Nursing Care of a Person with Altered Cardiovascular Function - Case Study Example

Title: Nursing Care of a person with altered cardiovascular Function Name: Registration No: Course Code: Professor’s name: Date of Submission: Item 1: Clinical Presentations During the initial assessment of Sylvie, there are a number of things that are likely to be seen, heard or felt. For instance, it is possible to observe Sylvie demonstrating signs of fatigue. This is because fatigue is a common symptom for a person suffering from dyspnoeic condition which is currently affecting Sylvie. Furthermore, fatigue can result from lack of enough supply of oxygen (Adler, Sharma, Higgins & McGee 2014). This is because currently, Sylvie is currently being supported by oxygen supply via nasal prongs and when this is not adequate, there is a likelihood of being fatigued. In addition, it is expected that Sylvie will complain of having the feeling tiredness. This is because she has not been eating well and is likely to experience energy loss in the body. She is also expected to explain that sometimes she has a feeling of breathlessness and inability to cook or shop for herself. This is because she has gained weight despite not eating well and thus unable to move or become active in the activities she performs. Another observation that is likely to be made is abnormal breathing or difficulty in breathing as a result of tracheal tug condition and intercostal condition (Basturk, Balkan., Aytekin, Unsal & Alagol, 2009). As a result of intercostal condition, her chest is likely to be observed to be moving inwards during breathing and she is likely to complain about difficulty in breathing. It is also likely to be observed that there will be swellings in her legs as a result of peripheral oedema condition and difficulty in breathing or restlessness as a result of respiratory acidosis condition. Item 2: Nursing Priorities The first nursing priority when Sylvie is received will be management of her dyspnea condition. This will be achieved by ensuring her respiratory patterns such as muscle movements during breathing, assessing the position of the patient during normal breathing and use oximetry to monitor oxygen saturation and pulse rate. The activity of nursing the dyspnea condition is of first priority because it will be important to ensure oxygenation is detected early on so that chances of respiratory failure can be detected and corrective measures taken (Boyle, Steel & Flynn, 2009). The next nursing priority will be management or respiratory acidosis condition. This will involve measuring the bicarbonate level in the exhaled air so that it is established whether the patient’s breathe is of the right PH or the right amount of bicarbonates (Butler, 2012). This will be important because it will ensure buffering is provided to control respiratory acidosis condition that can result into respiratory failure if not controlled immediately. The third nursing priority will be monitoring intercostal recession condition. This is because, this condition results into partial blockage of the trachea and sucking in of intercostal muscles between the ribs during breathing, thus blocking the airways and preventing the person from breathing (Daskalov, Vladimirova-Kitova & Lalabonova 2009). When this condition is not corrected immediately, the person can experience difficulty in breathing and respiratory failure may occur.  Item 3: Assessment and monitoring of cardiac function An example of a method that will be used to assess and monitor Sylvie’s cardiac function is conducting chest x-rays to determine the severity of intercostal recession condition and the use of pulse oximetry to measure blood oxygen level. The improvement of Sylvie’s condition will be determined by x-rays show that there are not retractions of chest muscles; it will be an indication that she is improving from the intercostal recession condition. The deterioration in her condition will be known when the results of the oximetry shows that there is no change in oxygenation and arterial blood gases are according to the normal concentration of CO2 and O2 (Garrard & Williams, 2008). Another assessment will be monitoring diaphragmatic muscle fatigue so that reversal motion pattern which is an indicative of respiratory failure can be known. In addition, monitoring will be conducted on the rates of inhalation and exhalation and irregular instances of apnea between repetitive patterns. The success of this assessment will be indicated by normal movement of the diaphragm while the failure will be indicated by paradoxical movement of the diaphragm which is an indication of ventilator muscle fatigue (Iijima, Brandstrup, Rodhe, Andrijauskas & Svensen, 2013). Another assessment method that will be important in understanding Sylvie’s cardiac function is measuring respiratory acidosis condition in her body. This will be achieved by measuring the amount of