quickly the air is passing inside the lungs (Liang et.al.., 2018). The main symptoms of COPD include:-

  1. The person is breathing with a quick shallow rhythm.
  2. He or she is feeling shortness of breaths and coughing.
  3. The level of oxygen in the body of a COPD patient is lower than normal. The patient always feels sleepy and confused.
  4. The quantities of mucus are increasing and the colors are yellow or green. The mucus is blood-tinged.
  5. The patient is suffering from wheezing.

The preventions of COPD are -

1. Consult with the pulmonologist about the lung treatments.

2. Quit smoking and drink plenty of fluids.

3. Avoid the gatherings during the flu season.

4. Observe the oxygen levels in the body with the pulse oximeter.

5. Wash the hands frequently and use sanitizer to prevent the germs (Chen et. al., 2016).

From the case study of Russell, we come to know that he has progressive dyspnoea over the last three months and he has some positive symptoms of Acute Exacerbation of COPD. Russell feels comfortable to sleep on three pillows and also feels breathless while dressing. These symptoms prove that he has shortness of breathing problems. For this reason, he used to take Frusemide (40 mg) and Spironolactone (25 mg) orally daily. Besides, COPD can also occur from the germs of air pollutants and the carbon-di-oxide from the air. Russell is a truck driver and he drives the truck the whole day. So, here is a risk factor that Russell can suffer from the bad germs of air pollutants. It may cause respiratory tract infections (Voelkel, Mizuno & Cool 2017).

Table for The Use of Drugs

Generic name

Perindopril

Spironolactone

Budesonide/Formoterol fumarate dihydrate puffs

Drug group

Angiotensin-converting enzyme (ACE) inhibitors

Aldosterone receptor antagonist

Long-acting beta-agonists

Mechanism of action

 This drug is used for the treatment of hypertension and coronary artery diseases (Ancion, Tridetti, Nguyen Trung, Oury & Lancellotti, 2019).

This drug is used to prevent high blood pressure, kidney problems, liver diseases, strokes, and heart attacks. It is also known as a water pill or potassium-sparing diuretic. 

 The brand name of this drug is Symbicort. This is the combination of two drugs 1. Budesonide and 2. Formoterol (Beasley et al., 2018). This drug is used for the treatment of Asthma-like wheezing, COPD (Chronic Obstructive Pulmonary Disease). 

Complications/side effects

 The side effects of these drugs are dizziness, upset stomach, back pain, headaches, diarrhea, and the serious side effects are low blood pressure, breathing problems, white blood cell count.

 The effects caused due to these drugs are lightheadedness, nausea, vomiting, dizziness and the serious side effects of these drugs are Hyperkalemia, abdominal pain, allergic reaction.

 The common side effects of this drug are throat irritations, upper respiratory tract infections, bronchitis, thrush, and sinusitis. The serious side effects of this drug are hyperglycemia, pneumonia, osteoporosis, adrenal insufficiency, eye problems like glaucoma, cataracts.

Nursing considerations

 This drug can be taken after 36 hours before/after eating the medicines that contain Sacubitril like Entresto. The nurses should follow the symptoms of the patient who take this drug for hypertension. The patient should sleep at least 2-4 hours after taking this medicine. 

 The nurses should check the patient’s blood pressure readings during the medication. The nurses should monitor the progress of the patient and check their blood test reports. The laboratory tests like sodium, potassium, creatinine, and urea should be done of the patients to prevent the side effects.

 The nurses should monitor the hypercorticism and liver problems of the patient during this treatment. If the patient suffers from shortness of breath, the nurses should consult with the doctor immediately.

Non-Pharmacological Recommendations for Russell

a. Prevent Heart Failure 

The non-pharmacological recommendations of heart failure are:

Proper nutrition:- The amount of salt should be <2000 mg and the amount of fluid in the body should be 1500-2000 ml for the patients who have advanced HF stage. High sodium is the reason for the fluid retention in the body. Ultrafiltration process is useful for removing the extra salts and fluids from the diet (Upadhya et. al..,2019). 

Exercise:- Primarily, the advanced HF patients are not advised for the exercise. But after some improvement in health, exercise training can be recommended to them after consulting with doctors.

