Question 1 For Nursing Assignment
1.1. Pathogenesis for chronic heart failure:
The increasing number of chronic heart diseases in Australia and all over the world is a major concern for the healthcare sector (Thomson et al. 2010, pp.5). The heart muscle becoming too stiff or too weak for working properly is the main reason for heart failure (Nhs.uk, 2014). Chronic heart failure may result from systolic dysfunction of left ventricle as evident in this case. The treatment of such heart condition involves the dosage of diuretic drugs as Frusemide. Exacerbation of chronic heart drives prolonged intake of diuretics that leads to excess fluid volume in such patients. The clinical manifestation of chronic heart failure includes severe fatigue, shortness of breath (dyspnoea) and ankle swelling. However, the diagnosis can only confirm the medical condition of heart failure. Diagnostic procedures as measuring blood pressure, pulse rate, confirming anaemia, liver or kidney damage, thyroid disorder and chest x-ray are effective as we can see in this Nursing Assignment. But the final confirmation comes from ECG (Electrocardiogram) and BNP (Brain Natriuretic Peptide monitoring) results.
LO1- It may result in adverse effect on cardiovascular, renal, respiratory and musculoskeletal body systems. Due to pulmonary oedema, rapid fluid accumulation in lungs takes place. The low cardiac output due to left ventricular dysfunction causes the increased norepinephrine secretion from sympathetic system. It activates the rennin-angiotensin-aldosterone system that retains water for increasing renal perfusion (Sarraf, Masoumi, & Schrier, 2009, pp.2020).
The diuretics are very essential in the treatment of heart failures. Chronic heart diseases forces the patient to intake the diuretics to reduce the fluid retention preventing kidney problems or dehydration. It affects kidney functions of reabsorption by inhibiting its normal functioning for a long time.
The respiratory system is affected by the acute exacerbation of chronic heart disease as it leads to the accumulation of the excess of fluid in and around lungs. The beta-blockers used in the treatment of heart failures blocks beta2receptors causing vasodilatation of blood vessels which supplies skeletal muscle beds. It results in cold hands and feet thus affecting the musculoskeletal body system (Corbett, Travaglia, & Braithwaite, 2011, pp.250).
1.2. Nursing strategies to manage the pulmonary oedema:
The accumulation of fluid in lungs in the alveoli and interstitial spaces results in pulmonary oedema (Nhs.uk, 2014). Pulmonary oedema is of two types- cardiogenic and non-cardiogenic. Cardiogenic pulmonary oedema indicates the possibility of renal failure that may cause the overload of fluid. Non-cardiogenic oedema drives the nurses’ emphasis on infection and risk of toxic gas inhalation by the patient. The nurses must follow the strategy of strict monitoring of the patients’ condition checking for blood-tinged sputum from a cough, sudden dyspnoea, skin status cool and moist, and distended jugular veins. The responsibility of the nurse is to provide the relevant diagnosis as Oxymetry, chest x-ray that reveals fluid in and around lungs, echocardiogram, and blood culture in the suspected infection medium and cardiac markers.
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The second major strategy that the nurses must follow is the immediate treatment till the arrival of the doctor (Boomer & Mccormack, 2010, pp.640). Correct identification of precipitation factors are very essential as it aids in the prevention of the recurrence of the pulmonary oedema. The nurses can opt for therapies or treatments as Oxygen Therapy through the re-breather mask, giving morphine to patients to reduce resistance to pumping of heart, diuretic therapy using Lasix (Frusemide) a loop diuretic. It controls fluid overload through diuresis. Vasodilator therapy is also effective through Nitro-glycerine that reduces the resistance to heart pumping and returning blood amount to heart.
LO2- Prompt action and notification to heath professional is a vital responsibility of the nurses. The other major nursing implication involves initially providing supplementary oxygen with facemask, cardiac monitoring, ECG, elevating patient’s head or sitting him, ascultating the lung fields for breathing sounds and crackles, ready emergency equipments as airway, intubation tray, etc. Nursing Assignment Reporting of steady weight gain, providing frequent mouth care for minimising mucous membrane drying, maintaining a calm environment, monitoring of vital signs every 15 to 30 minutes, assessing signs for hypoxia, are other nursing implication that are important for the care of people with acute exacerbation of chronic heart failure (Marquis & Huston, 2009, pp.452).
