Answers:
Concept Map On Left Heart Failure
Q1.

In the present case study, it is found that the patient, Mrs Brown, has been suffering from severe breathlessness, and a host of clinical manifestations, including severe dyspnoea, RP 24 bpm, SpO2 85%, BP 170/95 mmHg, PR 120 bpm and the auscultation of the lungs indicates bilateral basal crackles. She had been diagnosed with left-side heart failure. Left-sided heart failure has been proved to be a serious heath condition imposing life risk for the patient, and is marked by the inability of the left side of the heart to pump blood in an effective manner. Under normal conditions, the heart is responsible for pumping oxygen-rich blood that travels from the lungs to the left atrium and then on to the left ventricle after which it reaches to the different parts of the body (Liaw & Zimmermann, 2016). The left ventricle of the heart is supposed to supply most of the pumping action of the heart and is, therefore, larger than the other heart chambers. Normal functioning of the heart is chiefly dependent upon the left ventricle. Left sided heart failure is not to be considered as a diagnosis under medicl conditions. It actually is a representation of a group of signs and symptoms arising due to the condition when the heart is not in a condition to pump blood to the extent that is sufficient for meeting the metabolic needs of the body (Bosch et al., 2017).  

According to Jacobs et al., (2015) in the case of left-sided heart failure, increased pulmonary capillary oncotic pressure from left-sided backflow leads to the pulmonary interstitium to be filled with fluid as a result of the extravasation. The result is reduced pulmonary compliance and enhanced airway resistance. In addition, there is an increased ventilatory drive that is secondary to hypoxemia. Increased pulmonary capillary pressures and mismatch of perfusion and ventilation leads to shortness of breath. Paroxysmal nocturnal dyspnea is common in such cases of heart failure. The underlying mechanism is that redistribution of extravascular fluid from the periphery into the areas when the lungs exacerbate dyspnea. The ventricles are unable to adapt to the increase in volume, resulting in enhanced pulmonary pressure and pulmonary edema. Pulmonary crackles are a major health complication arising at the time of left-side heart failure. This is caused due to the adverse opened condition of the small airways previously closed by edema. Worsening pulmonary edema is a feature of a poor heart condition, and this has an association with crackles in lung fields.

Pulse rate more than the normal value (>100 bpm) is a common feature in patients suffering heart failure. This is the result of the activated form of the sympathetic nervous system against the reduced cardiac output. This is known as tachycardia. An irregular pulse rhythm indicates atrial fibrillation that is found in patients with heart failure. In the case of heart failure, the systolic blood pressure is usually elevated (>140 mm Hg). Increase in respiratory rate (>18 bpm) is an indication of respiratory distress in heart failure and this condition is also related to major pulmonary congestion. When patients suffer from heart failure, they have normal oxygen saturation level. This is due to the fact that though the volume of blood pumped is reduced, the saturation level is not affected immediately. With the passage of time, lack of oxygen has an impact on the organs of the body, leading to lower oxygen saturation.

Q2.

The first nursing strategy applied for Mrs Brown would be to provide supplemental oxygen to the patient. This is to be done on the basis of hypoxia and pulmonary congestion suffered by her. Providing oxygen relieves the ischemia at a flow rate depending on the condition. Oxygen supply going to the blood stream and lungs is increased by this method. Patients are better able to breathe as the heart’s workload is reduced. In the case of heart failure the heart is not able to pump in an effective manner, and thus the body requirements are not met. The therapy increases the oxygen amount delivered to the tissues. Supplemental oxygen is the therapy commonly considered when the saturation level is <90%, and in this case, it is 85%. The second nursing strategy would be to reduce anxiety level of the patient. Controlling anxiety is a key nursing intervention that aims to promote patient’s physical comfort. By providing psychological support and emotional guidance, nurses can help the patient cope up with the distressing situation. Different techniques to control anxiety are to be considered in this process that would suitably avoid any situation that is anxiety-provoking. Reduced anxiety level would enable the patient to bring improvements in her breathing conditions (Hamrick et al., 2013). Q3.    IV furosemide- Furosemide is administered in case of edema occurring as a result of heart failure. The drug acts by inhibiting the reabsorption of chloride and sodium from the Henle loop and distal renal tubule in the kidney. As a result of it, renal excretion of sodium, water, magnesium, chloride and calcium is significantly increased. Through the effective inhibition of sodium reabsorption, water reabsorption is also reduced. As there is a reduction in the glomerular filtration rate, there is also a decrease in the mulinal secretion. As the intravascular volume is reduced, there is a decrease in central venous pressure and left heart filling pressures. The ultimate result is increase of venous capacitance and return of intrapulmonary fluid into the circulation. The cardiac output successively increases. Sublingual glyceryl trinitrate- Glyceral trinitrate is known to increase the coronary blood flow through the dilation of the coronary arteries. In addition, the collateral flow to ischemic regions is also improved through the action of this drug. Vasodilation is produced that decreases the left ventricular end-diastolic pressure. Moreover, the myocardial oxygen consumption is also reduced. Patients are relieved of angina as cardiac output is increased (Lehne & Rosenthal, 2014).    A number of nursing implications are related to the administration of the two drugs to a patient with left-side heart failure. While administering Furosemide, the nurse must assess the fluid status of the patient and monitor hi skin tugour, edema, mucous membrane and lung sounds. Health care professional is to be notified if the patient has a weakness, lethargy or dry mouth. The pulse and blood pressure are to be monitored before and at the time of administration. The patient is to be assessed for taking digoxin for vomiting, nausea, muscle cramps as toxicity can form due to the potassium-depleting effect of the furosemide. In the case of Sublingual glyceryl trinitrate, the duration, intensity and location of occurring chest pain are to be assessed. Further, pulse and blood pressure are to be monitored before administration (Karch & Karch, 2016). References Bosch, L., Lam, C. S., Gong, L., Chan, S. P., Sim, D., Yeo, D., ... & Richards, A. M. (2017). Right ventricular dysfunction in left?sided heart failure with preserved versus reduced ejection fraction. European Journal of Heart Failure. Hamric, A. B., Hanson, C. M., Tracy, M. F., & O'Grady, E. T. (2013). Advanced Practice Nursing-E-Book: An Integrative Approach. Elsevier Health Sciences. Jacobs, W., Konings, T. C., Heymans, M. W., Boonstra, A., Bogaard, H. J., van Rossum, A. C., & Noordegraaf, A. V. (2015). Noninvasive identification of left-sided heart failure in a population suspected of pulmonary arterial hypertension. European Respiratory Journal, 46(2), 422-430. Karch, A. M., & Karch. (2016). Focus on nursing pharmacology. Lippincott Williams & Wilkins. Lehne, R. A., & Rosenthal, L. (2014). Pharmacology for Nursing Care-E-Book. Elsevier Health Sciences. Liaw, N. Y., & Zimmermann, W. H. (2016). Mechanical stimulation in the engineering of heart muscle. Advanced drug delivery reviews, 96, 156-160.