- Mr. Wrights admissions states that he has heart failure (congestive cardiac failure). Clearly define heart failure. What organs and which body systems are affected by this disorder?
Answer:- congestive cardiac failure is also known as congestive heart failure is an ongoing condition in which the heart muscle is weakened and cannot pump as well as it normal pump. It occurs when the myocardium loses its ability to pump enough blood to meet body’s metabolic needs and is generally accompanied by fluid accumulation in the body tissues, especially in the lungs. Apart from the cardiovascular system it can affect many other systems.
- Left sided heart failure affects the respiratory system by increasing the instance of pulmonary oedema.
- Systolic heart failure:- it occurs when the heart muscle doesn’t contract with enough force so there is less oxygen blood pumped throughout the body.
- Diastolic heart failure:- it occurs when heart contract properly but ventricles cannot rest because the less amount of blood enters during the heart filling.
- Right sided heart affects every other system due to increase of peripheral oedema.
- Give a brief overview of the normal function of the body system affects by this disorder.
- Circulation system has a role that haemoglobin in the red blood cells the supply of the oxygen to the cells. There are two types of circulation route that for transporting blood to the cells and each tissue and for blood to gas exchange in the lungs.
- Vascular system is comprised of the heart, arteries which carry fresh blood towards the body from the heart and, vein which returns blood to the heart and lungs to collect from the whole body blood include waste and carbon dioxide.
- Pulmonary circulation is fresh blood that contains a large amount of oxygen to circulate to the left atrium through the pulmonary vein. Circulation supplies to the whole body of fresh blood that contains a large amount of oxygen.
- Urinary system is composed of the kidneys, ureter, bladder, and urethral. Kidney has role that excrete waste products to outside of the body, adjust the blood pressure, store the water, regulate the electrolyte, and generate red blood cells.
- Original urine is made by filtration of the glomerular, secretion and reabsorption takes place in the tubular. Urine was made in the kidney, is urinated outside the body through the ureter, bladder, and urethra.
- Respiratory system has role that the uptake of oxygen from the outside and to discharge carbon dioxide and water from the body. The air flow is accept the oxygen from the nose and mouth, and exchanged from oxygen to carbon dioxide is diffused in the capillary and interstitial.
- Digestive system is composed of the gastrointestinal tract, stomach, liver, gallbladder, bile duct, and pancreas. Digestion is initiated by the action of digestive enzymes and gastric acid
in the gastric juice in the stomach. There is a metabolism in the liver.
- The gall bladder is responsible for temporarily stores bile made of hepatocytes. Pancreas to secrete a variety of digestive enzymes as exocrine organ and secrete hormones that make the regulation of blood glucose levels as endocrine organ. Intestinal has role that breakdown of food by the digestive juice and absorb the nutrients and moisture. Finally, it excretes waste products.
- Define the signs and symptoms of heart failure and explain why these signs and symptoms occur.
Signs and symptoms of heart failure are:-
- Fatigue, weakness and mental confusion:- these things occur due to decrease output from the ventricle creating insufficient amount of oxygen in the brain which create mental confusion and disturbed behaviour.
- Fluid retention and oedema:- it occurs due to increased capillary pressure that develops in the peripheral circulation in person with right sided heart failure and in the pulmonary circulation in persons with left sided heart failure. The increased capillary pressure reflects an overfilling of the vascular system because of increased sodium and water retention and venous congestion, referred to earlier as backward failure, resulting from impaired cardiac output.
- Cyanosis:- caused by excess desiderated haemoglobin in the blood. It is resulting from impaired pulmonary gas exchange, from extensive extraction of oxygen at the capillary level.
- Shortness of breath:- occurs due to congestion of pulmonary circulation.
- Arrhythmias:- represent disorder of cardiac rhythm related to alteration in automaticity, excitability, conductivity or refractoriness of specialized cells in the conduction system of the heart.
- Muscle weakness – due to insufficient blood supply and oxygen to the muscles.
- Rapid or irregular heartbeat – the heart needs to pump harder as it cannot pump blood at a normal rate.
- Chronic cough or wheezing – due to the fluid in the lungs and the lungs need to work harder.
- Ventricular failure – happens when it is left untreated.
