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I need 6 problems to be written up from the case study following care plan template which needs to be provided as an appendix therefore you can as many words as you would like. For main report which is task 2, you have to choose 2 problems from the 6 problems you have provided for task 1 as an appendix. Once you do that open the guidelines and go through page no 3 and 4 because those are the areas i want you to cover and also check the marking criteria carefully and provide the solution accordingly. I also want you to use the Harvard referencing for this order for which i will be providing you the guide. And i have provided the example paper of how to approach this task therefore kindly go through that paper and follow the format and please do not use any content fro there as it is for only example purpose.
Mr Anthony Khoury is a 67-year old male who was admitted to the emergency department with acute chest pain and shortness of breath. He has a medical history of type 2 diabetes, along with peripheral vascular disease (PVD) and symptomatic neuropathy because of diabetes, other medical complications include angina, hypertension, and dyslipidaemia; however, managed with medication. He had a surgical history of coronary angioplasty and stents due to the presence of Acute Myocardial Infarction (AMI) in 2010. This report is about Mr. Anthony Khoury where I will highlight the identification of two actual health risks about his medical diagnosis; also, will discuss the two-actual health problem pathophysiology, nursing intervention, and possible patient outcomes.
Mr. Anthony Khoury was provisionally diagnosed with cardiac disorders and most probably congestive heart failure manifested by the inability to pump sufficient blood into the pulmonary vein and rapid or irregular heart rate. After evaluation, bilateral coarse crackles are found on the lung bases, oedema in both ankles, shortness of breath, tachycardia, irregular heart rate, and left chest pain was found. The potential risk of congestive cardiac failure has characteristics signs like decrease cardiac output, increase fluid volume, activity intolerance, fatigue, dyspnea, hypertension, respiratory distress. Regardless of his clinical symptoms, associated medical conditions involve increase level of stress and anxiety and decline of general health.
Actual Problem:
Atrial Fibrillation:
Mr Anthony Khoury’s medical report shows the presence of risk factors like advanced age, hypertension, previous medical history of Acute Myocardial Infarction (AMI) and habit of alcohol consumption, atrial fibrillation, sleep apnea, which are associated with heart-related diseases. So, diagnosis and prioritizing nursing intervention regarding the treatment of atrial fibrillation (AF) is essential because it can lead to serious complications such as formation of blood clots in the heart which can block blood flow and leads to ischemia, stroke, congestive heart failure (CHF), coronary artery disease (CAD) and diabetes mellitus (Rosiak et al., 2010).
Pathophysiology:
Atrial fibrillation (AF) condition is usually identified by rapid and irregular heartbeat, which is most often caused by the disturbance in electrical signalling activity (van Brakel et al., 2013). In AF, the heart loses effective pumping activity due to the trembling and not unloading totally, which may lead to blood pool as well as blood coagulation. However, other promoting factors related to AF include metabolic stress, atrial inflammation, atrial ischemia, hemodynamic stress etc. (Yamazaki & Jalife, 2012; Araújo et al, 2013).
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OEDEMA:
Though, oedema is not considered as a disease rather demonstrated as a symptom. However, if left untreated it may cause skin infection or ulcer and eventually decreased blood circulation, resulting blood clots in the veins and further leads to deep vein thrombosis. Also, the clinical conditions associated with oedema include cirrhosis, cardiovascular diseases, heart failure, diabetes, and nephrotic syndrome. Considering all of these facts, diagnosis and nursing intervention regarding the treatment of oedema is crucial to avoid further complications.
Pathophysiology:
Oedema is usually developed due to the abnormal accumulation of fluid in the interstitial or intracellular spaces and as a result, reduced the water and electrolyte movement from the interstitium to the capillaries and lymphatic vessels. The enormous interstitial fluid collection is usually impeding the functioning of tissue as oedema development enhances the required distance for oxygen and nutrients diffusion that may be detrimental to cellular metabolism in the swollen tissue.
Nursing diagnosis, intervention and outcomes for Atrial Fibrillation:
Nursing diagnosis involves chest pain, shortness of breath, alteration in heart rate, HR 125-130 BPM, ECG shows Atrial fibrillation, BP Sitting: 146/88 and standing: 132/68. Atrial fibrillation is related to cardiovascular disorders.
Outcome
Desired nursing outcome include restoring normal heart rate and sinus rhythm within 24 hours, preventing blood clot formation. However, the ultimate goal is to achieve normal cardiac output and reduce the risk of stroke.