Change the lifestyle:- The HF patients should quit smoking and alcohol because these can cause Cardiomyopathy (Han et. al.., 2019). 

b. Prevent Exacerbation of COPD

The patient should quit smoking and maintain a proper diet consulting with the dietitian. The patient can take pneumonic or whooping cough vaccine to reduce respiratory symptoms like flu. The patient should drink at least eight types of fluids because it can make the mucus thinner to cough out easily. The patient should maintain proper weight because the overweight makes the functions of the lungs and hearts harder. COPD decreases the power of the immune system so the patient should be recommended to take at least three meals in a day and clear the airways before eating the meal. The patient should avoid cold and infectious diseases. 

c. Prevent Pneumonia 

The pneumonia is usually caused by bacteria or any harmful virus and it infects our lungs. The patient should take a pneumococcal and flu vaccine every year. They should maintain hygiene like wash hands with hand wash or soaps, use alcohol-based sanitizer frequently. The patient should quit smoking as soon as possible because it damages the lungs and maintains a balanced diet with proper calories. They should stay away from the cold and bacteria.

d. To Reduce His High Cholesterol Level

High cholesterol is the risk factor of Advanced heart attacks. But it can be controlled by improving the lifestyle. Saturated fat should be decreased because it can control the low-density lipoprotein (LDL) or bad cholesterol. The foods which have omega-3 fatty acids like salmon, walnuts, flaxseeds can not affect LDL cholesterol as well as it can reduce the blood pressure also. Saturated fat is usually found in red meats and dairy products. Whey protein and soluble fiber (oatmeals, pears, sprouts) foods can be added into the diet to reduce cholesterol from the bloodstreams. Physical activities like playing sports, ride bikes can increase the high-density lipoprotein (HDL) or good cholesterol. Quit smoking is also helpful to improve the HDL cholesterol level. Quitting smoking improves blood circulation and lung functions.

Conclusion on Russell Chronic Obstructive Pulmonary Disease Case Study 

The role of a registered nurse is very crucial for patients who are suffering from cardiovascular diseases along with COPD in the health care center. During the time of medication, the nurses always check the blood reports and monitor the vital symptoms of the patients. The nurses assist the patients to intake healthy foods according to their health conditions and consult with the physicians or doctors before giving them life-saving drugs. The nurses always update the electronic database and educate the families about the healthy behavior of the patients at their homes. The nurses diagnose the patient's heart condition and give them proper care before cardiac surgeries. When the patients get well, the nurses make a chart consulting with the doctors and advise the families of the patient for the proper care. The only purpose for all the efforts of the nurses is to recover the diseases of their patients (Bayrak & Tosun, 2018).

References for Russell Chronic Obstructive Pulmonary Disease Case Study 

Ancion, A., Tridetti, J., Nguyen Trung, M., Oury, C., & Lancellotti, P. (2019). A Review of the Role of Bradykinin and Nitric Oxide in the Cardioprotective Action of Angiotensin-Converting Enzyme Inhibitors: Focus on Perindopril. Cardiology And Therapy, 8(2), 179-191. doi: 10.1007/s40119-019-00150-w

Bayrak, D., & Tosun, N. (2018). Determination of nursing activities for prevention of heart attack and stroke in hypertension patients. International Journal of Caring Sciences, 11(2), 1073.

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

Chen, Y., Leung, J., & Sin, D. (2016). A Systematic Review of Diagnostic Biomarkers of COPD Exacerbation. PLOS ONE, 11(7), e0158843. doi: 10.1371/journal.pone.0158843

Edelmann, F., Knosalla, C., Mörike, K., Muth, C., Prien, P., & Störk, S. (2018). Chronic Heart Failure. Deutsches Aerzteblatt Online. doi: 10.3238/arztebl.2018.0124

Fang, J., Luncheon, C., Ayala, C., Odom, E., & Loustalot, F. (2019). Awareness of Heart Attack Symptoms and Response Among Adults — United States, 2008, 2014, and 2017. MMWR. Morbidity And Mortality Weekly Report, 68(5), 101-106. doi: 10.15585/mmwr.mm6805a2

Francis, G. S., & Tang, W. W. (2019). Pathophysiology of congestive heart failure. Reviews in cardiovascular medicine, 4(S2), 14-20.

Han, C., Kim, H., Lee, S., & Chung, J. (2019). Knowledge and Poor Understanding Factors of Stroke and Heart Attack Symptoms. International Journal Of Environmental Research And Public Health, 16(19), 3665. doi: 10.3390/ijerph16193665

Liang, Z., Long, F., Wang, F., Yang, Y., Xiao, J., & Deng, K. et al. (2019). Identification of clinically relevant subgroups of COPD based on airway and circulating autoantibody profiles. Molecular Medicine Reports. doi: 10.3892/mmr.2019.10498

Morris, C., Purvis, T., Hu, K., & Scheer, F. (2016). Circadian misalignment increases cardiovascular disease risk factors in humans. Proceedings Of The National Academy Of Sciences, 113(10), E1402-E1411. doi: 10.1073/pnas.1516953113

Upadhya, B., Lovato, L., Rocco, M., Lewis, C., Oparil, S., & Cushman, W. et al. (2019). Heart Failure Prevention in Older Patients Using Intensive Blood Pressure Reduction. JACC: Heart Failure, 7(12), 1032-1041. doi: 10.1016/j.jchf.2019.08.018

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

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