Pathogenesis of Cardiac Failure in Mr. Das
A 68-years old man called Mr. Das was admitted to the emergency department after he developed symptoms of breathlessness and chest pain. Assessments revealed that he underwent exacerbation of cardiac failure and fluid volume overload. Cardiac failure is a medical condition where the muscle of the heart is unable to pump blood effectively to other parts of the body and this leads to fluid accumulation in lungs, and dyspnea.
The RAAS system is central to pathogenesis of cardiac failure. Activity of the RAAS system increases in CHF patients and its mechanisms result in effects such as activation of sympathetic system and cardiac remodeling. In Mr. Das, activation of RAAS system resulted in regulation of his blood volume and promoted systemic vascular resistance. These mechanisms resulted in elevation of his blood pressure in a prolonged manner contributing to hypertensive episode. RAAS system caused further cardiac damage by increasing his levels of oxygen, calcium ions, and sodium ions which activated proteases and cellular death. It also contributed to increased arterial stiffening, CVD, and hypertension (Craft et al., 2019).
Breathlessness in Mr. Das could be due to blood pooling and accumulation of fluid in his lungs which made Mr. Das unable to effectively breathe. Fluid accumulation in lungs also obstructed his bronchioles in the respiratory tract thereby causing wheezing (Brennan, 2018). Presence of right-side pleuritic chest pain could be due to the build up of fluid around Mr. Das’s lungs. Pleurisy is a condition where the pleura, which are the two thin, large layers of the tissue which play a role in separating the lungs from the walls of the chest, get inflamed. This inflammation results in the two layers of the pleural membrane to rub against each other, which under normal conditions slide past each other without rubbing and allow easy breathing. Due to inflammation of the pleural membrane, Mr. Das therefore experienced pain while inhaling or exhaling (Craft et al., 2019). Edema or congestion probably caused Mr. Das’s lungs to become stiff which caused his respiratory and heart rate to rise (Craft et al., 2019).
Overload of fluid volume is a common sign of cardiac failure. Mr. Das showed signs of fluid overload as indicated by presence of bilateral pedal pitting edema, hypertension, and dyspnea. Pathogenesis of hypertensive crisis is increased levels of fluid in his blood which increased blood pressure. Dyspnea can also be attributed to excessive fluids in his lungs which limited his breathing ability. Fluid build-up also impacted Mr. Das’s ability to properly empty blood, which caused backing up of blood in his veins. This resulted in distention of his jugular veins (Chaudhary et al., 2021). Edema can be attributed to leaky blood vessels which resulted in entry of fluids to his surrounding tissues and caused swelling.
Mr. Das was also diaphoretic. The pathogenesis of this could be due to increased effort exerted by his hearts to ensure that blood is being pumped to the rest of the body effectively, however damaged heart muscles caused extra-exertion of his heart which is why Mr. Das was sweating excessively to keep his temperature down and maintain homeostasis. Cardiac enzymes, specifically troponin are normally present in only low levels in the body. Their levels increase when the heart functions in an abrupt manner and harder than usual indicating heart failure. This is why Mr. Das presented with increased troponin enzyme levels since his heart muscles were damaged and heart was functioning harder than usual. Cardiac failure also impacted functioning of his kidneys and caused decreased renal perfusion thereby leading to increased creatinine and blood urea nitrogen levels (Linton & Matteson, 2020).
Symptoms and Significance in Mr. Das
One high priority nursing intervention for Mr. Das is to reposition him to a Semi- Fowler’s position. This intervention will help Mr. Das to breathe in an effective manner and will relieve him of breathlessness. This position can be achieved by placing Mr. Das on his back and ensuring that the head of the bed is angled at 30-45 degrees. Care must be taken to straighten Mr. Das’s legs. This nursing intervention will alleviate shortness of breath, and abolish wheezing and crackles by increasing the lung capacity of Mr. Das by at least 10-15%. A semi-fowler’s position will also improve Mr. Das’s range of motion of his diaphragmatic muscles and thereby improve exchange of gases and also facilitate expansion of his lungs which will make breathing more easier for him. A semi-fowler’s position will ensure that Mr. Das’s chest is expanded maximally which will improve his oxygen levels (Chanif & Prastika, 2019).
If this intervention is not performed then Mr. Das’s lung expansion can decrease which can cause promotion of pulmonary congestion thereby progressing to cardiac failure and increasing his levels of fatigue and weakness. Not repositioning him can also worsen his dyspnea which may progress to respiratory failure that can be fatal for him (Chanif & Prastika, 2019).
