Acute Pulmonary Odema - Case Study Example

Acute cardiovascular condition: Acute pulmonary Odema (APO) Student Name Tutor Course Date Acute cardiovascular condition: Acute pulmonary Odema (APO). Introduction Acute diseases are severe and sudden and their symptoms are sharp and sensitive in appearance and worsen rapidly causing the patient to be in a complicated situation. Each year, millions of the Americans are affected with the situations related to acute cardiovascular diseases. The study below is an analysis of a case study concerning a 64 year old Trent who had was presented to emergency department with severe symptoms of chronic complications of cardiovascular; it focuses more on the APO condition of the patient. It specifically concentrates on the relevant medical background, presentation of the problem and assessment and management of the condition. The etiology & path-physiology relevant to the patient's clinical condition The patient, 64 year old Trent was brought to the emergency department with the complains of: increased shortness of breath, dry cough, and orthopea and chest tightness. He was diagnosed with Acute Pulmonary Oedema (APO). Acute Pulmonary Oedema is the most complicated disorder as it affects both the lungs thus interfering with the respiratory system and other important systems like blood circulation. The health records of the patient shows that he was diabetic (type 2), had hypertension and an episode of shortness of breath in December 2010. Pulmonary oedema or the fluids in the lungs are caused by many pathologies, for example, left heart failure, acute respiratory distress syndrome and fluid overload. However, left ventricular failure is considered as the leading cause of the disease. It either results to direct damage of the tissues or inadequate functioning of the heart and the entire circulation. The cardiogenic causes of pulmonary edema are associated with high pressure of blood in lungs caused by poor functioning of the heart. Congestive heart failure results from poor pumping function of the heart due to the weaknesses in the muscles of the heart. Abnormal heart valves and attacks of the heart leads to accumulation of excess amount of blood in the vessels, if the pressure of these fluids builds up it is likely to be drained out to the alveoli (Hatchett & Thompson, 2002). Non-cardiogenic pulmonary edema is caused by: Acute respiratory distress syndrome, kidney failure and inability to excrete toxic or excess fluids in the blood vessels, brain trauma (bleeding in the brain), expansion of lungs hence its collapsion. Overdose of drugs like heroin, methadone and Aspirin can lead to the condition. The complications related with heart attacks are associated with intense exertion, whether physical or psychological stress. Some other acute and severe infections like pneumonia triggers myocardial infarction rate. These are caused by change of whether and feeding habits thus causing infections and allergies on an individual. Key interventions There are many and varied nursing interventions of this patient with pulmonary edema. This is enhanced by first obtaining the history of the patient to ascertain the possible cause of the imbalances in the fluid. The nurses should help the patient to relax so as to maintain or regulate the amount of oxygen. Good maintenance of the administration of oxygen as required so as maintaining it at 90% or more. The patient is placed in high Fowler’s position for enhancement of the expansion of the lungs; oxygen should be administered as ordered by the experts. Incase of administration of any medicines like morphine to reduce the pain, the nurses should carefully record the amount given and carefully assess for any changes, the complications of the treatment should also be assessed like the depletion of electrolyte. The patient should also be carefully nursed to ensure that all is done to improve the condition. For example, efforts should be made to decrease the left ventricular diastolic pressure by reducing the systemic resistance of the vascular and improvement of diastolic and systolic functional reserve. They also promote coronary blood flow; the left and right coronary arteries and their sub branches are found to lying on the surface of the heart and are responsible for the distribution of blood to various areas of heart muscles. Intervention is also required to handle or correct acute respiratory failure (Fagan, 2002). The nurses should ensure that they comply with proper medication which is prescribed by the doctor. This works to avoid episodes of pulmonary edema which are likely to take place in future. This is well achieved by carefully and fully explaining all the necessary procedures to the patient and the family members. They should be informed of all the signs and symptoms of fluid overload so as to identify it and report at early stages for easier management. The patient should be made aware of all the prescribed medication and made to fully understand them. The most essential is the observation of the physical energy and ways of managing or maintaining it at the best level. The level of all the medicines prescribed like Aspirin, IV Frusemide 40mg, Anginine PRN to ensure that they are of the best quantity to avoid complications (Margaret, Fawcett & Runciman, 2006). The symptoms of the complication should be first treated to minimize their severity, for example, increased shortness of breath portrayed by the patient can result to sadden death if not immediately treated. Mr. Trent is diagnosed with pulmonary oedema thus he requires immediate treatment to eliminate the excess fluid in the