Intervention
Management or nursing intervention of atrial fibrillation condition depends on the current symptoms and severity. Monitoring vital signs are foremost; as per 2014 AHA/ACC/HRSguideline, the recommended resting heart rate is 110BPM; but it can vary if patients have cardiac disorders (Cutugno, 2015). Administration of recommended drugs like beta-adrenergic antagonists, calcium channel antagonists, digoxin is used to control heart rate (Sethi et al., 2017). Beta-blockers help to decrease cardiac contraction and pace of heartbeat; whereas, calcium- channel blockers decrease the heart rate by reducing the electrical activity (Cutugno, 2015; Beyer-Westendorf et al, 2015; Rogers and Bush, 2015). Anticoagulation therapy by the application of blood thinner helps to disintegrate and prevent blood clot and enhances blood flow. Fall prevention and monitoring the side effects of medications are crucial. To convert atrial fibrillation to regular sinus rhythm use of antiarrhythmics, electrical cardioversion, and ablation are found to be beneficial. Several antiarrhythmic agents like amiodarone, dofetilide and propafenone proved to be effective in conversion of atrial fibrillation to the normal rhythm (January et al., 2014; Shakkottai et al, 2017). The electrical cardioversion is utilised to reset heart’s electricity to prompt a normal cardiac rhythm; and the process involves continuous ECG monitoring along with advanced cardiac life support (ACLS) team (Curtis, 2013). The ablation technique is useful for the symptomatic AF patients, who are intolerant to other treatments and medications (Curtis, 2013). The process includes insertion of catheters to identify fibrillation causing atrial tissue into the patient’s heart; and followed by the scarring of pulmonary veins to eliminate or prevent ectopic stimuli conduction (Fichtner et al., 2012; Malmo et al, 2016). Monitoring of cardiac enzyme like troponin is crucial to determine the myosin and actin interaction in the cardiac muscle; and the measurement of creatine kinase MB level is used for the energy conversion related to the cardiac muscle contraction (Daubert and Jeremias, 2010). Furthermore, it is important to provide information regarding the risk of a blood clot formation and stroke.
After successful nursing interventions the effectiveness can be demonstrated by the adequate cardiac output, which in turn manifested by normal BP and pulse rate, the absence of dysrhythmia; also evidenced by the capability of activity tolerance without any signs of chest pain and dyspnea. The patient must verbalise the understanding of therapeutic regimen and possible adverse side effects. The long-term desired outcome include no signs of complications related to cardiac output or tissue perfusion, decreased anxiety or stress level, identify signs and symptoms related to heart failure (Hendriks et al., 2012; Zoni et al, 2014).
Nursing diagnosis, intervention, and outcomes for Oedema:
The nursing diagnosis includes increased fluid as demonstrated by oedema in ankles, bilateral coarse crackles in the bases of the lungs, tachypnea, atrial fibrillation, and pain in the left upper chest area that is reduced with the O2 administration. All of these symptoms are related to heart failure or cardiovascular diseases (House-Fancher & Foell, 2012).
The nursing outcome involves maintaining normal fluid and electrolyte balance, complete elimination of oedema, no evidence of difficulty in breathing and shortness of breath, decreasing fatigue and anxiety, monitoring principal vital signs along with blood pressure, cardiac output, venous pressure, and pulmonary capillary wedge pressure.
The nursing intervention includes monitoring vital signs and assessing potential risk factors to obtain baseline data. The assessment of the patient’s appetite is important to prevent excess fluid retention, also evaluate fluid intake and urinary output. To maintain fluid balance, assessments of oedema like regular monitoring of the location and extent of oedema are important as excess fluid volume may elevate hydrostatic pressure within the tissues, which is associated with heart failure and kidney failure. So, extremity measuring by using a millimetre tape is more effectual as compared to 1-4 scale (Azzolin et al., 2013). It is important to monitor respiratory rate for severity of dyspnea, tachypnea, and persistent cough; also, lung sound for crackles because negative respiratory status is related to pulmonary oedema and heart failure. Measuring daily body-weight is important because changes in weight reflect changes in body fluid volume and to evaluate the presence of crackles or congestion. Limitation of sodium intake can help in the renal excretion of excess fluid and prevent fluid retention. Administration of prescribed diuretics intravenously or orally can favour diuresis, vasodilation, no sign of edema, vasodilation and increased renal blood flow (Ter Maaten et al., 2015; Larsen et al, 2016). Application of the recommended antihypertensive is crucial to treat hypertension by counteracting effects of decreased renal blood flow. Maintaining fluid intake as it can increase the fluid retention amount. It is important to position patient in a semi-Fowler’s or high-Fowler’s manner to avoid dyspnea and prevent pressure ulcers. Sometimes, applying anti-embolic stockings can prevent fluid additional fluid accumulation in intravascular tissues Evaluation of mental status is important as it may indicate cerebral edema.
Evaluation of patient-centered care plan is important to measure effectiveness of nursing interventions. Within 8-10 hours, the patient must be able to verbalise understanding regarding the fluid and electrolyte intake to decrease excess fluid volume and prevent unnecessary fluid loss. The long-term nursing evaluation includes stable weight, normal vital signs, stabilised fluid volume, and elimination of oedema.
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Araújo, A.A.D., Nóbrega, M.M.L.D. and Garcia, T.R., 2013. ‘Nursing diagnoses and interventions for patients with congestive heart failure using the ICNP®’. Revista da Escola de Enfermagem da USP, 47(2), pp.385-392.
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