NURBN2012 Russell Case Study Sample 1

Subject Code : nurbn2012
University : Federation University Gradesaviours is not sponsored or endorsed by this college or university.
Subject Name : Nursing

Nursing Practice 3: Pathophysiology & Pharmacology Applied to Nursing

This is a case scenario of Russell a truck driver who is 68 years old and has presented to the hospital setting with the compliant of breathlessness. He has a medical history of hypertension, diabetes, cholesterol and COPD. The doctor examined him and concluded that he has developed heart failure. This report aims to identify the risk factors that have contributed to the development of heart failure. It also describes the pathophysiology of the right and left-sided heart failure using the clinical presentation and examination findings of the patient. The explanation of acute exacerbation of COPD will be given along with the drug details of three major drugs administered to him that are perindopril, spironolactone and budesonide/ formoterol fumarate dehydrate puffs. The last part of this report aims to give non- pharmacological recommendations for the prevention and management of heart failure, exacerbation of COPD, prevention of pneumonia and the reduction of high cholesterol levels.

The doctors have examined Russell and have confirmed that he has developed heart failure. The risk factors that have contributed to Russell developing heart failure are diabetes, high blood pressure and high cholesterol levels as stated by his medical history (Schwarzl et al., 2016). Heart failure is a complex clinical syndrome that is contributed by various risk factors but there may be a different group of risk factors in each individual. The increased exposure to the risk factors and the decreased access to health care contributes to the development of heart failure in the people. The bad lifestyle and health habits and factors are also the risk factors that contribute to the development of heart failure like cigarette smoking, no exercises, alcohol consumption, body mass index, unhealthy eating habits (Komanduri et al., 2017). Russell used to smoke 20 cigarettes per day since the age of 18 and he stopped it only when he suffered from a heart attack. He consumes alcohol also and his lifestyle is not healthy. High cholesterol and high systolic blood pressure are the major contributors to the development of heart failure. COPD (Chronic Obstructive Pulmonary Disease) is also a major contributor to the development of heart failure in the patients and this patient Russell has COPD for the past 30 years. He has presented with the complaint of breathlessness that characterizes the bad COPD health of the patient. The males who are smokers with significantly higher systolic blood pressure and cholesterol are at highest risk of developing heart failure (Lawson et al., 2020).

The pathophysiology of the right and left-sided heart failure is when the heart is no longer able to pump enough blood due to weakness in the heart muscles and also due to inelasticity. In left-sided heart failure, the left ventricle of the heart is not able to pump enough blood around the body as a result of which the body parts gets affected. This inefficiency of the left ventricle of the heart leads to the build-up of blood in the pulmonary veins (Arena & Ozemek, 2019). The pulmonary veins have a function of carrying blood away from the lungs to the body. These blood vessels that carry the blood away from the lungs have blood built up in them. Left-sided heart failure is the most common type of heart failure. The results of left-sided heart failure are seen when a person starts experiencing shortness of breath and has other breathing difficulties especially when the person is performing physical activities (Onciul & Dorobantu, 2018). The examination results of Russell stated that he presented with the complaint of breathlessness and his history states that he feels breathless while showering and dressing (physical work). He feels comfortable on rest that is at the time of sleeping. The examination through a chest X-ray also states that there is pulmonary oedema that occurs in left-sided heart failure.

The right-sided heart failure is when the right-sided ventricle of the heart is weak enough to be not able to pump the blood to the lungs. The blood builds up in the veins that are the blood vessels that carry blood to the heart from the tissues and other organs (Jan & Tajik, 2019). This right-sided heart failure leads to an accumulation of fluid in the legs and other organs of the body. This happens because there is increased pressure inside the veins because of the build-up that forces the fluid to push out of the veins into surrounding tissues. Russell examination states that he has mild oedema in his both legs and the jugular venous pressure (JVP) is elevated (Konstam et al., 2018). These are the clinical manifestations of Russell that characterize the right-sided heart failure.

The patient Russell has a history of COPD from the past 30 years. The term acute exacerbation of COPD refers to a sudden worsening of COPD symptoms that may last for several days like shortness of breath and phlegm increase. The acute exacerbation of COPD is very harmful to the patient because it further damages their lungs. This is best defined as sustained worsening of the symptoms that may lead to worsening of the current functioning status of the lungs (Sprooten et al., 2019). This is a long-lasting effect in which the inflammation that is caused due to irritation in the lungs takes a longer time to recover. The patients like Russell are at higher risk for acute exacerbations of COPD as he has a medical history of heart disease and contributing factors like high systolic blood pressure, diabetes and high cholesterol levels. The medical history also states that he used to smoke 20 cigarettes per day since the age of 18 and this adds up to the damage of the lungs. The most common cause of exacerbation is the infection in the lungs that may be due to some irritating substances that may cause allergy (Dransfield et al., 2019). Russell is a truck driver and he is more prone to getting infection out in the air.

