Scenario 1: 76-year-old Female Patient with a History of Congestive Heart Failure
Scenario 1: 76-year-old Female Patient with a History of Congestive Heart Failure
Scenario 1: 76-year-old female patient complains 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.
Scenario 3: 11-year-old boy complains of wheezing and difficulty “getting enough air.” Notices it more when he is playing baseball and symptoms improve when exercise activity stops. He says that the symptoms are getting worse and the symptoms are even occurring at rest. Mother says the child is allergic to cat dander and his next-door neighbor in their apartment building recently began sheltering cats for the local humane society. Auscultation demonstrates wheezes on forced expiration throughout all lung fields.
Scenario 2: A 65-year-old patient is 8 days post op after a total knee replacement. Patient suddenly complains of shortness of breath, pleuritic chest pain, and palpitations. On arrival to the emergency department, an EKG revealed new onset atrial fibrillation and right ventricular strain pattern – T wave inversions in the right precordial leads (V1-4) ± the inferior leads (II, III, aVF)
Scenario 4: 45-year-old woman presents with chief complaint of 3-day duration of shortness of breath, cough with thick green sputum production, and fevers. Patient has history of COPD with chronic cough but states the cough has gotten much worse and is interfering with her sleep. Sputum is thicker and harder for her to expectorate. CXR reveals flattened diaphragm and increased AP diameter. Auscultation demonstrates hyper resonance and coarse rales and rhonchi throughout all lung fields.
Left and Right Congestive Heart Failure
Left-sided congestive heart failure (CHF) occurs when the left ventricle cannot pump adequate blood around the body. Consequently, blood builds up in the pulmonary veins causing pulmonary congestion that manifests with shortness of breath (SOB), difficulties in breathing, and productive cough (Schwinger, 2021). In right-sided CHF, the right ventricle is unable to empty completely. As a result, increased volume and pressure develops in the venous system, and the veins push fluid out of the veins into surrounding tissue, resulting in peripheral edema (Schwinger, 2021). It is caused by left ventricular failure, pulmonary hypertension, or right ventricular myocardial infarction.
Immune system
In left-and right-sided CHF, the activation of the immune system contributes to increased production and release of various pro-inflammatory cytokines. Alterations of adaptive immunity are crucial for CHF pathophysiology. Patients with chronic ischemic cardiomyopathy have been found to have a systemic expansion of CD4+ and CD8+ T cells, which are found in the failing heart, circulation, and lymphoid organs (Perticone et al., 2019). In addition, CHF patients with reduced or preserved ejection fraction (EF) have different immune-mediated mechanisms of inflammation. Perticone et al. (2019) found a significant elevation of pro-inflammatory cytokines and a parallel reduction of the protective cytokine IL-10 in CHF patients with reduced EF, which reflects an increased activation of toll-like receptors (TLRs).
Neurological System
Low cardiac output (CO) in left-and right-sided CHF causes decreased cerebral perfusion. Cognitive impairment is a very common comorbidity in patients with chronic CHF. Villringer & Laufs (2021) explain that more than 40% of CHF patients show signs of memory impairment, attention deficits, and concentration difficulties. Notably, cognitive impairment in CHF is associated with poor prognosis. The fundamental role of the bi-directional interactions between the heart and the brain is increasingly recognized. Chronically decreased cardiac output causes neurological and cognitive dysfunction. This is because it causes reduced cerebral blood flow and slow metabolism, which causes dementia (Villringer & Laufs, 2021). Furthermore, CHF patients with reduced EF have reduced volumes in the fronto-median brain regions, including the orbito-frontal cortex, cingulate cortex, and precuneus. This affects neurological functions like executive, visuospatial, and delayed recall.
Endocrine System
Dysfunction in the endocrine system is often observed in patients with CHF. Endocrine dysfunction is more prevalent in CHF patients with reduced EF. The reduced cardiac output in left-sided CHF activates carotid, aortic, and cardiac baroreceptors. This results in the activation of different neuroendocrine patterns, including plasma atrial natriuretic peptide, noradrenaline, arginine-vasopressin (AVP), brain natriuretic peptide, endothelin and adenosine release, and activation of the renin-angiotensin-aldosterone system (Lisco et al., 2022). These responses are initially significant to reinstate short-term cardiovascular homeostasis. However, the responses become maladaptive in the long term, resulting in myocardial remodeling and increasing an individual’s susceptibility to arrhythmias.
Hematological system
Anemia occurs in CHF patients and usually has a poor prognosis. Anemia in CHF is usually caused by bone marrow depression due to increased cytokine production, malnutrition, and associated renal disease. The reduced cardiac output in left-sided CHF causes a reduced red blood cell (RBC) volume and an increased plasma volume, which results in reduced hematocrit (Schwinger, 2021). Hemodilution often occurs in edematous, hypervolemic CHF patients. Cytokine activation and inflammation in CHF contribute to anemia because of poor utilization of iron. Furthermore, CHF leads to reduced production of erythropoietin hormone by the kidneys. This occurs when there is reduced cardiac output, causing reduced renal supply and renal hypoxia.
