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Key Topics
- Analyse Health and respond to client information
- Q1. Explain the pathophysiology of emphysema. (2marks)
- Q2. Choose two vital signs that are affected by his emphysema? Explain why. (2 marks)
- Q3. Describe the pathophysiology of angina. (2 marks)
- Q4. Explain the pathophysiology of a Myocardial Infarction. Name one type of a MI – think about the area of the heart that may have been affected. (3 marks)
- Q5. How / why would his past AMI have caused his CCF? (2 marks)
- Q7. Explain Benign Prostate Hypermegaly (BPH) (2marks)
- Q8. What is Pulmonary Oedema? What signs and symptoms would you be looking for in case Mr Brown started to show signs of PO? (2 marks)
- Q9. Complete three nursing care plans for Mr. Brown. Each plan must identify one patient problem/issue, one goal and two courses of action you would take. The outcome should then be evaluated. (18 marks)
- Q10. State the general role of Allied Health workers providing patient care. (2 marks)
- Q11. List those that should be involved in Mr. Brown’s care to ensure that when he is discharged home, he will be able to live safely until he makes a decision to move into permanent care. Describe in detail their role and how they will assist Mr. Brown (6 marks).
- References:
Analyse Health and respond to client information
Answer 1.
The inhaled irritants (tobacco smoke or dust) may cause oxidative damage to the alveoli of the lungs and further prompts the inflammatory process. In response to the inflammation excess proteolytic enzymes released from polymorphonuclear leukocytes and reduce the antiprotease activity, resulting in disruption of the alveolar walls. The surface area for gas exchange reduces and further enhances the blood flow rate through the pulmonary capillary system (Mattison & Christensen, 2006).
Long-term exposure to irritants may cause erosion in the alveolar walls, which may lead to the development of large cavities i.e. bullae. Consequently, the gaseous exchange decreased significantly and bringing about inspired air to be trapped during exhalation (Hough, 2014).
Long-term exposure to irritants may cause erosion in the alveolar walls, which may lead to the development of large cavities i.e. bullae. Consequently, the gaseous exchange decreased significantly and bringing about inspired air to be trapped during exhalation (Hough, 2014).
Answer 2.
The two important vital signs of the patient are increased heart rate and blood pressure.
The emphysema patients may not inhale enough O2 and exhale enough CO2 which leads to the breathlessness. As a result, the oxygen level in blood decreases, consequently, the heart started to function more rapidly than usual to supply required oxygenated blood to the bloodstream (Jensen et al., 2013; Visca et al., 2013).
The patients with emphysema mostly suffered from hypoxia, inflammation, and loss of alveolar tissue which further leads to the constriction of the pulmonary artery blood vessels. (Held & Jany, 2012; Imaizumi et al., 2014). Subsequently, create high pressure to the right atrium and ventricle to pump more oxygenated blood to the alveoli and left part of the heart, resulting increase of BP (Engström et al., 2001).
The emphysema patients may not inhale enough O2 and exhale enough CO2 which leads to the breathlessness. As a result, the oxygen level in blood decreases, consequently, the heart started to function more rapidly than usual to supply required oxygenated blood to the bloodstream (Jensen et al., 2013; Visca et al., 2013).
The patients with emphysema mostly suffered from hypoxia, inflammation, and loss of alveolar tissue which further leads to the constriction of the pulmonary artery blood vessels. (Held & Jany, 2012; Imaizumi et al., 2014). Subsequently, create high pressure to the right atrium and ventricle to pump more oxygenated blood to the alveoli and left part of the heart, resulting increase of BP (Engström et al., 2001).
Answer 3.
Angina pectoris is the most widely recognized clinical symptom of myocardial ischemia which is developed due to the inadequacy of myocardial blood flow resulting from constriction of the epicardial coronary artery, however, unusual vasodilatation or more so vasoconstriction coming about because of the impeded endothelial function are likewise vital process (Albrecht, 2013). Increased heart rate, myocardial contractile state, and decreased diastolic perfusion are the principal determinants of myocardial ischemia, which help to meet the myocardial oxygen demand (Davies, 2000).
Answer 4.
Myocardial Infarction usually develops due to the obstruction in the vascular endothelium related to the ambiguous atherosclerotic plaque that invigorates the development of an intracoronary thrombosis (inadequate coronary blood flow), resulting in insufficiency of oxygen (hypoxia) and permanent necrosis of myocardial tissue (Bolooki & Askari, 2010).
ST-segment elevation myocardial infarction (STEMI) affects the middle layer or myocardium of the heart muscle.
ST-segment elevation myocardial infarction (STEMI) affects the middle layer or myocardium of the heart muscle.
