Describe about the Case Study of Pathophysiology of Edema in Congestive Heart Failure?
1. Tom is most likely suffering from a disease that affects the cardio-vascular system. His symptoms suggest that he has congestive heart failure in which the heart becomes weakened and is unable to pump blood to meet the needs of the body.
2. The reason for chest pain is because the heart does not receive enough blood which causes chest pain. The reason for swelling of legs in Tom is that in patients with CHF a number of humoral and neurohumoral mechanisms that facilitate sodium and water reabsorption by the kidney and increase of extracellular fluid are activated resulting in edema in legs. Also some abnormal starling forces like increased venous capillary pressure and decreased plasma oncotic pressure promote edema. (Navas,J Maldonado,M 1993)
3. The diagnostic procedure to confirm the condition are physical examination, patient history, electrocardiogram or echocardiogram. In cases where has history of angina and previous heart attack then cardiac catheterization may be done. Sometimes a less invasive test like stress test or nuclear stress test is performed.
4. Physical examination is to find the cause of the condition and to assess the heart function via stethoacope.
5. Patient history helps to gather information about any associated condition like BP, diabetes, etc
6. Electrocardiogram is used to measure the electrical activity in the heart.
7. Echocardiogram is used to detect the abnormalities in the structure of the heart and also to measure ejection fraction.
8. Cardiac catheterization helps to assess the function of the heart
9. Stress test is used to assess the presence of coronary heart disease.
10. The health professional required to treat Tom are Cardiologist who will treat the patient, the nurses who will take care of his medication and tests and an educator who will tell Tom about the diet, exercise and lifestyle he should adopt.
1. The five potential health issues that Mary could face due to her obesity are
2. Heart disease and stroke – Due to increased weight, it is more likely to have high BP and high cholesterol. Both these factors are a major cause for heart disease and stroke.
3. Sleep Apnea – It is linked to excess weight. It causes people to snore and sometimes stops breathing briefly.
4. Diabetes – Overweight people are more likely to develop type2 diabetes.
5. Osteoarthritis – Increased weight puts extra pressure on the joints which over time causes wearing of the cartilage that protects joints.
6. Gout – It occurs due to deposition of excess uric acid crystals in the joints and is more common in obese patients.
The two external factors affecting the health status of Mary are heredity and race. Both these factors make the patient more predisposed to develop type 2 diabetes.
The two internal factors are obesity as the more the weight the patient has the more resistant the cells become to insulin and inactivity because physical activity helps to control weight and uses the excess glucose for energy.
• The health professional and allied staff involved in care of Mary are
• General physician/family physician – they are the main source of care and they inform the health care team about patients health status.
• Endocrinologist – they are the specialist in treating diabetic patients
• Dietician – helps the patient to decide the food needs of the body depending on the weight, lifestyle, medication and other health goals.
• Nurse educator – Helps to educate about the daily aspects of diabetes self-care.
• Eye doctor – Diabetes can affect blood vessels of the eyes, so a checkup is essential
• Podiatrist – Diabetes causes nerve damage in extremities, so podiatrist helps to treat feet and problems in legs.
• Dentist – Diabetic patients are at greater risk of developing gum diseases
• Exercise trainer – helips to plan the fitness program for the patient
• The nurses should educate Mary about the importance of reducing weight and maintain a healthy lifestyle which should include diet counselling, physical activity counselling. She should be explained that her condition is a life-long disease and she will have to take care of herself continuously.
• The complications that may arise due to unstable blood glucose in a type 1 diabetes patient are
• Retinopathy – It occurs in 80% of the patients who have had type1 diabetes for more than 15 years.
• Kidney damage – 20-30 % of the patients develop kidney damage over long disease time which can cause more serious problems like kidney failure and heart attack if not controlled
• Poor blood circulation and nerve damage – Damage to nerve may lead to nausea, vomiting and diarrhea. Nerve damage and hardening of arteries leads to decreased sensation and poor circulation in feet.
• Heart attack – accumulation of plaque in blood vessels of the heart cause there clogging and can lead to heart attack.
• The five specific health care professionalist involved in long term care of type 1 diabetes patient are
• Endocrinologist or pediatric endocrinologist – They are the specialist in treating diabetic patients
• Nephrologist – They help to diagnose the diseases of the kidney
• Neurologist – They help in diagnosing any nerve damage and neurological disease like diabetic neuropathy.