lungs, decrease pulmonary capillary pressure and restore normal arterial oxygenation. Medical checkups like X-rays were conducted and the results show that he had increased interstitial markings. The symptoms shows that some of the most sensitive areas like respiratory organs and chest are affected thus thorough assessment is required. The professionals detected that the patient had some complications through the symptoms that he showed thus they saw the need to have him fully diagnosed to discover the exact disease that he was suffering from. The severe symptoms need to be handled with immediate effect for the purposes of improving the health conditions of the patient. After diagnosing the doctors came up with the conclusion that the patient was suffering from acute pulmonary oedema (APO) (Margaret, Fawcett & Runciman, 2006). Professional approach to nursing the patient with Acute pulmonary Odema (APO) As portrayed by the symptoms and signs, Acute Pulmonary Oedema is a serious medical complication which is manifested by signs of cardiac failure which sometimes may call for endotracheal intubation and efforts of mechanical ventilation. The patient was taken to the emergency department with severe symptoms of increased shortness of breath, chest tightness, orthopea, dry cough among the others. After being carefully diagnosed, the health professionals found that patient was suffering from Acute pulmonary oedema (APO). The health history also enabled the professionals to make conclusions on the complications of the patient. This included: hypertension, type 2 diabetic and had an episode of shortness of breath the previous year. Immediate medical attention was given to the patient to prevent complication of the condition especially the most severe symptoms like shortness of breath (Fagan, 2002). The professionals considered Electrocardiogram (ECG) to diagnose an acute myocardial infarction, heart block or arrhythmia’s-wave inversion is also assessed, this a characteristic of myocardial infarction and angina; where the infarction is not fully thickened there may be T wave inversion although no Q waves. This was also essential to determine the need for reperfusion therapy because of the complications of the chest. They also considered it to check on the underlying disease of the heart with strain of the left ventricular or hypertrophy, electrolyte disturbance or preexisting disease of coronary artery. Chest X-ray was also done to test the presence of APO or distinguish it from exacerbation, chronic obstructive disease of the lung or asthma. This also detected the increased interstitial markings between the spaces of the alveoli of the lungs; this may indicate complications of pneumonia or other lungs conditions. Thorough blood count was carried out to check on the contents and found to be: Troponin 405, second troponin level 468, Creatinine 108 and Potassium 4.6 (Baltazar, 2009). Unfractionated heparin is the main treatment of these complications of myocardial infarction; this was commenced on the patient. The assessment to monitor the sinus rhythm was also considered check on the heart beats of the patient since when he got in the ward it was very high. Medicines such as IV Frusemide 40mg, Anginine PRN and Aspirin were considered to reduce the pain or treat the condition of the patient (Fulde, 2009). Professional caring of the patient with cardiovascular incorporates both science and the art of nursing care. The patient needs health attention as an inpatient and in an acute care setting referred to as the cardiac care unit for the provision of the excellence care required. However the professionals should be conscious of the context because sometimes this unique environment brings about some potential problems especially for the old and recovering patients as they feel some sense of isolation because of their chronic condition. Careful assessment of the needs should be made in the efforts to plan for the care based on the complications of the individual patient. It is essential for one nurse to be assigned the responsibility of carefully observing and ensuring that all the needs are well catered for. All the severe symptoms of the condition of Trent should be keenly considered in the efforts to treat him to improve the health conditions of the patient. For example, the prescription of the pain relievers to minimize the pain that the patient experiences. The professional caring of the patient is also evidence by the efforts of the doctors to support the distinctive emotional, social and spiritual strength on the patient so as to encourage him to recover. The patients need some emotional as well as psychological support because he is an independent father who is independent with the activities of daily life with his wife and son (Kucia & Quinn, 2009). Analysis of issues arising in the case management The management of the complications of Trent requires regular efforts to monitor all the changes and assessment of the signs and symptoms as they are held responsible for the state in which the patient is in. Proper management starts with efforts to handle the symptoms which deteriorate the health conditions of the individual. The medical and nursing management of the cardiovascular diseases so as to balance between the maintenance of the normal (Intracranial pressure) ICPs and blood supply. The CPP should also be maintained on a good level for the provision of glucose and oxygen to various tissues of the brain. According to the medical records of the patient, the health practitioner recommended that the CPP was to be kept more than 70mmHg, Body temperature between 35° to 35.5°, ICP less than 15mmHg and MAP at 80mmHg (Aronow & Fleg, p. 357). The patient was found to be having high blood pressure (130/86), respiratory rate 28, Heart rate 100, Blood Sugar Level (BSL) 9.8 Temperature 37.2 and other complications like Oxygen saturation 92% in the room air. In management of the condition, the data pertaining the condition of the symptoms should be obtained through observation or monitoring the characters of the patient. The most sensitive issues include the efforts to check or assess the signs of herniation or the complications of highly increased ICP which can result in a state of devastating brain damage (WHO Scientific Group on Cardiovascular Disease and Steroid Hormone Contraception, 1998). The patient with APO should be sited upright to ensure optimized functions of the lung and applied high-flow oxygen through a non-rebreather mask and commence non-invasive monitoring in a resuscitation area. Continuous cardiac monitoring is also essential, this concerns the process of electrocardiography and the assessment of the condition of the patient in relation to the cardiac rhythm. Commence vasodilator therapy should be addressed with nitrates for reduction of preload. Glycerly trinitrate should be prescribed although it should not be continued if the blood pressure reduces below 100mmHg. For the chest pain, the patient should be given a combination of glycerly trinitrate and dextrose. Frusemide 40mg IV should be given or double the whole dose if the patient is taking frusemide tablets and be repeated between 20-30 minutes (Fulde, 2009). Morphine should also be prescribed if there is dyspoea and agitation although it should not be done routinely because it could lead to complications of asthma or cold or pressure of carbon dioxide. Non-invasive ventilatory assistance should be considered if the patient does not respond to the above treatment of pharmacological therapy. The efforts to control the blood pressure were also considered as well as maintenance of the balance between hypotension and hypertension. If not well handled, hypertension may result in rising of ICP and hypotension can reduce the tissue perfusion. The application of Philadelphia should be a precaution considered in all the efforts to handle all the injuries of the head for the immobility of the cervical spine. Mannitol is a hypertonic crystalloid which was found to be most essential in the control of high ICP of the patient. Post Mannitol was also considered for the careful monitoring of the body’s electrolytes in the fluids, the output of the urine, systematic blood pressure and central venous pressure. However, some of the practitioners recommended that Mannitol should not be overused as it also leads to rise in MAP thus contributing to CPP. The efforts to minimize the level of carbon dioxide in the body were also considered; it should not be too high or too low leading to vasoconstriction thus decreasing the cerebral flow of blood or ischemia. To ensure this is achieved, an end-tidal monitor was put in the expiratory circuit or the ventilator and close to the airway to monitor the amount of carbon dioxide inhaled (Lieh-Lai, Ling-McGeorge & Asi-Bautista, 2001). After the temperature of the patient became elevated, the increased rate of metabolic cerebral was controlled through the use of a cooling blanket or inducing of hypothermia. This was however keenly done so as not to cause shivering hence an increase in the metabolic rate and the end result might be cardiac arrhythmias renal and abdominal complications. The patient was provided with a sedation of a combination of propofol, morphine and midazolam. This was adequate for control of intolerance to the ventilator and pain or the anxiety of experiencing feelings which could worsen the cerebral metabolism (Urden, Kathleen & Lough, 2004). Conclusion The patient in the case study had complications of Acute Pulmonary Oedema. This is a cardiovascular related disorder and they affect the flow of the blood across various parts of the body as well as respiratory process. These were first displayed by the symptoms that he had as he came into the emergency room, for example, increased shortness of breath, high blood pressure, increased heart rate and so on. This was then confirmed by the diagnoses which showed that he had Acute Pulmonary Oedema. Professional care and management of the condition was needed to rescue him from the danger. Bibliography Fulde, G., 2009, Emergency Medicine: The Principles of Practice, Elsevier Australia, Australia. Baltazar, R., 2009, Basic and Bedside Electrocardiography, Lippincott Williams & Wilkins, New York. Hatchett, R. & Thompson, D., 2002, Cardiac nursing: a comprehensive guide, Elsevier Health Sciences, Makati. Margaret, F., Fawcett, J. & Runciman, P., 2006, Nursing practice: hospital and home: the adult, Elsevier Health Sciences, Makati. Urden, L., Kathleen M. & Lough, M., 2004, Priorities in critical care nursing, Mosby, Missouri. WHO Scientific Group on Cardiovascular Disease and Steroid Hormone Contraception, 1998, Cardiovascular disease and steroid hormone contraception: report of a WHO Scientific Group, World Health Organization, New York. Lieh-Lai, M., Ling-McGeorge, K. & Asi-Bautista, M., 2001, Pediatric acute care, Lippincott Williams & Wilkins, New York. Kucia, A. & Quinn, T., 2009, Acute Cardiac Care: A Practical Guide for Nurses, John Wiley and Sons, New York. Aronow, W. & Fleg, J. Cardiovascular disease in the elderly: Volume 48 of Fundamental and clinical cardiology, (48)1: 2004 p. 357. Fagan, T., 2002, Cardiovascular system. Elsevier Health Sciences. Salt Lake. Read More