Answer 5.
AMI involving a degree of myocardial tissue damage, repetitive ischemia followed by myocardial stunning and loss of cardiomyocytes, left ventricular dysfunction due to oxidative stress and calcium overload are the potential cause of progression of CCF after AMI (Dargie, 2005; Struthers, 2005).
Answer 6.
In CCF the heart loses the ability to pump blood sufficiently to meet the blood supply originating from the venous system and causing blood coming back to the heart through the veins to go down; which in turn causes the fluid accumulation in ankles and legs (Watson et al., 2000; Hosenpud & Greenberg, 2007).
Answer 7.
Benign Prostate Hypermegaly (BPH) is the nonmalignant enlargement of the prostate gland resulting from epithelial and stromal proliferation, impeded apoptosis or both. BPH is a common condition found in aged men, mostly after 50 years and may impair the flow of urine from the bladder (Nimeh et al., 2016; Emberton et al., 2008).
Answer 8.
Pulmonary Oedema (PO) is a condition developed due to the excess fluid accumulation in the alveoli of the lungs. This hampers the gaseous exchange process and can cause shortness of breath (Murray, 2011).
The signs and symptoms of PO in case of Mr. Brown are breathlessness during activity, swelling in legs and ankles, increased heart rate.
The signs and symptoms of PO in case of Mr. Brown are breathlessness during activity, swelling in legs and ankles, increased heart rate.
Answer 9.
Ans:
I.Chronic Obstructive Pulmonary Disease (COPD): Goal is to achieve the airway clearances which involves assessment and monitoring of respiration rate and breathes sounds, coughing pattern; and administering bronchodilators and corticosteroids. The desired outcome includes maintenance of patent airway with clear breath sound; demonstrate practices to enhance airway clearance like controlled coughing (Barnett, 2008; Finset, 2007).
II.Hypertension: Goal is to increase the cardiovascular function; and course of action include monitoring blood pressure (BP) and heart rate; observing skin color, temperature, and moisture. The expected outcome includes normal BP and stable cardiac rhythm (Wilson & Ferrer, 2005; Bolton, 2005).
III.Benign Prostate Hypermegaly (BPH): Goal includes relieve chronic urinary retention; encouraging urination during every 2-4 hours, monitoring urinary stream and recording size of the force. Possible outcome includes sufficient urination without bladder distention and pain (Davidian, 2016; European Association of Urology, 2006)
I.Chronic Obstructive Pulmonary Disease (COPD): Goal is to achieve the airway clearances which involves assessment and monitoring of respiration rate and breathes sounds, coughing pattern; and administering bronchodilators and corticosteroids. The desired outcome includes maintenance of patent airway with clear breath sound; demonstrate practices to enhance airway clearance like controlled coughing (Barnett, 2008; Finset, 2007).
II.Hypertension: Goal is to increase the cardiovascular function; and course of action include monitoring blood pressure (BP) and heart rate; observing skin color, temperature, and moisture. The expected outcome includes normal BP and stable cardiac rhythm (Wilson & Ferrer, 2005; Bolton, 2005).
III.Benign Prostate Hypermegaly (BPH): Goal includes relieve chronic urinary retention; encouraging urination during every 2-4 hours, monitoring urinary stream and recording size of the force. Possible outcome includes sufficient urination without bladder distention and pain (Davidian, 2016; European Association of Urology, 2006)
Answer 10.
The Allied health workers work within multidisciplinary health teams to provide specialized patient care through comprehensive assessment and diagnosis, accumulate and manage clinical data, also develop potential therapeutic and rehabilitative interventions to prevent range of illness and promote fast recovery and positive health outcomes (McPherson et al., 2006; "Allied Healthcare Professionals and their role in the healthcare delivery system - ET HealthWorld", 2018)
Answer 11.
To promote recovery of Mr. Brown following home care guidelines are provided after discharge from the hospital.
- The nurse must provide written and verbal information regarding medications and its side effects to prevent further complications.
- Encourage him to measure BP at home and provide instructions to manage hypertension.
- Instruct moderate activity and breathing retraining exercises to control COPD and prevent heart disorders (Barnett, 2008).
- Encourage healthy eating habit (low-sodium diets, non-spicy foods, avoid alcohol, and coffee) and increase fluid intake; also provide information regarding the early signs and symptoms of heart failure (Wilson & Ferrer, 2005).
- The nurse must provide guidelines for monitoring urinary output and exercises for regaining of urinary control (European Association of Urology, 2006).