- Lack of Appetite or Nausea— when the liver and digestive system become congested they fail to receive a normal supply of blood. This can make you feel nauseous or full, even if you haven’t eaten.
- Fluid Build-up and Swelling— because blood flow to the kidneys is restricted, the kidneys produce hormones that lead to salt and water retention. This causes swelling, also called oedema that occurs most often in the feet, ankles and legs.
- Rapid Weight Gain— the fluid build-up throughout the body, may cause you to gain weight quickly.
- Heart Grows Larger— the muscle mass of the heart grows in an attempt to increase its pumping power, which works for a while. The heart chambers also enlarge and stretch so they can hold a larger volume of blood. As the heart expands, the cells controlling its contractions also grow.
- Heart Pumps Faster— In an attempt to circulate more blood throughout the body, the heart speeds up.
- Blood Vessels Narrow— As less blood flows through the arteries and veins, blood pressure can drop to dangerously low levels. To compensate, the blood vessels become narrower, which keeps blood pressure higher, even as the heart loses power.
- Blood Flow Is Diverted— When the blood supply is no longer able to meet all of the body’s needs, it is diverted away from less-crucial areas, such as the arms and legs, and given to the organs that are most important for survival, including the heart and brain. In turn, physical activity becomes more difficult as heart failure progresses.
- Congested lungs:-Fluid backup in the lungs can cause shortness of breath with exercise or difficulty breathing at rest or when lying flat in bed. Lung congestion can also cause a dry, hacking cough or wheezing.
- Dizziness, and weakness:- Less blood to your major organs and muscles makes you feel tired and weak. Less blood to the brain can cause dizziness or confusion.
- Confusion and impaired thinking:- changing level of certain substances in the blood such as sodium can cause confusion.
- List the information taken on his admission that demonstrates these signs and symptoms.
Low oxygen saturation, tachycardia, tachypnoea, hypertensive due to APO, loss of fluid into 3rd spaces or frusemide.
- Do you think his diabetes is related to his leg ulcer and amputated left toe? Explain
Yes diabetes can be related to leg ulcer and amputated left toe because in diabetes neuropathy or peripheral nerve disease and damage may lead to leg ulcers and serious foot problems from which limb amputation may result.
- One of the medicines he is taking is lasix. What is the action of lasix? Which body systems are affected by it? Explain why you think Mr. Wright is ordered Lasix.
Lasix is known as frusemide it is a loop diuretic that prevents your body from absorbing too much salt, allowing the salt instead be passed in your urine. As lasix is a diuretic drug that induce urination to decrease the body fluid volume, so the blood pressure will decrease therefore it will affect the urinary tract system and the cardiovascular system.
- List three conditions in Mr. Wright relevant medical history that is commonly associated with aging.
Asthma:- asthma is common among older people over age 65 and can cause serious problems in bones and joints.
Glaucoma:- glaucoma is a progressive degeneration of the nerve that can caused by increased intra ocular pressure.
Arthritis:- arthritis is a inflammation of the joints that can cause pain and stiffness which can be worsen as the person age.
- Using Mr. Wrights admission history and assessment, list the factors that may impact on his safety whilst in hospital and when he returns home.
Limited vision, impaired mobility, pain, self administration of frusemide combined with beta blocker and hypotension, low Sao2, hypo/hyper tension, decreased appetite, lower leg ulcer, confusion, anxiety and history of falls.
- What other health professionals will be involved in his care and what services can they provide for Mr. Wright.
Dietician:- to monitor his diet about the diabetes and in assist the meals on wheels with the preparation of the meals.
Domiciliary:- in order to assist with his daily living activities.
Psychologist:- to monitor his situation and watch for any signs of over anxiety.
Physiotherapist:- to assist him with maintaining his impaired mobility.
General practitioner:- assist him with his medications and refer to any other specialist if needed.
- List the nursing documentation you would expect to be used in the care of Mr. Wright.
Fluid chart, general observation chart, diet chart, bowel chart, admission information, medical history questionnaire, nursing notes, progress note, care plan and allergies.
- http://www.emedicinehealth.com/drug-furosemide/article_em.htm viewed on 5 September 2014
- http://www.australiandiabetescouncil.com viewed on 5 September 2014
- http://www.webmd.com/heart-disease/guide-heart-failure viewed on 5 September 2014
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