Pathophysiology Assessment: CHF Case Study Essay Paper

Pathophysiology Assessment: CHF Case Study Essay Paper

Pathophysiology Assessment: CHF Case Study Essay Paper

Pathophysiology is the study of health alterations which includes the disease of organs. This case study is about a 70 years old male who arrived with the complaint of exacerbation of CHF, he also has hypercholesterolemia, MI, angina, hypertension, and type 2 diabetes. He is on medications for the above illness which are atorvastatin, furosemide, and metformin. The goal of this case study is to identify the role of registered nurse in the assessment of an individual who is experiencing health alterations. This paper identifies two healthcare primary priorities according to ABCDE framework, then it follows by interventions for those primary priorities. These primary priorities linked with available data such as vital signs, patient history, and the pathophysiological changes are discussed. The interventions are made to manage the patient’s primary priorities, a discharge plan will also be provided.

Nurses have an important role in patient’s assessment and during follow up, most importantly nurses ensure of evidence-based care approach which helps to early diagnosis and treatment of disease, the ABCDE approach is considered a vital tool for all patient assessment ( Coccia, Palkowski, Schweitzer, Motsohil & Ntusi, 2016) . The primary priority for the patient would be the shortness of breath (Soltan & Kim 2016). In accordance with the ABCDE framework, a patient first should be checked for airways, the airways should be open and unobstructed. It is a life-threating matter so it must be checked and treated, the breathing is checked subsequently as the second step of the ABCDE framework (Coccia et al., 2016). Mr. Smith complaints about his breathing so according to ABCDE framework it must be checked as a primary priority, the SOB or dyspnoea’s pathophysiology is complex however, primarily it occurs as the result of respiratory or cardiovascular impairments (Coccia et al., 2016).

In order to increase the breathing, it needs to activate the chest wall, as well as several receptors related to upper and lower airways (Coccia et al., 2016). The second primary priorities for the patient will be the exacerbation of CHF, Mr. Smith is feeling weak and fatigue due to pleuritic pain in the chest. According to ABCDE framework circulation is the third stage of the patient’s assessment (Soltan & Kim 2016). The vital signs of Mr. Smith show that his blood pressure is 170/90 which is considered high therefore, it results in reducing the cardiac output, Mr smith’s circulation is affected so that is the reason for his complaint of chest pain (Braun & Anderson 2017: Pathophysiology Assessment: CHF Case Study Essay Paper). The first intervention for above primary priorities is the administration of oxygen, the second intervention is pharmacological therapy which prescribed by the doctor and the third intervention is to provide education and support to the patient and if possible to patient’s family members.

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Interventions made by the nurse in case of patients with cardiovascular disease are goals directed (Verloo et al,. 2017). The first intervention made by the nurse is to administer oxygen to the patient as it is prescribed by the doctor, the second intervention suggested by the nurse is pharmacological therapy as it is also prescribed by the doctor. The third intervention for Mr. Smith is to provide education and support and encourage the patient to be actively involved in his own care plan.

Intervention 1: Administration of oxygen

The oxygen therapy and the right dosage is prescribed by the doctor, and the nurse administers oxygen therapy. Providing education and demonstration on how to administer the oxygen to the patient and his family members as part of nurse duty and it is in accordance with the nurse scope of practice. In order to ensure that the patient is receiving an adequate amount of oxygen, the nurse checks the patient vital signs which include the pulse oximeter check before administrating the oxygen therapy (Goharami, Miri, Kouchek & sistanizad 2017). It could be fatal in case if it is given inappropriately so the oxygen therapy must be prescribed by the doctor, this is an important intervention given by the nurse and the oxygen therapy is the first line of treatment for many emergency cases so, the nurse should be confident in administration (Goharami et al,. 2017).

During the treatment, the nurse should check the oxygen regularly and monitor the PR, RR, BP and level of patient’s consciousness with careful consideration (Mayhob 2018). The RN should be aware of the targeted oxygen saturation, indication, percentage of inspired oxygen, range of oxygen, and oxygen delivery device (Mayhob 2018). The right amount of oxygen is necessary because the high amount of oxygen may result in toxicity (Goharami et al,. 2017). As discussed, it is the nurse role to inform Mr. Smith and his family members on oxygen therapy dosage and the consequences of overusing the machine. Therefore, the correct amount of oxygen therapy and educating patient’s family members through therapeutic relationship are the indented outcome of this intervention. This would ensure the quality life of the patient because the family members learned how to act upon it immediately if SOB occurs in the future. These steps should be documented in the patient care plan by the RN.