Generic name	Perindopril	Spironolactone	Budesonide/Formoterol fumarate dehydrate puffs
Drug group	Angiotensin-converting enzyme (ACE)	Diuretic	Bronchodilator
Mechanism of action	The somatic ACE drugs have two domains N and C of which the C- domain is involved in blood pressure regulation. ACE inhibitors bind and inhibit the activity of both N and C domains but they predominantly inhibit C domain. The active metabolite of this drug competes with AT1 for binding to ACE that plays a major role in inhibiting the pressor effects of AT11 (DrugBank, 2020). This drug also leads to an increase in plasma renin activity because of the loss of feedback inhibition through baroreceptors.	Spironolactone has a major role to play in inhibiting the aldosterone dependent sodium-potassium exchange channel competitively. These channels are inhibited in the distal convoluted tubule (DrugBank, 2020). This inhibition results in higher levels of sodium and water excretion as a result of which there is more potassium retention. This diuretic leads to antihypertensive effects due to increased excretion of water.	Formoterol is a drug that is inhaled beta-2 agonist that works best for the treatment of COPD. It has a function to act on bronchial smooth muscle for dilation and relaxation of the airways. This drug is administered as a racemic mixture and it is rapid in the onset of its effect in the patients upon inhalation (DrugBank, 2020). It is a selective long-acting agonist of beta- 2 adrenergic receptors because these receptors are found in the bronchial smooth muscles. The beta receptors are activated by agonists like formoterol because it is used in the stimulation of intracellular adenylyl cyclase that is an enzyme that works for the conversion of ATP to cyclic AMP. Higher levels of cAMP in the bronchial smooth muscle relax them that in return dilates the airways. They also inhibit the release of hypersensitive mediators that are released from the mast cells.
Complications/side effects (2 major)	Body pain Sneezing and sore throat	Little or no urination Signs of electrolyte imbalance	Throat pain and irritation Lower respiratory tract infections like bronchitis
Nursing considerations (2 major)	The nurse will look to the following factors when administering this medication: Chest pain: if the patient has chest pain then the nurse will not administer this medication Frequent urge to urinate: This might happen as a side effect of this drug and if this problem persists then the nurse will stop this medication because the patient is already diabetic.	The nurse will look to the following factors when administering this medication: A light-headed feeling; pass out feeling: If the person is feeling passed out then the nurse will monitor vital signs High potassium levels:	The nurse will look to the following factors when administering this medication: The nurse will take care of the respiratory issues that may develop as a complication due to this drug. The patient already has COPD and if the patient will experience choking then the nurse will monitor the patient The second nursing consideration will be chest pain because this is the potential complication that the patient may develop as a side effect.

The non- pharmacological recommendations that can be made for Russell are:

For heart failure:
Diet and nutrition: The patient must have control over salt intake and must follow the DASH diet. The potassium intake should be limited and fluid restriction of 1500- 2000 mL is advised.
Rest and exercise

Physical rest is advised along with adhering to exercise training sessions.

Self- care behaviour
Take care of weight gain and should keep checking for symptoms (Woods, Walker & Duff, 2016).
Lifestyle changes

No smoking or alcohol intake and the patient must look over mental health too.
Adequate disease management and follow- up

The nurses must take follow- up sessions for the patient to observe the current condition and health of the heart.
To prevent exacerbation of COPD
No smoking as smoking cessation will reduce the risk of exacerbation of COPD.
To take care of nutritional status because there should be a positive energy balance in the patients. Nutritional deficiency like hypophosphataemia can worsen the health (ur Rehman et al., 2019).

The patient must adhere to medication regime so that the airways are dilated and even if the allergen enters, there is minimal choking.

The patient must attend the follow- up sessions in which the nurse will check the status of COPD in the patient (Mulhall & Criner, 2016).
The patient must adhere to oxygen therapy to improve the quality of life
To prevent pneumonia
The patient will be recommended for hand hygiene and maintaining the hygiene of the body (Oliveria et al., 2014).
The patient will be recommended for smoking cessation so that there is no risk of complications.

The patient would be advised to adhere to the medication regime

The patient will be recommended for a regular health check-up and follow-up so that the health status can be checked.
To reduce his high cholesterol level
The patient must adhere to a strict diet that contains green vegetables and nuts
The patient must adhere to the medication regime

The patient must get his cholesterol levels checked every week (Pall & Zrinyi, 2019)

The patient must adhere to the exercise regime that will help in controlling LDL cholesterol.
The cessation of tobacco intake and alcohol intake should be the target of the patient.

The conclusion drawn is that the patient Russell has developed heart failure due to his bad lifestyle and health behaviour. He was a smoker, has a history of diabetes, high cholesterol levels and high blood pressure. These are the major risk factors that have contributed to the development of heart failure. The right-sided heart failure has led to the development of fluid retention in the legs and the left-sided heart failure has led to breathlessness, a complaint with which he presented. His medical history states that he had COPD from the last 30 years and he was administered few medications for the management of his condition. He is at high risk of acute exacerbation of COPD because he is a truck driver and used to smoke 20 cigarettes per day in the past and he started this at the age of 18 years. Thus, good nursing management and non- pharmacological recommendations can only help the patient Russell for preventing further health deterioration.

References for Russell Case Study

Arena, R., & Ozemek, C. (2019). Intracardiac multimorbidity: Assessing right ventricular function in left-sided heart failure through cardiopulmonary exercise testing. Expert Rev Cardiovascular Therapy, 17(5), 331-333.

Dransfield, M. T., Voelker, H., Bhatt, S. P., Brenner, K., Casaburi, R., Come, C. E., ... & Hatipoğlu, U. (2019). Metoprolol for the prevention of acute exacerbations of COPD. New England Journal of Medicine, 381(24), 2304-2314.

DrugBank. (2020). Formoterol. Retrieved from https://www.drugbank.ca/drugs/DB00983

DrugBank. (2020). Perindopril. Retrieved from https://www.drugbank.ca/drugs/DB00790

DrugBank. (2020). Spironolactone. Retrieved from https://www.drugbank.ca/drugs/DB00421

Jan, M. F., & Tajik, A. J. (2019). Diagnosing and Managing Pulmonary and Right-Sided Heart Disease: Pulmonary Hypertension, Right Ventricular Outflow Pathology, and Sleep Apnea. In Hypertrophic Cardiomyopathy (pp. 231-248). Springer, Cham.

Komanduri, S., Jadhao, Y., Guduru, S. S., Cheriyath, P., & Wert, Y. (2017). Prevalence and risk factors of heart failure in the USA: NHANES 2013–2014 epidemiological follow-up study. Journal of Community Hospital Internal Medicine Perspectives, 7(1), 15-20.

Konstam, M. A., Kiernan, M. S., Bernstein, D., Bozkurt, B., Jacob, M., Kapur, N. K., ... & Raval, A. N. (2018). Evaluation and management of right-sided heart failure: a scientific statement from the American Heart Association. Circulation, 137(20), e578-e622.

Lawson, C. A., Zaccardi, F., Squire, I., Okhai, H., Davies, M., Huang, W., ... & Kadam, U. T. (2020). Risk Factors for Heart Failure: 20-Year Population-Based Trends by Sex, Socioeconomic Status, and Ethnicity. Circulation: Heart Failure, 13(2), e006472.

Mulhall, P., & Criner, G. (2016). Non‐pharmacological treatments for COPD. Respirology, 21(5), 791-809.

Oliveira, J., Zagalo, C., & Cavaco-Silva, P. (2014). Prevention of ventilator-associated pneumonia. Revista Portuguesa de Pneumologia (English Edition), 20(3), 152-161.

Onciul, S., & Dorobanţu, M. (2018). Left Heart Pathology and Right Ventricle Function. In Right Heart Pathology (pp. 371-380). United States: Springer, Cham.

Páll, D., & Zrínyi, M. (2019). Non-pharmacological Treatment of Hypertension. In Hypertension in Children and Adolescents(pp. 211-224). Unites States: Springer, Cham.

Schwarzl, M., Ojeda, F., Zeller, T., Seiffert, M., Becher, P. M., Munzel, T., ... & Beutel, M. E. (2016). Risk factors for heart failure are associated with alterations of the LV end-diastolic pressure-volume relationship in non-heart failure individuals: data from a large-scale, population-based cohort. European Heart Journal, 37(23), 1807-1814.

Sprooten, R. T., Rohde, G. G., Lawyer, G., Leijte, W. T., Wouters, E. F., & Franssen, F. M. (2019). Risk stratification for short‐term mortality at hospital admission for acute exacerbations of COPD. Respirology, 24(8), 765-776.

ur Rehman, A., Hassali, M. A. A., Abbas, S., Ali, I. A. B. H., Harun, S. N., Muneswarao, J., & Hussain, R. (2019). Pharmacological and non-pharmacological management of COPD; limitations and prospects: a review of current literature. Journal of Public Health, 1-10.

Woods, L. S., Walker, K. N., & Duff, J. S. (2016). Heart failure patients' experiences of non-pharmacological self-care. British Journal of Cardiac Nursing, 11(10), 498-506.