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European Journal Of Cardiovascular Nursing: Case Study

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Question: Describe about the European Journal of Cardiovascular Nursing?     Answer: Asthma is said to be an airway complication, which can be categorized physiologically as variable and partly reversible airflow obstruction and pathologically with overgrown mucus glands, bronchoconstriction, inflammation and thickening of airways because of scarring (Frieri, 2005). Bronchoconstriction is said to be the condition where airways become narrowed down within the lungs because of tightening of associated smooth muscle. Bronchial inflammation causes narrowing sown of airways because of swelling and edema caused by various immune reactions to allergens.  Pathophysiology of chronic obstructive pulmonary disease (COPD) Severe damage of small airways leads to the buildup of big air pockets that is medically known as bullae and changes the tissue of the lungs. These complications are referred to as bullous emphysema (Rodríguez-Roisin, 2005). COPD occurs as constant and significant inflammatory response to the inhaled irritants. Continual bacterial infectivity may sometimes take part in inflammatory condition. Inflammatory cells, which are associated with COPD: neutrophil granulocytes, macrophages and few white blood cells. In addition smokers pose eosinophil, TC1and lymphocyte association. Pathophysiology of hypertension The hypertension pathophysiology is very much complicated. Various factors can modulte blood pressure for sufficient tissue perfusion (Zanchetti, 2014). These are: humoral mediators, circulating volume of blood, blood viscosity, cardiac output, neural simulation. Humoral factors may include balance of vasodilators and vasoconstriction.   Pathophysiology of chronic heart failure The pathophysiology of chronic heart failure and leg swelling are correlated. The swelling of leg might have arisen because of fluid accumulation inside Linda’s system. Fluid accumulation takes place because of reduced blood flow out of the heart and causes blood to return to heart through veins. This initiates accumulation of fluid within the lower limbs (Coats, 2000).  2. Clinical manifestations of chronic heart failure includes shortness of breathing or dyspnoea, fatigue, wheezing or chronic cough, irregular heartbeat, nausea or lack of appetite, impaired thinking, fluid buildup and quick weight gain. Important clinical manifestations, which go along with Linda’s condition may include: productive and persistent cough, breathing shortness or dyspnoea, fluid buildup in legs and recent weight gain (Des Jardins and Burton, 2011). Dyspnoea may takes place because of the feeling of inadequate oxygen, chest tightness and daily living activity. Congestive heart failure takes place when a heart fails to properly circulate the blood successfully and fails to maintain the flow of blood to meet the system’s requirements. If the case of chronic heart failure worsens, a patient may retain fluid inside his/her system. This takes place because of restricted blood flow to the kidneys (Skrabal et al., 2014). Consequently, kidneys generate hormones, which retain water and salt. This results in fluid accumulation inside the system, especially in leg or ankle region. Fluid buildup inside the lungs is the main reason for productive and persistent cough in Linda’s case. Fluid buildup throughout the system may cause Linda to gain recent weight. 3. Linda’s bending over the bedside table is might be because of her weakness, persistent coughing that makes her more tired, increased heart rate and little elevated respiratory rate. Nursing intervention Rationale Take notes on respiratory depth, rate and ease of breathing. Observation of associated muscles, change in color of mucous membrane Respiration rate may get increased because of pain or initial compensation to accommodate lung tissue scarcity. Nevertheless, increased breathing may indicate rapid oxygen consumption and immense energy expenditure or diminished respiratory reserve. Auscultation of lungs for the movement of air and abnormal sounds of breathing Lack of the movement of air on damaged side of the lungs Evaluation of restless condition and alterations in consciousness level Specify increased hypoxia Encourage resting periods and restrict activities to patient acceptance Increased consumption of oxygen can give rise to increased dyspnoea and alterations in vital indications with activity. Nevertheless, primary mobilization is preferred to assist the patient to avoid pulmonary difficulty and to attain and retain circulatory and respiratory efficiency (BURKE, PENSTON and RILEY, 2008). Maintain airway by properly positioning patient, application of suctioning and airway adjuncts Airway obstruction hampers gas exchange and ventilation. Frequent reposition of patient, place patient in sitting pose  and to side position from supine position Maximize drainage secretion and lung expansion. These interventions are associated with impaired gas exchange. Nursing intervention Rationale Suctioning can be applied if breathing sounds do not get cleared after cough effort. After suctioning patient should be advised for deep breathing and coughing soon. Routine suctioning process can increase the chance of mucosal damage and hypoxemia. It should be performed gently to induce effective coughing These interventions are associated with inefficient airway clearance.  