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Nursing Practice 3 - Pathophysiology and Pharmacology Applied to Nursing

Introduction to Nursing Practice

COPD is a condition characterized by severe breathlessness and dyspnea. It has been seen that prolonged COPD can lead to cardiac failure (Canepa et al., 2018). Pathophysiological investigations are necessary to investigate the changes in the body organs or the functions of the organs in order to track their workings. Both COPD and Cardiac failure are two complex conditions that can impact the normal life of a person. This as assignment revolve around the case study of Russell who is a 68 years old truck driver. Purpose of the assignment is to make desirable pathophysiological investigations for Russell’s condition. The assignment will primarily explain the risk factors that lead to the development of heart failure for Russell. It will then provide a detailed pathophysiological analysis of the left sided heart failure and right sided heart failure for Russell. Since Russell have a long lasting history of COPD so the assignment will then discuss the term “acute exacerbation of COPD” with an involvement of the factors that impose a high risk of exacerbations for Russell. Further the workings of the prescribed drugs will be studied based upon their drug group, mechanism of action, complications and nursing considerations. Lastly, the assignment will discuss about the non-pharmacological interventions that can be followed for heart failure, prevention of COPD exacerbations, pneumonia and high cholesterol level.

Risk Factors of Heart Failure for Russell

Heart failure is a cardiac disorder in which the heart stops to pump the blood to the body (Swirski & Nahrendorf, 2018). It has a number of risk factors including smoking, alcohol consumption, high blood pressure, previous history of heart failure, diabetes and a history of long term COPD (Swirski & Nahrendorf, 2018). Primary risk factor of Russell developing cardiac failure could be his history of having a heart attack 15 years back. It has been stated that having a medical history of heart failure can increase the risk of a heart failure by multiple times (Nakamura et al., 2020). Moreover, it also makes the heart more vulnerable to damage and degradation. Russell complains to have comorbidities such as diabetes and blood pressure. It has been stated that having high glucose level in the body for a prolonged duration can cause damage to the blood vessels present in the heart which can lead to heart failure (Nakamura et al., 2020). Russell has mild edema with an increased cholesterol which also become a risk factor for his cardiac failure. Moreover, he also have a history of smoking 20 cigarettes per day so this can made him even more vulnerable to the cardiac failure.

Pathophysiology of Right and Left Sided Heart Failure

It has been stated that heart failure is a result of any atherosclerotic disease which decrease the heart’s ability of pumping enough blood for the body (Low Wang et al., 2016). Moreover, the health of one chamber of the heart determine the health of another chamber of the heart. Damage to the left side of the heart can result in the damage to the right side of the heart. Pathophysiological investigations have reported that the right sided heart failure is a result of the inability of the left-sided heart to pump enough blood for the body. Moreover, the damage to the left-sided heart could be due to risk factors such as increased blood pressure, increased blood glucose level or prolonged exposure to COPD. According to Van Diepen et al., (2017), a shared and mutual processing of the heart can ensure effective pumping ability of the heart. However, damage to one side of the heart can thus overlay greater pressure on another side of the heart which force the healthy side of the heart to pump blood beyond its capacity. And, ultimately it lead to muscle fatigue and right-sided heart failure.

It has been seen that patients having left-sided cardiac failure experience symptoms such as breathlessness and shortness of breath while doing basic domestic tasks such as exercising, running, or bathing (Canobbio et al., 2017). This is because of the obstructions in the pulmonary veins. It has been seen that an obstruction in the pulmonary vein can lead to edema which is a clear indication of heart failure. Edema is a metabolic and physical state in which the inability of the heart to pump blood pushes back the blood to the legs and ankles which cause swelling and inflammation (Van Diepen et al., 2017). COPD often lead to condition of Alveolar hypoxia which in turn cause pulmonary hypertension. This cause backflow of the blood present in the lungs to the left side of the heart which ultimately lead to left-sided cardiac failure in patients with COPD. This also impact the renin-angiotensin aldosterone system of the body and cause greater fluid retention. This worsen up the edema and further contribute to the prognosis of right sided cardiac failure. “Russell has edema and breathlessness which indicated a left-sided heart failure and prolonged COPD and history of heart attack has increased work load on his heart which have led to right-sided heart failure”.

Further damage to the left side of the heart lead to right-sided heart failure because of the increased workload of the right-sided heart. According to Canobbio et al., (2017), collection of the blood in the veins is result of inability of the heart to pump the required amount of blood which thus lead to the condition of edema in abdomen, lungs, legs and genitals (rarely).

