Causes And Nursing Management Of Severe Dyspnoea: Essay.

Causes of Severe Dyspnoea in Mrs Brown

Questions:

1. The pathogenesis causing manifestations manifested in Mrs Brown.

2. Nursing strategies to manage Mrs Brown condition.

3. Mechanism of action of IV furosemide and sublingual glyceryl trinitrate.

Severe dyspnoea

First, the severe dyspnoea that was revealed in Mrs Brown is a breathing discomfort that is characterized by shortness of breath (Yancy et al., 2013). Cardiovascular conditions such as low cardiac output and ischemic heart disease is an important cause of dyspnoea. The patient may have developed the condition after an intense exercise, high altitude experience or adverse changes in temperature. According to Yancy et al. (2013), Mrs Brown’s condition may have been caused by her sedentary lifestyle, asthma and interstitial lung infection among other coronary and pulmonary conditions. The conditions may have reduced the oxygen carrying capacity leading to cardiac failure and subsequently the shortness of breath. 

Increased anxiety, allergic reactions, anaemia, and pneumonia are also attributed to severe cases of dyspnoea. According to McMurray et al. (2012), Mrs Brown may have also been exposed to dangerous levels of carbon monoxide or as a result of her other heart problems that include pulmonary hypertension. Severe dyspnoea that the doctors diagnosed is majorly triggered by environmental pollutants such as smoke and chemicals that may have made it difficult for Mrs Brown to breathe normally (Wagner et al., 2014).

Also, if Mrs Brown was asthmatic, then exposure to allergens such as pollen could have triggered severe dyspnoea episodes. Comprehensive physical examinations of using chest X-rays and CT images revealed more accurate diagnosis of Mrs Brown’s heart, lungs and associated system to ascertain the stipulated causes of severe dyspnoea (Slaughter et al., 2010).    

Correspondingly, a respiratory rate of 24 breaths/minute indicates acute reactive airways diseases such as COPD (chronic obstructive pulmonary disease) and pneumonia. According to Wagner et al. (2014), the normal respiratory rate for older patients such as Mrs Brown should be between 12 and 18 breaths/minute.

Thus, a pulmonary rate above the average especially in elderly patients like Mrs Brown indicated hypotension and necessitated immediate medical assessment. Asthma, lung and heart conditions can also cause rapid respiratory rate that Mrs Brown was experiencing. Research by Aitken, Marshall, & Chaboyer (2016) also attributes to increased respiratory rate to Mrs Brown’s possible response to stress, unknown pain, and anger, or even a possible overdose of aspirin.             

SpO2 85%

Moreover, SpO2 85% indicates an oxygen level of about 85% that the doctors established in Mrs Brown. According to Slaughter et al. (2010), the normal oxygen saturation degree in an individual’s blood should be between 92% and 94%. Therefore, the 85% established implied that Mrs Brown’s body was not getting enough oxygen and straining her heart and other body organs. The chronic level of oxygen can be accredited to heart or lung diseases that Mrs Brown may have suffered from in the past. Also, according to Yancy et al. (2013), sleep disorder (obstructive sleep apnoea) may cause the airway not to open especially during sleep resulting in little oxygen circulation fully.     

Environmental Elements that Trigger Severe Dyspnoea

BP 170/95mmHg

Besides, the BP 170/95mmHg diagnosed implied that Mrs Brown had a high blood pressure (hypertension) of stage 2. According to McMurray et al. (2012), a blood pressure greater than 120/80mm Hg is considered to be above normal and must be controlled. Smoking, obesity majorly causes blood pressure, inadequate physical activity, increased salt consumption and stress. Also, the condition can be caused by old age, genetic, sleep apnoea and chronic heart and kidney conditions. Mrs. Brown had been diagnosed with a heart failure two years back, implying that the hypertension he is suffering from might be the result of the complications of the ongoing diagnosis. As a result of left ventricle dysfunction, pulmonary hypertension might arise due to the passive backward transmission of elevated left-sided filling pressures which occur due to systolic or diastolic LV dysfunction (Rosenkranz 2016).   As per the authors, patients with left ventricular heart failure (HF) are likely to suffer the development of pulmonary hypertension (PH) and there is a significant impact on disease progression, morbidity, and mortality.

A pulse rate of 120 beats/minute

Also, a pulse rate of 120 beats/minute especially when resting or sleeping in the case of Mrs Brown is abnormal. According to Slaughter et al. (2010), a standard pulse rate should be between 60 and 100 beats/minute. Some of the things that may have caused Mrs Brown’s heart beat to increase above the standard rate include high blood pressure, food allergies and thyroid diseases. It is to be noted that Mrs. Brown had already been diagnosed with heart failure 2 years back. High blood pressure might also lead to heart failure due to left ventricular hypertrophy. Ventricular hypertrophy is the thickening of the heart muscle that leads to muscle relaxation between heart beats that are less effective. The heart is incapable of pumping blood for reaching to the organs of the body, especially at the time of exercises. Due to this, the body holds on to the fluids and the heart rate increases. Asthma, smoking and sedentary lifestyle are also attributed to increased heartbeat (Craft et al., 2015).      