• Cardiologist – They help to diagnosis any heart condition present
• Ophthalmologist – People with type 1 diabetes should have their eyes checked within a year of diagnosis and then regularly.
• The services available in community care for long term are diabetic sessions, specialist podiatry treatment, wound care, routine risk foot conditions, comprehensive diabetic care including information about insulin pumps, blood glucose monitoring, carbohydrate monitoring, Diabetic home care plan for individual and care staff.
• The two internal factors that affects the client’s physical condition are firstly he is under the influence of alcohol which make him loose control over himself and his behaviour and secondly is a young driver of 24 years of age who are inexperienced and aggressive at this age. Young male drivers are more predisposed to Motor vehicle accidents.
• The two external factors affecting the client’s condition are the emergency department environment and the medical care provided to him.
• If the client level of consciousness begins to decrease after 6 hours of admission then he may be suffering from mild traumatic brain injury. The patient was under the influence of alcohol while driving and also because of which his manifestations of the injury were masked first. But as the effect of alcohol decreases, the condition of the patient should improve but as the effect of alcohol subsides, the patients level of consciousness decreases indicating TBI.
• The diagnostic test required for diagnosis are Glasgow come scale which helps to assess the initial severity of brain injury, computerized tomography scan helps to locate any fractures, bleeding in the brain, blood clot and brain tissue swelling, magnetic resonance imaging gives a detailed view of the brain and intracranial pressure monitor used to measure pressure inside the skull.
• The two specific health care professionals involved in the care of the client are a neurologist who deals with the brain and nerves. He will assess the functioning of the brain and will check for any abnormal actions. The second specialist is radiologist who will perform the CT scan and MRI. They are involved in diagnosing problems in the X-rays.
• The ethical issues which should be considered when dealing with the client are according to Buddhism a person has the right to decide when they will die therefore the nurse should be aware of the Buddhist beliefs. They donot take any medication and want to die with a calm mind and saying their prayers. Also after the death, the body should be kept in a peaceful state and should not be touched. All this should be kept in mind by the nurse. The nurse should also keep in mind that Buddhist have strict dietary regulations. Buddhists use religious objects like prayer beads and images for meditation. Life support machines are not considered to be helpful according to the Buddhists. They believe that having an alert mind and not having excess pain during death are important.
• The registered nurse should use non-pharmacological pain management therapy like meditation. It has been tested and is thought to be able to facilitate patient comfort. The nurse must balance the level of pain relief needed against the need for alertness required by the client. WHO analgesics ladder can be used. Non-opiad analgesics and weak opiods should be preffered. If the pain become severe and uncontrolled, strong opiods could be used to provide relief and have best cognitive function that would allow the client meditative spiritual practices. The nurses could seek advice from the doctor treating the client and the family members of the client.
• The non-pharamcological treatment that can be provided for pain relief are
• Relaxation
• Hypnosis
• Mindfulness meditation
• Immersive virtual reality distraction
• Listening to music
• Differential positive reinforcement of desired behaviour
• Identification and modification of unhelpful thoughts
• Goal setting to achieve desired behaviour
• Acupuncture/Acupressure
• Transcutaneous electrical nerve stimulation
• Manual and massage therapies
• Heat and cold application
• Distraction especially in children
References:
Navas,J & Maldonado,M 1993, Pathophysiology of edema in congestive heart failure, https://www.ncbi.nlm.nih.gov/pubmed/8156185
Schug,S & Macintyre,P, 2007, Acute pain management: scientific evidence, https://www.anzca.edu.au/resources/college-publications
/pdfs/Acute%20Pain%20Management/books-and-publications/8.%20Non-pharmacological%20techniques%20FINAL.pdf
Chan,T Poon,E & Hegney,D , 2011,What nurses need to know about Buddhist perspectives of end-of-life care and dying, Progress in palliative care Vol 19 No 1 Pg 1-5, https://www.academia.edu/2357157/What_nurses_need_to_know_about_Buddhist_perspectives_of_end-of-life_care_and_dying
Hughes,J & keown,D, 1995, Buddhism and Medical ethics: A bibliographic introduction, Journal of Buddhist ethics, Vol 2, https://www.changesurfer.com/Bud/BudBioEth.html
Smith-marsh,D, Type 1 diabetes complications, https://www.endocrineweb.com/conditions/type-1-diabetes/type-1-diabetes-complications
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