A 78-year-old man is admitted to the hospital with the chief complaint or shortn

Question

A 78-year-old man is admitted to the hospital with the chief complaint or shortness of breath. He states the shortness of breath has been increasing over the past 2 months and is aggravated by exertion. He has found that he often awakens at night with a sensation of smothering that is partially relieved when he gets up and opens the window. He has had not ankle swelling or edema noted. Past medical history is only positive for myocardial infarction 8 years ago. He currently does not have complaints of chest pain. BP is 140/98. When the nurse listens to his heart, she hears a normal S1 and S2 with a rate of 88. When listening to the lungs, the nurse notes bibasilar crackles. There is no peripheral edema. The admission diagnosis for the patient was left-sided heart failure. Describe the pathophysiology of left-sided heart failure. Which of the clinical manifestations given in the case would be found in a patient with left-sided heart failure and why? How does left-sided heart failure impact pre load, after load, and contractility? Describe other clinical manifestations the nurse would monitor for in this patient. Which clinical manifestations would be seen in only left-sided failure? Which symptoms would occur if right-sided failure was present also? Describe why the patient would have the following classification of drugs administered by the nurse? a. Diuretics b. ACE inhibitors c. beta -blockers (Learning Objectives 1, 2, 3, 5, 6, 7)

Explanation / Answer

1. Hypertension leads to vasoconstriction of blood which causes the workload to be increased. This results in the increase in the force of left ventricle which puts stress on the left ventricular muscle causing left ventricular hypertrophy. This results in reduction in atrial empting with upward atrial pressure causing left sided heart failure.

2. Hypertension, obesity, and diabetes along with manifestations like fatigue, dyspnea, and orthopnea. All these are due to ventricular stress.

3. Pre-load reduced, increased afterload and contractility.

4. Hypertension, obesity, and diabetes along with manifestations like fatigue, dyspnea, and orthopnea for left sided only and for right sided failure fluid accumulation, swelling affecting lower extremities, and frequent night time urination.

5. Diuretics would reduce blood pressure by reducing cardiac output as a result of reduced blood volume due to decreased retention of sodium and water; ACE inhibitors block enzyme ACE which converts angiotensin I to vasoconstrictor angiotensin II along with producing nitric oxide which is vasodilator and beta blockers would primarily reduce the cardiac output and hence reduce BP.

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