The nurses need to have the knowledge and efficiency of optimum utilisation of the diagnostic tools as BNP assay that effectively deciphers the symptoms observed in patient in relation to other complications. Nurses need to be able to use the hemodynamic profile to develop effective treatment strategy. The knowledge and good idea of the anticipated results of the treatment strategy is very essential for evaluating the treatment plan’s effectiveness.
2.1. Mechanism of action of frusemide:
Furosemide (frusemide) finds extensive use in treating cardiac oedemas resulting in states as left ventricular heart failure as evident in the current case study. Studies indicate that the frusemide drug acts at the luminal surface of ascending portion of the Loop of Henle of t the renal tubule. Frusemide being a diuretic inhibits the re-absorption of chloride from the filtered fluid resulting in increase in urine output. It starts action in 1 hour of oral administration with diuresis lasting for 6-8 hours and within 5 minutes of injection with a diuresis duration of 2 hours. The fluid and electrolyte balance of the patient affect the dosage modulation (Ncbi.nlm.nih.gov, 2014). Frusemide adversely disturbs the fluid and electrolyte balances, organ functions. The drug has very poor water solubility, site-specific absorption, etc. It binds mainly to the plasma proteins (albumin) that restrict its distribution at steady state.
2.2. Nursing implications for frusemide use to patient with acute exacerbation of chronic heart failure:
The nursing implications on treating a chronic heart failure patient with frusemide loop diuretic drug are as follows:
Strict monitoring of the blood pressure during dieresis is important to prevent sudden death from cardiac arrest. Reporting sudden alteration in fluid and electrolyte balance to prevent adverse reactions is the nurse’s responsibility (Antrobus & Kitson, 2009). Nurses must record blood count, CO2, blood glucose, serum, urine electrolyte, uric acid values periodically from the first month of dosage. Nurses must monitor Input and Output ratio and pattern, S&S of hypokalemia, patient weight. Older adults are checked for the occurrence of excessive dehydration on prolonged salt restriction.
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Apart from these the nurses must assess the allergic traits of the patient to identify the presence of allergy to furosemide. Prior assessment of skin, oedema, BP, urinary output patterns, serum electrolytes, urinalysis, weight etc is essential. The frusomide is given with food or milk for avoiding gastro-intestinal issues. The dosage is lowered in presence of another anti-hypertensive. The nurses must monitor fluid changes, liver function, etc stringently and report to physician timely. The arrangement of potassium-rich food is also very essential (Web.squ.edu.om, 2014).
LO3- In order to deliver their roles and responsibilities efficiently the nurses must possess a sound knowledge of the heart failure (right-sided or left-sided failure) to be able to use appropriate pharmacological interventions. The interventions involve ACE inhibitor, Diuretics and Beta-blockers. The ACE inhibitors include Captopril (Captoten). The diuretics include the Furosemide (Lasix) and Beta-blocker is the carvedilol (Coreg). The administration of frusemide to the heart failure patient cannot expect decrease in pain (Richardson & Storr, 2010, pp.18). Decreased cardiac output indicates activity intolerance. The weight gain of the patient indicates fluid accumulation with expanded blood volumes.
The careful observation of the ECG readings, report derivations and assisting the patient with ambulating is a major responsibility of the nurses. The monitoring of the vital signs of patient after administering the furosemide is essential to note the appearance of the patient’s reactions to the drug. The nurse must administer the furosemide drug in the early time of the day to prevent sleep disturbance of the patient due to frequent and increased urination that is caused by the medicine (Web.squ.edu.om, 2014). The nurse must have the knowledge of preferring the oral dosage of frusomide to IV use. The avoidance of mixing of the parental solution with acidic solutions of pH less than 3.5 is to be maintained by the nurses.