References:
Act FAST. (2018). Stroke.org. Retrieved 12 February 2018, from http://www.stroke.org/understand-stroke/recognizing-stroke/act-fast
Allied Healthcare Professionals and their role in the healthcare delivery system - ET HealthWorld. (2018). ETHealthworld.com. Retrieved 12 February 2018, from https://health.economictimes.indiatimes.com/news/industry/allied-healthcare-professionals-and-their-role-in-the-healthcare-delivery-system/46835292
Albrecht, S. (2013). The Pathophysiology and Treatment of Stable Angina Pectoris. US Pharm, 38(2), 43-60.
Appleton, J. P., Sprigg, N., & Bath, P. M. (2016). Blood pressure management in acute stroke. Stroke and vascular neurology, e000020.
Awtry, E., Jeon, C., & Ware, M. G. (Eds.). (2006). Blueprints cardiology. Lippincott Williams & Wilkins.
Barnett, M. (2008). Nursing management of chronic obstructive pulmonary disease. British Journal of Nursing, 17(21), 1314-1318.
Barnes, P. J., & Drazen, J. M. (2002). Pathophysiology of asthma. In Asthma and COPD (pp. 343-359).
Baird, A. (2010). Acute pulmonary oedema: Management in general practice. Australian family physician, 39(12), 910.
Barnes, P. J. (2012). COPD and Asthma: Effects Beyond the Respiratory System. Tanaffos, 11(3), 9.
Bolooki, H. M., & Askari, A. (2010). Acute myocardial infarction. Disease Manag Proj.
Davies, M. J. (2000). The pathophysiology of acute coronary syndromes. Heart, 83(3), 361-366.
Bolton, C. (2005). Nursing management of hypertension. Nursing best practice guideline: Shaping the future nursing.
Dargie, H. (2005). Heart failure post-myocardial infarction: a review of the issues. Heart, 91(suppl 2), ii3-ii6.
Davidian, M. H. (2016). Guidelines for the treatment of benign prostatic hyperplasia. US Pharm, 41(8), 36-40.
Dawes, M. (2013). Why is controlling blood pressure after stroke so difficult?. Canadian Medical Association Journal, 185(1), 11-12.
Emberton, M., Cornel, E. B., Bassi, P. F., Fourcade, R. O., Gomez, J. M. F., & Castro, R. (2008). Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. International journal of clinical practice, 62(7), 1076-1086.
Engström, G., Wollmer, P., Valind, S., Hedblad, B., & Janzon, L. (2001). Blood pressure increase between 55 and 68 years of age is inversely related to lung function: longitudinal results from the cohort study ‘Men born in 1914’. Journal of hypertension, 19(7), 1203-1208.
ETHealthworld.com. (2018). Allied Healthcare Professionals and their role in the healthcare delivery system - ET HealthWorld. [online] Available at: https://health.economictimes.indiatimes.com/news/industry/allied-healthcare-professionals-and-their-role-in-the-healthcare-delivery-system/46835292 [Accessed 12 Feb. 2018].
European Association of Urology. (2006). Guidelines on Benign Prostatic Hyperplasia/J. de la Rosette, G. Alivizatos, S. Madersbacher, C. Rioja Sanz, J. Nordling, M. Emberton, S. Gravas, MC Michel, M. Oelke.
Finset, A. (2007). Health care needs of patients with obstructive lung diseases.
Furie, K. L., Kasner, S. E., Adams, R. J., Albers, G. W., Bush, R. L., Fagan, S. C., ... & Mitchell, P. H. (2010). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke.
Gluecker, T., Capasso, P., Schnyder, P., Gudinchet, F., Schaller, M. D., Revelly, J. P., ... & Wicky, S. (1999). Clinical and radiologic features of pulmonary edema. Radiographics, 19(6), 1507-1531.
Held, M., & Jany, B. (2012). Pulmonary hypertension in COPD. Respiratory care, respcare-02058.
Hurt, K., & Bilton, D. (2012). Haemoptysis: diagnosis and treatment. Acute Med, 11(1), 39-45.
Hosenpud, J. D., & Greenberg, B. H. (Eds.). (2007). Congestive heart failure. Lippincott Williams & Wilkins.
Hough, A. (2014). Physiotherapy in respiratory and cardiac care: an evidence-based approach. Cengage Learning.
Imaizumi, Y., Eguchi, K., & Kario, K. (2014). Lung disease and hypertension. Pulse, 2(1-4), 103-112.
Larici, A. R., Franchi, P., Occhipinti, M., Contegiacomo, A., del Ciello, A., Calandriello, L., ... & Bonomo, L. (2014). Diagnosis and management of hemoptysis. Diagnostic and interventional radiology, 20(4), 299.