Cardiovascular system
The reduced cardiac output in left-sided CHF causes the heart’s walls to thicken to provide more muscle mass to pump enough blood to meet the body’s requirements. This is a compensatory mechanism that leads to more forceful contractions, which further increase cardiac output. However, the myocardium tends to hypertrophy more rapidly than how the circulation can provide adequate blood supply to the muscle (Liu et al., 2021). A hypertrophied heart is usually oxygen deprived to some extent. The compensatory mechanism results in an increase in the consumption of myocardial oxygen. However, when there is an increased demand for oxygen, and the myocardial reserve gets exhausted, clinical manifestations of heart failure occur.
Pulmonary system
When the heart cannot pump efficiently, blood backs up into the pulmonary vein. This results in pressure building up in the pulmonary vein, and fluid is pushed into the alveoli in the lungs. The fluid in the alveoli hinders normal oxygen movement through the lungs. Consequently, pulmonary edema develops, which is an abnormal buildup of fluid in the lungs and causes shortness of breath (Dobbe et al., 2019). Pulmonary edema that develops in acute decompensated heart failure is caused by dysregulation of pulmonary fluid homeostasis and the forces that maintain an equilibrium of fluid movement into the alveolar space (Dobbe et al., 2019). Furthermore, fluid in the alveoli disrupts surfactant function and increases surface tension, which often contributes to more edema formation and atelectasis with impaired gas exchange.
Renal/Urinary system
CHF is a significant risk factor for renal disease. Low cardiac output in left CHF results in decreased blood flow to the kidneys, and the kidneys experience a reduced supply of oxygenated blood. Also, when the heart cannot pump efficiently, it becomes congested with blood that, causes pressure build up in the inferior venacava, which is connected to the kidneys (Schwinger, 2021). This further leads to congestion of blood in the kidneys, and they start failing. Reduced renal supply results in the hormone system, which regulates blood pressure, going into overdrive to increase blood supply to the kidneys. Consequently, the heart is forced to pump against the higher pressure in the arteries and eventually fails from the high workload. Blood supply to the kidneys then reduces, resulting in progressive renal failure.
Digestive System
Patients with CHF present with common GI manifestations like anorexia, early satiety, and abdominal pain. Patients with advanced CHF often present with ascites, protein-losing enteropathy (PLE), and cachexia. These symptoms are associated with poor perfusion of abdominal organs and edema. Ascites is a pathologic condition characterized by fluid collection within the abdominal cavity (Trongtorsak et al., 2022). Right-sided CHF causes high pressure in the blood vessels of the liver and low levels of albumin. The venous return is obstructed in CHF, which causes an expansion of venous volume, higher hydrostatic pressure, and, eventually, fluid filtration into the peritoneal cavity. Cardiac cachexia is a catabolic state characterized by unintentional and non-edematous weight loss of more than 7.5% of premorbid body weight over six months (Trongtorsak et al., 2022). Cardiac cachexia is related to left ventricular systolic function, poor survival independently of functional capacity, or peak oxygen consumption
References
Dobbe, L., Rahman, R., Elmassry, M., Paz, P., & Nugent, K. (2019). Cardiogenic pulmonary edema. The American Journal of the Medical Sciences, 358(6), 389-397. https://doi.org/10.1016/j.amjms.2019.09.011
Lisco, G., Giagulli, V. A., Iovino, M., Zupo, R., Guastamacchia, E., De Pergola, G., Iacoviello, M., & Triggiani, V. (2022). Endocrine system dysfunction and chronic heart failure: a clinical perspective. Endocrine, 75(2), 360–376. https://doi.org/10.1007/s12020-021-02912-w
Liu, Y., Chen, X., & Zhang, H. G. (2021). Cardiac Hypertrophy: From Compensation to Decompensation and Pharmacological Interventions. Frontiers in Pharmacology, 12, 665936. https://doi.org/10.3389/fphar.2021.665936
Perticone, M., Zito, R., Miceli, S., Pinto, A., Suraci, E., Greco, M., … & Perticone, F. (2019). Immunity, inflammation and heart failure: their role on cardiac function and iron status. Frontiers in Immunology, 10, 2315. https://doi.org/10.3389/fimmu.2019.02315
Schwinger, R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302
Trongtorsak, A., Kittipibul, V., Antala, D., Meng, Q., & Puwanant, S. (2022). Heart Failure-Related Ascites With Low Serum-Ascites Albumin Gradient: Diagnostic Clues From Triphasic Abdominal Computed Tomography. Cureus, 14(1), e21251. https://doi.org/10.7759/cureus.21251
Villringer, A., & Laufs, U. (2021). Heart failure, cognition, and brain damage. European Heart Journal, 42(16), 1579-1581. https://doi.org/10.1093/eurheartj/ehab061
Module 2 Assignment: Case Study Analysis
An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.
Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.
Photo Credit: yodiyim / Adobe Stock
Module 2: Case Study Analysis Assignment
By Day 1 of Week 3, choose a case study scenario for this term and assign the scenario to your students in your section. Please post by copying and pasting the case study scenario in the “Course Announcements” section of the course. Students will need their assigned scenario to complete the Assignment for this module. Note: These case study scenarios will be rotated throughout each term to reduce any academic integrity issues. For each term, please use one case study scenario at a time. Please contact your lead faculty member if you have any questions.
An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.
In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.
To prepare:
By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Course Announcements” section of the classroom for your assignment from your Instructor.
Assignment (1- to 2-page case study analysis)
In your Case Study Analysis related to the scenario provided, explain the following
- The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.
- Any racial/ethnic variables that may impact physiological functioning.
- How these processes interact to affect the patient.
By Day 7 of Week 4
Submit your Case Study Analysis Assignment by Day 7 of Week 4
Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templates). All papers submitted must use this formatting.
Submission and Grading Information
To submit your completed Assignment for review and grading, do the following:
- Please save your Assignment using the naming convention “M2Assgn+last name+first initial.(extension)” as the name.Scenario 1 76-year-old Female Patient with a History of Congestive Heart Failure
- Click the Module 2 Assignment Rubric to review the Grading Criteria for the Assignment.
- Click the Module 2 Assignment link. You will also be able to “View Rubric” for grading criteria from this area.
- Next, from the Attach File area, click on the Browse My Computer button. Find the document you saved as “M2Assgn+last name+first initial.(extension)” and click Open.
- If applicable: From the Plagiarism Tools area, click the checkbox for I agree to submit my paper(s) to the Global Reference Database.
- Click on the Submit button to complete your submission.
Grading Criteria
To access your rubric:
Module 2 Assignment Rubric
Click here to ORDER an A++ paper from our MASTERS and DOCTORATE WRITERS: Scenario 1: 76-year-old Female Patient with a History of Congestive Heart Failure
Check Your Assignment Draft for Authenticity
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Submit your Module 2 Assignment draft and review the originality report.
Submit Your Assignment by Day 7 of Week 4
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Module 2 Assignment
What’s Coming Up in Module 3?
Photo Credit: [BrianAJackson]/[iStock / Getty Images Plus]/Getty Images
In Module 3, you will analyze processes related to gastrointestinal and hepatobiliary disorders through case study analysis. To do this, you will analyze alterations in the relevant systems and the resultant disease processes. You will also consider patient characteristics, including racial and ethnic variables, which may impact physiological functioning and altered physiology.
Week 5 Knowledge Check: Gastrointestinal and Hepatobiliary Disorders
In Week 5 Knowledge Check, you will demonstrate your understanding of the topics covered during Module 3. This Knowledge Check will be composed of a series of questions related to specific scenarios provided. It is highly recommended that you review the Learning Resources in their entirety prior to taking the Knowledge Check since the resources cover the topics addressed. Plan your time accordingly.
Next Module
Week 4: Alterations in the Cardiovascular and Respiratory Systems
Cardiovascular and respiratory disorders can quickly become dangerous healthcare matters, and they routinely land among the leading causes of hospital admissions. Disorders in these areas are complicated by the fact that these two systems work so closely as contributors to overall health. APRNs working to form a similarly close partnership with patients must demonstrate not only support and compassion, but expertise to guide the understanding of diagnoses and treatment plans. This includes an understanding of patient medical backgrounds, relevant characteristics, and other variables that can be factors in their diagnoses and treatments.
This week, you examine alterations in the cardiovascular and respiratory systems and the resultant disease processes. You also consider patient characteristics, including racial and ethnic variables, and the impact they have on altered physiology.
Learning Objectives
Students will:
- Analyze processes related to cardiovascular and respiratory disorders
- Analyze alterations in the cardiovascular and respiratory systems and the resultant disease processes
- Analyze racial/ethnic variables that may impact physiological functioning
- Evaluate the impact of patient characteristics on disorders and altered physiology
Learning Resources
Required Readings (click to expand/reduce)
McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.
- Chapter 32: Structure and Function of the Cardiovascular and Lymphatic Systems; Summary Review
- Chapter 33: Alterations of Cardiovascular Function (stop at Dysrhythmias); Summary Review
- Chapter 35: Structure and Function of the Pulmonary System; Summary Review
- Chapter 36: Alterations of Pulmonary Function (stop at Disorders of the chest wall and pleura); (obstructive pulmonary diseases) (stop at Pulmonary artery hypertension); Summary Review
Note: The above chapters were first presented in the Week 3 resources. If you read them previously you are encouraged to review them this week.