“Acute Exacerbation of Chronic Obstructive Pulmonary Disorder”

COPD or “chronic obstructive pulmonary disorder” is a condition of distress, dyspnea and breathlessness (Roversi et al., 2018). It is characterized by a number of symptoms such as coughing, fatigue, excess of mucus production and breathlessness. The exacerbations of COPD are sudden and complex worsening of the symptoms with persistent cough with mucus. It is characterized by breathing in a fast and shallow pattern (Roversi et al., 2018). Mild activities such as bathing or exercising can lead to exacerbations in patients with COPD. It also lead to shortness of breath even at minimal activity. Moreover, it is characterized by feeling confused and sleepy at most of the times. The signs of exacerbations last for 2 or more days with an intensive nature. Exacerbations lead to conditions of chest tightness and discomfort as a result of sudden exposure to allergens and air pollutants.

Risk Factors of Acute Exacerbations of COPD

COPD is characterized by a number of risk factors. These risk factors include exposure to pollutants, exposure to tobacco smoking, cigarette smoking, and occupational exposure to dust, genetics and medical history (Bellou et al., 2019). Russell is a truck driver and he had a past history of smoking 20 cigarettes per day. Cigarette smoking is one of the most common and influential risk factor of COPD. It has been stated that COPD is very common in people over the age of 40 years and the risk continues to increase with an increase in the age. Russell is 68 years old which have made him vulnerable to COPD and his increased exposure to pollutants and dust on the road have contributed to worsening of his COPD. People that are incapable of following a medical plan or who forget to take their prescriptions on time are often at the risk of COPD (Bellou et al., 2019). For example: timely use of a COPD inhaler can prevent exacerbations in patients with COPD.

Medication for Russell

Generic name

Perindopril

Spironolactone

Budesonide/Fomoterol fumarate dehydrate puffs

Drug group

ACE inhibitor

(angiotensin converting enzyme)

Potassium-sparing diuretic drug

Corticosteroids

Mechanism of action

The medication is prescribed to patients with hypertension, and stable coronary artery disease. The basic mechanism of action for perindopril is an inhibition of the ACE activity. The medicine works to prevent heart failure in patients with a coronary artery disease (Poulter et al., 2019).

It is used for the diagnosis and management of conditions such as hyper-aldosteronism. It acts on the distal renal tubules of the patients in the form of a competitive antagonist of aldosterone. It then starts to conserve the hydrogen and the potassium ions. This in turn increases the water and sodium chloride excretion. It is often used to treat edematous conditions with patients with congestive heart failure and essential hypertension (De Denus et al., 2017).

Budesonide is a drug that is only administered through inhalation. It works to reduce inflammation in the lungs and help patients with conditions of wheezing and chest tightness. It relax the muscles in the heart and ease breathing (Wolthers, 2016).

Complications/side effects

Cough

Nasal congestion

Difficulty in breathing

Unusual tiredness and weakness

Mental disturbance

Fluid and electrolyte imbalance

Weakness and drowsiness

Adverse drug reactions with LABA drugs.

Sinusitis

Upper respiratory tract infections

Nursing considerations

. It is expected from the nurse to ask the patient about any condition of hereditary angioedema, history of liver disease, kidney disease, diabetes or heart disease (Poulter et al., 2019).

The nurse must ask the patient about any allergies to ACE inhibitors such as captopril, Ramipril or moexipril. 

The nurse must inform the physician about conditions of sore throat, irregular heartbeat, dry cough and persistent dry cough. 

The nurses must be aware of the dose and the available form of tablets in addition to the suitability of those medicine for the patients. For ex: the tablets are present in the dose of 25, 50 and 100 mg. 100mg/day is administered to patients with edema, and 50-100 mg/day is used for essential hypertension (De Denus et al., 2017).

The nurse must inform the physicians about conditions of drowsiness, headache, weakness, confusion, impotence, hypotension and fluid or electrolyte balance.

The patient must be educated to report any adverse signs in case it happens to them.

The nurse must warn the patients about their asthma. Patients with asthma can experience greater risk of death from asthma due to side effects of the medicine.

It does not relieve symptoms such as shortness of breath but a nurse must ask the patients to keep a rescue inhaler in the case of exacerbations (Wolthers, 2016).

Non-Pharmacological Recommendations

For heart failure: diet and exercise are one of the most effective way of managing the heart failure through non-pharmacological management (Rasmussen et al., 2020). Patients with heart failure must be informed to control the amount of salt in the diet. The salt must be less than 2,000 mg. They should also be informed to maintain fluid retention. A fluid retention of 1,500-2,000 ml can be effective for the patients. Russell will thus be recommended to maintain his salt intake and fluid retention.

To prevent exacerbations of COPD: pulmonary rehabilitation will be recommended to the patient in order to enhance muscle strength and physical activity (Nyberg et al., 2016). It is described as a technique in which an evidence-based, comprehensive and multidisciplinary interventions for COPD are followed. These interventions works to minimize symptoms of COPD for patients like Russell. 

To prevent pneumonia: Exercise training will be recommended to Russell for preventing pneumonia. Breathlessness and increased respiratory distress can be managed by following proper respiratory exercises. Exercises to improve tolerance, oxygen uptake and endurance tie will be recommended.