Allied Healthcare Professionals and their role in the healthcare delivery system - ET HealthWorld. (2018). ETHealthworld.com. Retrieved 12 February 2018, from https://health.economictimes.indiatimes.com/news/industry/allied-healthcare-professionals-and-their-role-in-the-healthcare-delivery-system/46835292
Albrecht, S. (2013). The Pathophysiology and Treatment of Stable Angina Pectoris. US Pharm, 38(2), 43-60.
Appleton, J. P., Sprigg, N., & Bath, P. M. (2016). Blood pressure management in acute stroke. Stroke and vascular neurology, e000020.
Awtry, E., Jeon, C., & Ware, M. G. (Eds.). (2006). Blueprints cardiology. Lippincott Williams & Wilkins.
Barnett, M. (2008). Nursing management of chronic obstructive pulmonary disease. British Journal of Nursing, 17(21), 1314-1318.
Barnes, P. J., & Drazen, J. M. (2002). Pathophysiology of asthma. In Asthma and COPD (pp. 343-359).
Baird, A. (2010). Acute pulmonary oedema: Management in general practice. Australian family physician, 39(12), 910.
Barnes, P. J. (2012). COPD and Asthma: Effects Beyond the Respiratory System. Tanaffos, 11(3), 9.
Bolooki, H. M., & Askari, A. (2010). Acute myocardial infarction. Disease Manag Proj.
Davies, M. J. (2000). The pathophysiology of acute coronary syndromes. Heart, 83(3), 361-366.
Bolton, C. (2005). Nursing management of hypertension. Nursing best practice guideline: Shaping the future nursing.
Dargie, H. (2005). Heart failure post-myocardial infarction: a review of the issues. Heart, 91(suppl 2), ii3-ii6.
Davidian, M. H. (2016). Guidelines for the treatment of benign prostatic hyperplasia. US Pharm, 41(8), 36-40.
Dawes, M. (2013). Why is controlling blood pressure after stroke so difficult?. Canadian Medical Association Journal, 185(1), 11-12.
Emberton, M., Cornel, E. B., Bassi, P. F., Fourcade, R. O., Gomez, J. M. F., & Castro, R. (2008). Benign prostatic hyperplasia as a progressive disease: a guide to the risk factors and options for medical management. International journal of clinical practice, 62(7), 1076-1086.
Engström, G., Wollmer, P., Valind, S., Hedblad, B., & Janzon, L. (2001). Blood pressure increase between 55 and 68 years of age is inversely related to lung function: longitudinal results from the cohort study ‘Men born in 1914’. Journal of hypertension, 19(7), 1203-1208.
ETHealthworld.com. (2018). Allied Healthcare Professionals and their role in the healthcare delivery system - ET HealthWorld. [online] Available at: https://health.economictimes.indiatimes.com/news/industry/allied-healthcare-professionals-and-their-role-in-the-healthcare-delivery-system/46835292 [Accessed 12 Feb. 2018].
European Association of Urology. (2006). Guidelines on Benign Prostatic Hyperplasia/J. de la Rosette, G. Alivizatos, S. Madersbacher, C. Rioja Sanz, J. Nordling, M. Emberton, S. Gravas, MC Michel, M. Oelke.
Finset, A. (2007). Health care needs of patients with obstructive lung diseases.
Furie, K. L., Kasner, S. E., Adams, R. J., Albers, G. W., Bush, R. L., Fagan, S. C., ... & Mitchell, P. H. (2010). Guidelines for the prevention of stroke in patients with stroke or transient ischemic attack. A guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke.
Gluecker, T., Capasso, P., Schnyder, P., Gudinchet, F., Schaller, M. D., Revelly, J. P., ... & Wicky, S. (1999). Clinical and radiologic features of pulmonary edema. Radiographics, 19(6), 1507-1531.
Held, M., & Jany, B. (2012). Pulmonary hypertension in COPD. Respiratory care, respcare-02058.
Hurt, K., & Bilton, D. (2012). Haemoptysis: diagnosis and treatment. Acute Med, 11(1), 39-45.
Hosenpud, J. D., & Greenberg, B. H. (Eds.). (2007). Congestive heart failure. Lippincott Williams & Wilkins.
Hough, A. (2014). Physiotherapy in respiratory and cardiac care: an evidence-based approach. Cengage Learning.
Imaizumi, Y., Eguchi, K., & Kario, K. (2014). Lung disease and hypertension. Pulse, 2(1-4), 103-112.
Larici, A. R., Franchi, P., Occhipinti, M., Contegiacomo, A., del Ciello, A., Calandriello, L., ... & Bonomo, L. (2014). Diagnosis and management of hemoptysis. Diagnostic and interventional radiology, 20(4), 299.
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