Note: The above article was first presented in the Week 3 resources. If you read it previously you are encouraged to review it this week.
Required Media (click to expand/reduce)
Alterations in the Cardiovascular and Respiratory Systems – Week 4 (15m)
Pneumonia
Note: The approximate length of the media program is 13 minutes.
(Previously reviewed in Week 3)
Online Media from Pathophysiology: The Biologic Basis for Disease in Adults and Children
In addition to this week’s media, it is highly recommended that you access and view the resources included with the course text, Pathophysiology: The Biologic Basis for Disease in Adults and Children. Focus on the videos and animations in Chapters 32, 33, 35, and 36 that relate to cardiorespiratory systems and alteration in cardiorespiratory systems. Refer to the Learning Resources in Week 1 for registration instructions. If you have already registered, you may access the resources at https://evolve.elsevier.com/
Rubric Detail
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Content
Name: NURS_6501_Module2_Case Study_Assignment_Rubric
| Excellent | Good | Fair | Poor | ||
| Develop a 1- to 2-page case study analysis, examing the patient symptoms presented in the case study. Be sure to address the following:
Explain both the cardiovascular and cardiopulmonary pathophysiologic processes of why the patient presents these symptoms. |
Points Range: 28 (28%) – 30 (30%)
The response accurately and thoroughly describes the patient symptoms. The response includes accurate, clear, and detailed reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation. |
Points Range: 25 (25%) – 27 (27%)
The response describes the patient symptoms. The response includes accurate reasons, with explanation for both the cardiovascular and cardiopulmonary pathophysiologic processes supported by evidence and/or research, as appropriate, to support the explanation. |
Points Range: 23 (23%) – 24 (24%)
The response describes the patient symptoms in a manner that is vague or inaccurate. The response includes reasons for the cardiovascular and/or cardiopulmonary pathophysiologic processes, with explanations that are vague or based on inappropriate evidence/research. |
Points Range: 0 (0%) – 22 (22%)
The response describes the patient symptoms in a manner that is vague and inaccurate, or the description is missing. The response does not include reasons for either the cardiovascular or cardiopulmonary pathophysiologic processes, or the explanations are vague or based on inappropriate or no evidence/research. |
|
| Explain how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. | Points Range: 28 (28%) – 30 (30%)
The response includes an accurate, complete, detailed, and specific explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
Points Range: 25 (25%) – 27 (27%)
The response includes an accurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
Points Range: 23 (23%) – 24 (24%)
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
Points Range: 0 (0%) – 22 (22%)
The response includes a vague or inaccurate explanation of how the cardiovascular and cardiopulmonary pathophysiologic processes interact to affect the patient. |
|
| Explain any racial/ethnic variables that may impact physiological functioning. | Points Range: 23 (23%) – 25 (25%)
The response includes an accurate, complete, detailed, and specific explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation. |
Points Range: 20 (20%) – 22 (22%)
The response includes an accurate explanation of racial/ethnic variables that may impact physiological functioning supported by evidence and/or research, as appropriate, to support the explanation. |
Points Range: 18 (18%) – 19 (19%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, and/or explanations based on inappropriate evidence/research. |
Points Range: 0 (0%) – 17 (17%)
The response includes a vague or inaccurate explanation of racial/ethnic variables that may impact physiological functioning, or the explanations are based on inappropriate or no evidence/research. |
|
| Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria. |
Points Range: 5 (5%) – 5 (5%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria. |
Points Range: 4 (4%) – 4 (4%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet are brief and not descriptive. |
Points Range: 3 (3%) – 3 (3%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic. |
Points Range: 0 (0%) – 2 (2%)
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided. |
|
| Written Expression and Formatting – English Writing Standards: Correct grammar, mechanics, and proper punctuation |
Points Range: 5 (5%) – 5 (5%)
Uses correct grammar, spelling, and punctuation with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) grammar, spelling, and punctuation errors. |
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) grammar, spelling, and punctuation errors. |
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the reader’s understanding. |
|
| Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, running heads, parenthetical/in-text citations, and reference list. | Points Range: 5 (5%) – 5 (5%)
Uses correct APA format with no errors. |
Points Range: 4 (4%) – 4 (4%)
Contains a few (1 or 2) APA format errors. |
Points Range: 3 (3%) – 3 (3%)
Contains several (3 or 4) APA format errors. |
Points Range: 0 (0%) – 2 (2%)
Contains many (≥ 5) APA format errors. |
|
| Total Points: 100 | |||||