Lungs auscultation 

Lastly, given that the auscultation of Mrs Brown’s lungs identified bilateral basal crackles, she maybe had excess fluid in her lungs. Bilateral basal crackles are majorly caused by pneumonia which results into pus-filled and inflamed air sacs in the lungs. Likewise, bronchitis (that may lead to a severe cough and wheezing) and pulmonary oedema (causes blood pressure and collection of fluid in the lungs’ air sacs) are important causes of bilateral basal crackles (Yancy et al., 2013).     

Diagnosis of Dyspnoea: Comprehensive Physical Examinations

The first major policy is the comprehensive nursing assessment that includes various non-pharmacological interventions. Under this strategy, the nurses focus primarily on patient observation to ascertain the effectiveness of the treatment and intervention procedures (Wagner et al., 2014). The nurses are also tasked with understanding and implementing various patient self-management strategies. As such, the nurses will first assess Mrs Brown’s health history to establish conditions such as dyspnoea and oedema.

The patient’s understanding of left heart failure is also explored coupled with other relevant physical examination (McMurray et al., 2012). For example, in the case of Mrs Brown, the nurses auscultated the lungs to establish the presence of crackles and wheezes. This nursing strategy will also involve measuring the urinary output of Mrs Brown as a form of diuretic therapy (Craft et al., 2015). The care plan under this strategy includes the promotion of patient’s physical activity and stressing of the patient’s self-care program among other relevant programs.

Also, there is the pharmacological nursing management strategy that includes using diuretics to relieve associated systems of left heart failure such as oedema (Aitken, Marshall, & Chaboyer, 2016). For instance, given that Mrs Brown has a history of heart failure, aspirin will be the most efficient anti-heart failure medication.    

IV furosemide is a potent diuretic that is used in the elimination of water and salt from the body (Aitken, Marshall, & Chaboyer, 2016). The drug function by blocking sodium, chloride, and water from being absorbed in the kidney tubules. After an oral admission of IV furosemide, there will be an increase in urine output that is eliminated from the body. The recommended dosage of IV furosemide is 20-80 mg per dose among adults administered every 6-8 hours.

Correspondingly, sublingual glyceryl trinitrate works by making the body’s veins and arteries to relax and dilate making it easier for the heart to pump more blood to other parts of the patient’s body (McMurray et al., 2012). The drug with is orally administered is quickly absorbed into the body and prevent possible heart attack, high blood pressure, and chest pains.   

Nursing implication of the stipulated drugs

Common side effects of IV furosemide include reduced blood pressure, dehydration, nausea, diarrhoea, dizziness and abnormal pain. Some of the side effects of sublingual glyceryl trinitrate also include a headache, dizziness, fainting, increased heartbeat, tongue ulcers and allergic reactions. The nurse must educate the patient about these potential side effects so that the patient is aware of the medical conditions that require immediate medical attention. Educating the patient about the side effect ensures that she is able to demonstrate self management techniques for combating medical emergencies.

Diuretic therapy through the administration of Furosemide is significant in providing the patient with a sense of relief from the symptoms of fluid retention associated with heart failure. The nurse is required to monitor and record the weight, pulse, blood pressure and lung sounds of the patient. In addition, the patient needs to be assessed for peripheral oedema. In case the patient is hypotensive, that is the systolic pressure is less than 100 mmHg, and there are signs of dizziness, fatigue or muscle cramps, the cardiologist is to be consulted at the earliest. The patient has to be reviewed the next day, and the symptoms are to be assessed again. The main element of the reassessment would be fluid status. This can be monitored by assessing the mucous membrane and skin integrity. When Sublingual glyceryl trinitrate is given, it is imperative to assess the vital signs appropriately. The drug is to be administered with caution to patients who are hypotensive or hypovolemia. The patient needs to be checked for thee level of consciousness. Moisture on sublingual tissue is required for dissolution of a sublingual tablet, and this needs to be taken care of. The nurse must also look for symptoms such as a headache, palpitations, nausea, vomiting, fever and cold skin (Liley et al., 2014).

References

Aitken, L., Marshall, A., & Chaboyer, W. (2016). Acccn's Critical Care Nursing. Elsevier Health Sciences.

Craft, J., Gordon, C., Huether, S. E., McCance, K. L., & Brashers, V. L. (2015). Understanding pathophysiology-ANZ adaptation. Elsevier Health Sciences.

Lilley, L. L., Collins, S. R., & Snyder, J. S. (2014). Pharmacology and the Nursing Process-E-Book. Elsevier Health Sciences.

McMurray, J. J., Adamopoulos, S., Anker, S. D., Auricchio, A., Böhm, M., Dickstein, K., ... & Jaarsma, T. (2012). ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012. European journal of heart failure, 14(8), 803-869.

Slaughter, M. S., Pagani, F. D., Rogers, J. G., Miller, L. W., Sun, B., Russell, S. D., ... & Adamson, R. M. (2010). Clinical management of continuous-flow left ventricular assist devices in advanced heart failure. The Journal of Heart and Lung Transplantation, 29(4), S1-S39.

Wagner, K. D., Hardin-Pearce, M. G., Brenner, Z. R., & Krenzer, M. (2014). High-acuity nursing.

Yancy, C. W., Jessup, M., Bozkurt, B., Butler, J., Casey, D. E., Drazner, M. H., ... & Johnson, M. R. (2013). 2013 ACCF/AHA guideline for the management of heart failure. Circulation, CIR-0b013e31829e8776.