Intervention 2: Pharmacological therapy

The second intervention is made by the nurse is pharmacological therapy. Once the doctor prescribed the medications the RN role is to administer the prescribed medications carefully.

The RN ensures that giving the right medications and verifies it based on the order. The patient is taking multiple medications, checking patient history and allergies are important so, the RN check the patient file to ensure of patient current allergies and if found any allergy the RN inform the doctor before proceeding(WHO 2011). The RN emphasize the patient allergy in all communication with other hospital staff especially doctor and encourage the patient to stay alert about his given medication (Verloo et al,. 2017). The nursing education has been highlighting the importance of using the five rights before administering medicines, the five Rs are; right drug, right time, right rout, right dose and right patient (WHO,2011). It is important to ensure patient adherence to the medication therapy for the prescribed time because the patients with CHF are high at risk and their medications should be administered properly. The safe medication practice is a team activity that includes the patient and his family member, a clear communication may help to minimize the error and ensure of patient safety(WHO,2011).The medication for symptomatic treatment of the heart failure is prescribed by the doctor and the nurse role is to administer the medications accordingly.

The RN educate the patient about drugs and any associated side effects, the RN also monitors the patient after giving the prescribed drug and document any changes(Verloo et al,. 2017). It is essential that an RN has the required knowledge about medicines, side effects, and therapeutic use. The RN being acquainted with drug hazards and the drug safety precautions of proper administration reduce the risk of errors, such as being familiar with different methods of routes(Goharami et al,. 2017). The cardiac medicines can have an adverse effect and sometimes may lead to lethal effects if administered without discretion(Carone et al ,.2016). For example, Mr. Smith is taking furosemide and the most important side effects to consider are dry skin and mucosa which leads to dehydration in the patient, the patient should be monitored for imbalanced serum potassium signs, palpitation and muscle cramps (Carone et al ,.2016). The medication complexity and the volume may lead to increasing the risk of errors so, Mr. Smith must be monitored after medicines therapy. The RN addresses any signs of discomfort or problem in the patient because the medicine might be reacting and the doctor must be informed. The intended outcome is to reduce the errors during administering medications and improve patient safety through clear communications, knowledge and following safety procedures.

Intervention 3: Providing education and support to patient and family members

The third intervention is to educate the patient and his family members regarding CHF and other complexity that the patient is experiencing. In patients with CHF, the patient may experience extreme chest pain which sometimes become unbearable. As a result, the cardiac output is reduced and the body fails at fulfilling the peripheral demands(Braun & Anderson 2017: Pathophysiology Assessment: CHF Case Study Essay Paper). Mr. Smith has increased heart rate and suffers from myocardial infarction so, the patient and his family members need to be cautious and learn how to take actions if it occurred in the future. The patient and family members are usually highly motivated to learn, they have an important role to improve the treatment outcome and they usually contribute significantly.

The patient with T2DM and cardiovascular disease need frequent medical attention and they need proper medical clinical management. Patients need encouragement to identify and manage symptoms and the nurses have the ability to focus on their clinical needs through therapeutic communication. The patient needs a designed educational intervention plan to resolve the learning barriers like the functional and cognitive limitation, low self- esteem, low motivation and misconception of disease( Driver & Gosian 2015). The information about symptoms of CHF, daily activities, diet, and restriction should be discussed by the nurse to the patient and his family members.

The RN should take time to explain every details about CHF and to ensure patient understood all doctor’s advice, review it with patient and his carers, provide proper guideline about medications, side effects, promote patient self-care, encourage to seek help if patient condition changed and ensure patient and his family members are confident with provided information. This is an appropriate intervention because the patient and family members may be lacking a great deal of knowledge and misconception about CHF. The nurse level of knowledge and education is vital in this intervention, the nurses should consistently upgrade their knowledge with medical contents in order to pass on accurate information to the patient and family members. The intended outcome of this intervention is that increasing patient knowledge and getting them involved in their care plan and treatment increase the patient quality of life.