bicarbonates in the exhaled air as well as measuring the PH of the exhaled air followed by buffering the respiratory acidosis condition (Kane, Shamliyan, Mueller, Duval & Wilt 2007). This is where reactions on the erythrocytes of her blood cells will be buffered by the removal of hydrogen ions so that bicarbonates concentration is improved in her blood. The increase in bicarbonates concentration will be expected to result into a normal PH of blood. the kidneys will also be examined to determine their ability to retain the bicarbonate ions as a result of an elevated pCO2.The success of interventions aimed at controlling the levels of bicarbonates and PH in the respiratory system will be determined by the return of the PH of plasma to the normal condition and the rise in bicarbonate level which contributes to a reduction in acidosis condition. The deterioration in her condition will be assessed by failure of compensatory response to respiratory acidosis such as failure of the kidneys to respond to an increase in arterial pCO2 and the failure of the PH to return to normal condition (Pahlevan & Gharib, 2014). Another measure of failure of the intervention will be the inability of the kidneys to retain bicarbonate ions when there is a high concentration of pCO2. Item 4: Nursing Management: Reducing cardiac workload An example of a strategy aimed at reducing cardiac workload and myocardial oxygen demand to improve recovery is administration of platelet-modifying drugs such as aspirin and darnole (Perk et al. 2012). This will ensure the ability of platelets to carry oxygen is increased and the person is able to absorb more oxygen into the blood stream so that oxygen demands of the body are met. Another example of a strategy aimed at reducing cardiac workload and myocardial oxygen demand is the use of analgesia that contributes to reduced stimulation of the nervous system and thus reducing myocardial workload. This may involve providing the patient with intravenous nitroglycerine that may be continued for 24 hour so that myocardial work is reduced (Pérusse-Lachance et al. 2012). Furthermore, nitroglycerine ensures a reduction in myocardial oxygen requirements as well as increasing the supply of oxygen to the myocardium. This drug ensures afterload is reduced. It also ensures coronary arteries are dilated and blood flow is enhanced in the collateral channels so that myocardial tissue risk is prevented. Another analgesia that can enhance the functions of nitroglycerin is sildenafil which contributes to precipitation of a considerable drop in blood pressure. Furthermore, fibrinolytic therapy and agents can be used to solve and break up clots in blood so that cardiac workload is reduced. These drugs activate the fibrinolytic system to destroy clots, and ensuring there is a free flow of blood to tissues that have been obstructed. Various forms of fibrinolytic agents can be used today (Adler, Sharma, Higgins & McGee, 2014). The most cost-effective drug is Streptokinase, which is less expensive compared with other drugs. Another strategy that will ensure cardiac workload is reduced is to ensure the patient has enough bed rest during the first 12 hours. The bedside commode is applicable and according to studies, it is a less stressful method compared to a bedpan. When the patient becomes stable; the patient can be allowed to sit in a chair at the bedside. Activities can be increased as tolerated and it is preferred to use a quiet, calm environment. The patient can then be provided with oxygen through the nasal cannula at 2 to 5 L/min so that oxygenation is improved in the myocardium and other tissues. Item 5: Nursing management – Medication management The purpose for prescription of cardiac glycoside for Sylvie is that it will enable cardiac failure does not occur to her. This drug maintains heart functions and reduces chances of heart failure. This is because she has been diagnosed with tachycardia condition which can result into the failure of her heart; a condition that can be fatal if not addressed immediately. The purpose for prescription of ACE inhibitors is that it will slow the activity of the enzyme, ACE that contributes to a decreased production of angiotensin II which is a chemical that causes muscles that surround the blood vessels to contract, hence narrowing the vessels and resulting into increase in blood pressure (Ogata, Ishikawa, Yukitoshi & Minami, 2009). When ACE inhibitors are provided to a patient, heart pump pressure is decreased and the functions of a failing heart can be improved. Furthermore, it ensures a kidney disease resulting from high blood pressure is slowed. This prescription will be important for Sylvie because she is suffering from a tachycardia condition which is characterized by high blood pressure. The purpose of prescription of diuretics is that it will contribute to a reduction in water in the body of Sylvie. The drug is important in treating conditions such as high blood pressure, diabetes and oedema. This is based on the fact that she has been diagnosed with oedema which is a condition that results from increased accumulation of water in the tissues (Basturk, Balkan, Aytekin, Unsal & Alagol, 2009). By providing her with this medication, it will be possible to get rid of the excess water. There are a number of nursing responsibilities associated with administering these medications. An example of such a responsibility is that the nurse must ensure the patient takes the right medication at the right time and in the correct amount. In addition, the nurse must ensure the patient does not take the drug which is not prescribed at a particular time. Monitoring style that will be used to ensure Sylvie responds to these medications involve observing that she takes the right amounts of cardiac glycoside and also takes them at the right time and does get confused and use a different drug. A similar monitoring will be carried out for the manner in which Sylvie is using ACE inhibitors and diuretics (Boyle, Steel & Flynn, 2009). Monitoring will also involve establishing whether there are any side effects as a result of use of the drugs such as whether there is increased loss of fluids as a result of the use of diuretics, the possibility of coughs as a result of the use of ACE inhibitors and possibilities of taking an overdose of cardiac glycoside such as irregular heartbeat, nausea, rashes in the skin and the feeling of tiredness or drowsiness. Item 6: Preparation for Discharge An example of a patient teaching topic to be taught is personal care. This is where Sylvie will be instructed to be responsible for her physical needs such as rest, sleep and monitoring her health and taking the right action in case she observes lack of normalcy in her health. Another area of teaching will be adherence to drugs. This is where Sylvie will be taught how to observe accuracy in the timing and the amount of drugs taken as well as taking the right drugs. The first topic is important for Sylvie because it will ensure she is able to monitor her body characteristics so that whenever she experiences a health problem such as difficulty in breathing or tiredness, she can inform her family members or contact the nearest health facility for medical attention. The lessons about having enough rest and sleep is important because a person with a history of suffering from cardiovascular functions needs to have enough sleep and rest so that her health is maintained within a normal level of functions of the heart. The second topic of adherence to drugs will ensure she takes drugs that maintain her cardiovascular functions at the right level so that she does not miss doses or take a wrong dose. Thus, the intended effects of the drugs on her body will be achievable. Item 7: Legal and ethical practice There are a number of rights that Sylvie has during decision making process in relation to her case such as: The right to contribute to the discussion regarding her care by suggesting ideas on how she thinks her medical condition can be managed The right to explain her likes and dislikes in the manner in which her medical conditions should be managed The right to oppose a decision which she thinks will be less beneficial and accept a decision which she thinks will be beneficial to her The right to talk with the Cardiac Specialist, the Medical Team registrar and her parents during the discussion She has the right to know the types of drugs she will be expected to use when she is discharged from the hospital and why she will be using them. As a registered nurse, there are steps I would take to ensure Sylvie is involved in in the information sharing and decision making in relation to her care. These steps include: i. Asking her to explain any difficulty she needs to be addressed in her medical attention. For instance, whether she thinks she will not be able to take care of herself when she is discharged so that action can be taken to address the problem. ii. Asking her to explain the activities she would like to perform on her own and those she wanted to be assisted to do iii. Ensuring her views is factored during the meeting to discuss how to manage her health care process after she leaves the health care facility. iv. Informing her about the drugs she would be using and why she will be required to use them v. Ensuring she is informed about the nature of activities she would be required to perform so that her condition is maintained to a normal level. References Adler AC, Sharma R, Higgins & T,McGee WT (2014) Hemodynamic Assessment and Monitoring in the Intensive Care Unit: an Overview. 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Bioenergetics S1:001. http://omicsgroup.org/journals/mental-work-stimulates-cardiovascular-responses-through-a-reduction-in-cardiac-parasympathetic-modulation-in-men-and-women-2167-7662.S1-001.pdf Read More