To reduce his high cholesterol level: Cholesterol is a lipid molecule but its increase can be a reason of heart disease (Johnston et al., 2017). Dietary modification can be an important non-pharmacological intervention for management of lipid. 

Conclusion on Nursing Practice

In conclusion, heart failure and COPD are conditions that impact the normal functioning of a person. Russell was a 68 years old truck driver who was suffering from COPD and was at the edge of cardiac failure. Left sided cardiac failure is a result of increase in the blood pressure, diabetes and COPD and in turn the right-sided heart failure is caused due to an increased load on the heart. This lead to an inability of the heart to pump the required amount of blood and exhibit symptoms such as breathing problem, edema and chest tightness. Exacerbations of COPD are heavy distressed breathings and coughs due to risk factors such as smoking, exposure to irritants such as dust and pollutants. Non-pharmacological interventions that strives to improve symptoms of the patients are effective in disease management. These interventions include dietary management, exercise, and pulmonary rehabilitation.

Reference for Nursing Practice

Bellou, V., Belbasis, L., Konstantinidis, A. K., & Evangelou, E. (2019). Elucidating the risk factors for chronic obstructive pulmonary disease: an umbrella review of meta-analyses. The International Journal of Tuberculosis and Lung Disease23(1), 58-66.

Canepa, M., Straburzynska‐Migaj, E., Drozdz, J., Fernandez‐Vivancos, C., Pinilla, J. M. G., Nyolczas, N., & Maggioni, A. P. (2018). Characteristics, treatments and 1‐year prognosis of hospitalized and ambulatory heart failure patients with chronic obstructive pulmonary disease in the European Society of Cardiology Heart Failure Long‐Term Registry. European Journal of Heart Failure20(1), 100-110.

Canobbio, M. M., Warnes, C. A., Aboulhosn, J., Connolly, H. M., Khanna, A., Koos, B. J., & Stout, K. (2017). Management of pregnancy in patients with complex congenital heart disease: a scientific statement for healthcare professionals from the American Heart Association. Circulation135(8), e50-e87

De Denus, S., O’Meara, E., Desai, A. S., Claggett, B., Lewis, E. F., Leclair, G., & Pfeffer, M. A. (2017). Spironolactone metabolites in TOPCAT—new insights into regional variation. The New England Journal of Medicine376(17), 1690.

Johnston, T. P., Korolenko, T. A., Pirro, M., & Sahebkar, A. (2017). Preventing cardiovascular heart disease: Promising nutraceutical and non-nutraceutical treatments for cholesterol management. Pharmacological Research120, 219-225

Low Wang, C. C., Hess, C. N., Hiatt, W. R., & Goldfine, A. B. (2016). Clinical update: cardiovascular disease in diabetes mellitus: atherosclerotic cardiovascular disease and heart failure in type 2 diabetes mellitus–mechanisms, management, and clinical considerations. Circulation133(24), 2459-2502.

Nakamura, Y., Kita, S., Tanaka, Y., Fukuda, S., Obata, Y., Okita, T., & Miyagawa, S. (2020). A disintegrin and metalloproteinase 12 prevents heart failure by regulating cardiac hypertrophy and fibrosis. American Journal of Physiology-Heart and Circulatory Physiology318(2), H238-H251

Nyberg, A., Carvalho, J., Bui, K. L., Saey, D., & Maltais, F. (2016). Adaptations in limb muscle function following pulmonary rehabilitation in patients with COPD–a review. Revista Portuguesa de Pneumologia (English Edition)22(6), 342-350.

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 Drugs19(3), 313-323.

Rasmussen, S. M., Hansen, E. S. H., Toennesen, L. L., Pitzner-Fabricius, A., Hansen, N. B., & Backer, V. (2020). Diet and Exercise: A Novel Cure for Asthma?-A Short Communications on a Non-Pharmacological Strategy. J Phys2(1), 15.

Roversi, S., Boschetto, P., Schito, M., Garofalo, M., Stendardo, M., Ruggieri, V., & Fabbri, L. M. (2018). Breathlessness, but not cough, suggests chronic obstructive pulmonary disease in elderly smokers with stable heart failure. Multidisciplinary Respiratory Medicine13(1), 35.

Swirski, F. K., & Nahrendorf, M. (2018). Cardioimmunology: the immune system in cardiac homeostasis and disease. Nature Reviews Immunology18(12), 733-744

Van Diepen, S., Katz, J. N., Albert, N. M., Henry, T. D., Jacobs, A. K., Kapur, N. K., & Thiele, H. (2017). Contemporary management of cardiogenic shock: a scientific statement from the American Heart Association. Circulation136(16), e232-e268.

Wolthers, O. D. (2016). Budesonide+ formoterol fumarate dihydrate for the treatment of asthma. Expert Opinion on Pharmacotherapy17(7), 1023-1030.

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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