Furosemide is a diuretic that works by increasing secretion of sodium ions along with water by the kidney by inhibiting its reabsorption from the distal convoluted tubule, proximal convoluted tubule, and loop of Henle. This action of Furosemide is achieved by inhibiting the Na-K-Cl co-transporter that causes excessive secretion of ions. Mr. Das was prescribed with this medication to manage overload of fluid volume by helping his body in getting rid of excess sodium and water into urine (Brown et al., 2020). Nursing consideration of this medication includes monitoring Mr. Das’s fluid intake and output levels, his urine output, weight, and electrolyte levels, his BGL and kidney functions. He must be administered the medication in the morning to avoid nocturia. The expected clinical response is restored fluid volume accompanied by an increasing output of urine. Clinical observations that must be continued include monitoring his clinical status and looking for any signs of deterioration. Mr. Das must be assessed for oliguria, and development of electrolyte imbalances (Bullock & Manias, 2017).
Glyceryl trinitrate(GTN) is a medication that act to relax the vascular smooth muscles and causes dilation of peripheral arteries and veins. It works by converting aldehyde dehydrogenase to nitric oxide which causes activation of guanylatecyclase and leads to synthesis of cyclic guanosine 3′, 5′-monophosphate (cGMP). Protein kinase-dependent phosphorylation and dephosphorylation of myosin light chain is stimulated by cGMP which leads to relaxation of blood vessels thereby improving blood flow. This medication was administered to Mr. Das to reduce the workload on his heart which would thereby relieve his chest pain, and also lower his blood pressure (Rees, 2020). Nursing consideration of GTN include timely monitoring BP, heart rate, GI functions and assessing his mucus membranes. The clinical response expected after administering GTN to Mr. Das is vasodilation, decreased BP, and relief from chest pain and also dyspnea. Clinical observations that must be continued include monitoring his BP, oxygen saturation levels, heart rhythm and rate, and fluid intake and output levels.
References
Brennan, E. J. (2018). Chronic heart failure nursing: integrated multidisciplinary care. British Journal of Nursing, 27(12), 681-688. https://doi.org/10.12968/bjon.2018.27.12.681
Brown, A., Westley, K., Robson, J., Armstrong, L., Matthews, I., Runnett, C., … & Thomas, H. (2020). Furosemide in end-stage heart failure: community subcutaneous infusions. BMJ Supportive & Palliative Care. https://dx.doi.org/10.1136/bmjspcare-2019-002158
Bullock, S., & Manias, E. (2017). Fundamentals of pharmacology. Pearson Higher Education AU. https://books.google.co.in/books?hl=en&lr=&id=ODjiBAAAQBAJ&oi=fnd&pg=PP1&dq=fundamentals+of+pharmacology+bullock&ots=WKdgMhFf6Q&sig=3sAA8viJTQTof4r7AOxCJUqjIXw&redir_esc=y#v=onepage&q=fundamentals%20of%20pharmacology%20bullock&f=false
Chanif, C., & Prastika, D. (2019). Position of Fowler and Semi-fowler to Reduce of Shortness of Breath (Dyspnea) Level While Undergoing Nebulizer Therapy. South East Asia Nursing Research, 1(1), 14.
https://scholar.archive.org/work/g6lcubslgzhujdws7qqludbudu/access/wayback/https://jurnal.unimus.ac.id/index.php/SEANR/article/download/4809/pdf
Chaudhary, R., Sukhi, A., Simon, M. A., Villanueva, F. S., & Pacella, J. J. (2021). Role of Internal Jugular Venous Ultrasound in suspected or confirmed Heart Failure: A Systematic Review. Journal of cardiac failure. https://doi.org/10.1016/j.cardfail.2021.08.009
Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2019). Understanding Pathophysiology 3e Australia New Zealand. Elsevier Health Sciences.
https://books.google.co.in/books?hl=en&lr=&id=Re2DDwAAQBAJ&oi=fnd&pg=PP1&dq=Craft,+J.,+Gordon,+C.,+Huether,+S.+E.,+McCance,+K.+L.,+%26+Brashers,+V.+L.+(2018).+Understanding+Pathophysiology+3e+Australia+New+Zealand.+Elsevier+Health+Sciences.+&ots=rKNVm_0v1q&sig=yL351SdWBieEKeRoqL8s4jClQi8&redir_esc=y#v=onepage&q&f=false
Linton, A. D., & Matteson, M. A. (2020). Medical-Surgical Nursing E-Book. Elsevier Health Sciences. https://books.google.co.in/books?hl=en&lr=&id=DA-IDwAAQBAJ&oi=fnd&pg=PP1&dq=medical+surgical+nursing+linton&ots=7H8-KSkCWM&sig=RPGflXkFBjGv1n3pCZNNvoQ9img&redir_esc=y#v=onepage&q=medical%20surgical%20nursing%20linton&f=false
Rees, S. (2020). GLYCERYL TRINITRATE. Journal of Prescribing Practice, 2(7), 372-373. https://doi.org/10.12968/jprp.2020.2.7.372
Order an Essay Now & Get These Features For Free:
Turnitin Report
Formatting
Title Page
Citation
Outline