Nurses should take care of Linda’s safety factor. Linda has a chance to fall down so Linda should be assisted with bedrails or nurse aide, who can look after her during her movements. 4. Three nursing diagnoses for Linda should include pain management, fluid management and anxiety control.  Pain management in nursing care is very much significant. It helps to evaluate cancer associated pain indications that may involve bone tissues, nerve or viscera. Application of rating scale helps patient to evaluate the pain level and offers tool for examining efficiencies of analgesics and this also enhance pain control. Patient should be provided with proper diet chart that will help the patient to maintain proper fluid balance for the entire day. Linda should be emotionally supported that will help her to initiate discovering and coping with the realism of cancer and associated treatment (Sloman, 2002). Linda might ask for time to recognize feelings or might ask for time to convey them. 5. Nursing intervention associated with pain management may include: asking patient regarding pain, determining characteristics associated with pain, for example: aching, burning and continuous and measure the pain intensity with the help of 0-10scale (Carr, Christensen and Layzell, 2010).  Patient should be asked about their complication associated with fluid accumulation in the legs, whether it is painful or what other difficulties the patient is experiencing (Yarbro, Wujcik and Gobel, 2011). The reality about patient’s concerns and fear should be acknowledged and patient should be supported so that patient can express the inner feelings. 6. Linda’s immediate support service might include a nurse aide, who can assist her with activities, movements and she might be support with emergency registered nurse, who can start monitoring and reviewing her ongoing health condition.    Case study 2 1:  Mr. Papadakis is a diabetic patient. The blood pressure of him found to be 156/72. He has high blood pressure. The normal heart rate is 100 beats per minute but his heart rate is more than normal rate that is 104 beats per minute. The normal temperature of human body is 37º C but his body temperature is slightly more than the normal temperature. 15 years ago he was diagnosed with type 2 diabetes and now his blood sugar level is 16.2 mmol/L. His body weight is 78 kgs which is not good for his health. He should reduce his body weight. He is suffering from chronic kidney disease because of the prolong time of diabetes. Recently he was diagnosed with parkinson’s disease which is a disorder of central nervous system. The symptoms of this disease are sleeping problem, emotion problems, slowness of walking, dementia, rigidity etc. Because of his extreme blood sugar level he is now taking insulin twice a day. H e was not control his blood sugar level when it was diagnosed initially. For this reason oral dose of anti diabetic drug is not working. It is clear that his health condition is deteriorating day by day. He is not maintaining a proper diet chart. A diabetic patient should maintain a proper diet chart for his high blood sugar level but he eats whatever his wife puts infront of him. His health condition is not good but he is not aware of his health. When he had extra insulin when he feels he has eaten too much. The life style of him is not healthy. 2:  Diabetes is a vast problem for a society. A person dies from diabetes in every six seconds. Diabetes is a group of metabolic diseases characterized by a chronic hyperglycemic condition effecting from inadequate action of insulin ('Dyslipidemia Management in Adults With Diabetes', 2003). The blood glucose level of Mr. Papadakis is 16.2  mmol/L. An increased amount of glucose in the blood is an indication that diabetes is out of control. It happens when the body cannot use the insulin or does not have enough insulin. Signs of hyperglycemia are great thirst, dry mouth and need to urinate often (, 2015). For non-diabetic person: Pre-prandial plasma glucose: 4-5.9mmol/L Post-prandial plasma glucose: <7.8mmol/L For type II diabetic patient: Pre-prandial plasma glucose: 4.7mmol/L Post-prandial plasma glucose: >8.5mmol/L Because of the diabetes the small blood vessels are damaged. So the function o

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