Discharge Planning

The discharge planning starts as soon as the patient is admitted to hospital and it contains information about follow up procedures, details of the patient regular medical practitioner, current medications and future medical appointments. It is the nurse responsibility to prepare and finalize the discharge plan. Social justice framework should be followed in discharge plan, by using the social justice principles there will be a strong commitment to care and education which will be lasting beyond the health institution walls (Hatchett et al,.2015). The potential factors indicated for re-hospitalization that is inadequate and the non-adherence of the patient to the instruction provided on discharge( Driver & Gosian 2015).The discharge plan also includes identification, assessment, goal setting plans, implementation, coordination, and evaluation. It is the most important that help patient treatment after the patient leaves the hospital ( Driver & Gosian 2015: Pathophysiology Assessment: CHF Case Study Essay Paper). The patient is a 79-year-old male with multiple comorbidities, he has decreased physiological reserve so it would resist the changes. The social environment in which the patient will be discharged needs to be assessed. The discharge plan for Mr. Smith will be a collaborative process between the cardiovascular team and social team. The discharge plan includes:

Activity: The patient is best to start with mild exercise such as walking and gardening, the more exercise he does the better effect it has on his overall physical wellbeing.

Diet: Restricting the salt intake, it also recommended to avoid consuming alcohol and increase his liquid intake.

Tobacco: Smoking increase MI, it harms the blood vessels that carry oxygen to heart so, if the person is smoking he should quit.

Medicine: It is emphasized to the patient to take medicines on time with the right dosage. Weight monitoring: The patient BMI is 34 which is considered obese, the patient is advised to monitor the weight regularly and seek medical help if his weight increased beyond 2 pounds daily.

As directed in the discharge plan, collaborative follow up appointments should be made such as visiting dietitian. The first follow up appointment should be made within 7 days after discharge.

The above case study and its pathophysiological changes may best conclude with the fact that the role of RN in primary patient assessment and implementing interventions is very important. The better treatment outcome is when the patient is actively involved in his own care plan and be the vigilantes of his own care. An understanding of the inherent hazards and medications errors, a good level of knowledge, therapeutic communication will effect on nurse performance and minimize the errors in patient care. The patient and his carer education will improve the treatment plan and the patient quality of life.

Reference list

Braun, CA & Anderson, CM 2017, Applied pathophysiology : a conceptual approach to the mechanisms of disease, Third edition.

Carone, Oxberry, Twycross, Charlesworth, Mihalyo, & Wilcock 2016, ‘Furosemide’ Journal of Pain and Symptom Management, vol. 52, no. 1, pp. 144–150, doi: 10.1016/j.jpainsymman.2016.05.004.

Driver, J & Gosian, J 2015, ‘Post-Discharge Medication Reconciliation Intervention in Elderly Veterans with CHF’ Journal Of The American Geriatrics Society, vol. 63, pp. S139– S139.

Goharani, R, Miri, M, Kouchek, M, & Sistanizad, M 2017, ‘Familiarity of Physicians and Nurses with Different Aspects of Oxygen Therapy; a Brief Report.’ Emergency (Tehran, Iran), vol. 5, no. 1, p. e39, doi: 10.22037/emergency.v5i1.12005.

Hatchett, Elster, Wasson, Anderson & Parsi 2015, ‘Integrating Social Justice for Health Professional Education: Self-reflection, Advocacy, and Collaborative Learning’ online journal of health ethic, vol. 11, no.1, doi: 10.18785/ojhe.1101.04

Mayhob 2018 , ‘Nurses’ Knowledge, Practices and Barriers Affecting a Safe Administration of Oxygen Therapy’ Journal of nursing and health science, vol. 7 no. 3, pp. 42-51 doi: 10.9790/1959-0703024251

Soltan, M & Kim, M 2016, ‘The ABCDE approach explained’ Student BMJ, vol. 24, doi: 10.1136/sbmj.i4512.

Verloo, H, Chiolero, A, Kiszio, B, Kampel, T, & Santschi, V 2017, ‘Nurse interventions to improve medication adherence among discharged older adults: a systematic review’ Age and Ageing, vol. 46, no. 5, pp. 747–754, doi: 10.1093/ageing/afx076.

World health organization 2011, Improving medication safety, viewed 8 April 2019. https://

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