NURS 6501 Cardiovascular Systems Discussion

Outline for Pathophysiology Week 4 Assignment #2

Intruduction

1. The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
2. Any racial/ethnic variables that may impact physiological functioning.
3. How these processes interact to affect the patient, and implications to patient health.

Scenario 1: A 76-year-old female patient complains of abdominal swelling, weight increase, shortness of breath, and peripheral edema. She has a history of congestive heart failure and admits to skipping her diuretic because it requires her to “get up every couple hours to go to the bathroom.” She now has to sleep with two pillows to obtain adequate air.

NURS 6501 Cardiovascular Systems Discussion Sample Discussion Paper

Intruduction

Heart failure (HF) is a clinical illness characterized by the heart’s inability to pump enough blood to meet the body’s metabolic needs. Any disease that reduces ventricular filling (dyastolic dysfunction) and/or myocardial contractility can cause HF (systolic dysfunction). It can be an inherited or acquired cardiac structural problem.

It will manifest a set of symptoms (dyspnea and exhaustion) and signs (edema and rales) that will result in repeated hospitalizations, a poor quality of life, and a short life expectancy. In affluent countries, coronary artery disease (CAD) and hypertension have become the leading causes of heart failure (HF) in both men and women, accounting for 60-70% of cases. NURS 6501 Cardiovascular Systems Discussion

The cardiovascular and cardiopulmonary pathophysiologic processes

This patient presented with classical signs and symptoms of weight gain, shortness of breath, peripheral edema, and abdominal swelling. She has a history of congestive heart failure and admits to not taking her diuretic, as it makes her “have to get up every couple hours to go to the bathroom.” She now has to sleep on two pillows in order to get enough air.

The patient clearly admits that she is not compliant with medications regimen as ordered. This patient is experiencing an acute heart failure exacerbation with fluid overload. The pathophysiology involve in heart failure is very complex. The causes of systolic dysfunction (decreased contractility) are reduction in muscle mass, dilated cardiomyopathies, and ventricular hypertrophy can be caused by pressure overload as in systemic or pulmonary hypertension and aortic or pulmonic valve stenosis, also volume overload for example, valvular regurgitation, shunts, and high-output states. NURS 6501 Cardiovascular Systems Discussion

The causes of diastolic dysfunction (restriction of ventricular filling) are increased ventricular stiffness, ventricular htpertrophy, infiltrative myocardial diseases, myocardial diseases, myocardial ischemia and MI, mitral or tricuspid valve stenosis, and pericardial disease. As cardiac function decreases after myocardial injury, the heart relies on the following compensatory mechanisms: (1) tachycardia and increased contractility through sympathetic nervous system activation, (2) increased preload increases stroke volume, (3) vasoconstriction, and (4) ventricular hypertrophy and remodeling. Although these compensatory mechanisms initially maintain cardiac function they are responsible for the symptoms of HF and contribute to disease progression (McCance & Huether, 2019). NURS 6501 Cardiovascular Systems Discussion

The neurohormonal model of HF recognizes that initiating events such as acute MI leads to decreased cardiac output but that the HF state then becomes a systemic disease whose progression is mediated largely by neurohormones and autocrine/paracrine factors. These substances include angiotensin II, norepinephrine, aldosterone, natriuretic peptides, arginines vasopressin and enthelins peptides, proinflammatory cytokines such as TNF-a and various interleukins, and endothelins-1 (McCance & Huether, 2019). Therfore, persistent neuro-humoral activation induces maladaptive processes resulting in detrimental ventricular remodelling and organ dysfunction. Based on that, pharmacological therapies that inhibit the sympathetic and renin-angiotensin-aldosterone systems.

Any racial/ethnic variables that may impact physiological functioning. NURS 6501 Cardiovascular Systems Discussion

Racial and ethnic differences in the underlying etiology and pathophysiology of heart failure may contribute to differences in outcomes. Heart failure is commonly associated with diabetes and hypertension in black patients, while white patients have higher rates of coronary disease leading to ischemic cardiomyopathy. Similarly, black, Hispanic, and Asian patients had more hypertension, diabetes, and chronic kidney disease compared to white patients. Black patients have a 50% higher incidence of HF that occurs at an earlier age than white patients, and the other ethnic groups with epidemiological studies suggesting 30% to 50% hospitalized with incident HF have HFpEF (Chen et al., 2020). NURS 6501 Cardiovascular Systems Discussion

Epidemiological studies suggest more rapid progression of HF in black patients, and explanations have included higher prevalence of key risk factors such as hypertension, diabetes mellitus, and obesity; possibility of disparate health care; worse socioeconomic status; and potential differences in physiological responses to elevated blood pressure. It is noted that minority patients hospitalized for heart failure may be healthier than whites to explain the discrepancy between lower mortality and higher readmission rates for minority patients (Chen et al., 2020)

How these processes interact to affect the patient, and implications to patient health.

Heart failure affect the patient life style mostly by intolerance of the activities of daily living. The patient presentation may range form asymptomatic to cardiogenic shock, the primary symptoms are dysnea (particularly on exertion) and fatigue, which lead to exercise intolerance. Other pulmonary symptoms include orthopnea ( patient needs to sleep on two pillows in orhter to breath), paroxysmal nocturnal dyspnea, tachypnea, and cough. Fluid overload can result in pulmonary congestion and peripheral edema. NURS 6501 Cardiovascular Systems Discussion

Nonspecific symptoms may include fatigue, nocturia, hemoptysis, abdominal pain, anorexia, nausea, bloated ascites, poor appetite, mental status changes, and weight gain. Physical examination findings may include pulmonary crackles and S3 gallop, and cool extremities, Cheyne-Stockes respirations, tachycardia, narrow –pulse pressure, cardiomegaly, symptoms of pulmonary edema (extreme breathlessness, anxiety, sometimes with coughing and pink frothy sputum), peripheral edema, jugular venous distention, hepatojugular reflux, and hepatomegaly. (Bills, & Rose, 2021).

NURS 6501 Cardiovascular Systems Discussion References

1. Bills, G. W., & Rose, C. (2021). Principles of pharmacology for respiratory care.
2. Chen J, Normand SL, Wang Y, Krumholz HM. National and regional trends in heart failure hospitalization and mortality rates for Medicare beneficiaries, 2020. JAMA. 2011;306(15):1669–78. [PMC free article] [PubMed] [Google Scholar]
3. McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic
4. Mosby/Elsevier. basis for disease in adults and children (8th ed.). St. Louis, MO: