Analyzing an Aspect of Nursing Care Based on a Provided Profile of a Patient - Essay Example

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Name of the Student Nursing Name of the Concerned Professor 14 May 2012 Analysing a Chosen Aspect of Nursing Care Based On a Provided Profile of a Patient Introduction A 77 year old male patient with past history of myocardial infarction (MI), left ventricular failure, COPD, duodenal ulcer and peripheral vascular disease was admitted with an acute presentation of stroke…
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Download file to see previous pages Although, the patient has multiple system involvement, given the recent history of myocardial infarction and resulting LVF, heart failure is likely to be the leading cause of hospital readmission in this case. LVF, when coexisting with COPD, makes pharmacological treatment challenging (Padeletti, Jelic and LeJemtel, 2008). This disease is likely to impact and overshadow the management and prognosis of all other associated conditions. Limitation of functional capacity due to LVF is a serious hindrance for the patient to seek treatment for other associated conditions and participate in a rehabilitation program for stroke, peripheral vascular disease and COPD. Acute decompensation of LVF can occur because of treatment non-compliance, infection or poor nutritional status and can be fatal. Thus, nurses play an important role in preventing acute decompensation and rehospitalisation. Heart failure patients generally have a poor prognosis and a reduced quality of life (Gould, 2002). However, because of advances in treatment and dedicated heart failure programs, the prognosis of the condition has improved with the 6 month mortality rate declining from 26% in 1995 to 14% in 2005(Mehta, et al., 2009). Concurrently, hospitalization rates are increasing. An elderly patient with multiple comorbidities, multiple medications and reduced quality of life is the typical profile of a patient with heart failure. In this patient, MI, LVF, COPD, peripheral vascular disease as well as duodenal ulcer have common risk factors of age, smoking and atherosclerosis. Pathophysiology of left ventricular failure Left ventricular failure may be defined as the inability of left side of the heart to pump enough blood to meet the metabolic needs of the body. Coronary artery disease leading to myocardial infarction is the most common cause of left sided heart failure (NICE, 2010, Gould 2002). MI impairs myocardial contraction and hence, reduces its efficiency to pump blood. Severity of the infarction is proportional to the severity of LVF. Other common causes of left ventricular failure include hypertension, cardiomyopathy and valvular heart disease. Positive history of smoking, peripheral vascular disease and age, point towards atherosclerosis and resulting MI as the cause of LVF in this patient. COPD also causes heart failure which is mainly right sided. However, it can also precipitate LVF (Paudel, et al., 2008). LVF, in turn, can cause right heart failure by increasing pulmonary vascular resistance (pulmonary hypertension). Signs and symptoms As the ability of the left ventricle to pump blood in the forward direction is impaired, symptoms result from pulmonary vascular congestion and inadequate cardiac output. Pulmonary congestion affects gas exchange in the alveoli and causes dyspnea, orthopnoea, cough, dizziness, confusion, syncope, fatigue, and decreased functional capacity and exercise tolerance (Buckler, 2009). New York Heart Association (NYHA) grading is a useful tool for grading the severity of LVF that should be used. Physical examination reveals tachypnea, gallop rhythm and features of pulmonary oedema, such as crepitations over lung fields, predominantly at the base. Respiratory distress and production of pink frothy sputum is present in decompensated cases, ...Download file to see next pagesRead More
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