NR507 Week 3 Discussion Essay

1. Discuss the pathophysiological mechanisms that can lead to heart failure.
2. Differentiate between systolic and diastolic heart dysfunction
3. Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night and the need to prop herself up on three pillows. Include pathophysiological mechanisms that causes each of these signs and symptoms.
4. Include two points of teaching for this patient
5. Support your response with at least one current evidence based resource.
6. Students must post a minimum of three times in each graded discussion (see participation guidelines on the discussion rubric).

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EXAMPLE SOLUTION

Heart failure occurs when the heart is no longer able to produce an adequate amount of cardiac output to meet the body’s demands. It is commonly predisposed by certain diseases, such as coronary artery disease, hypertension, diabetes, myocardial infarction (MI), or cardiomyopathy (McCance & Huether, 2019; Rogers & Bush, 2015). Cardiomyopathy or a MI reduces contractility of the heart with damage to the myocardial structure by inducing inflammatory and neurohumoral processes that cause hypertrophy and dilation to the ventricles, which causes an increase in preload (McCance & Huether, 2019). Coronary artery disease and hypertension cause the heart to pump against increased vascular resistance, which causes the heart to hypertrophy with increased work from the inability to adequately pump blood out of the heart and an increase in afterload (McCance & Huether, 2019; Rogers & Bush, 2015). With a reduced cardiac output, the kidneys try to compensate with the renin-angiotension-aldosterone system (RAAS), which further increases peripheral vascular resistance and plasma volume, as well as preload and afterload, leading to a worsening state of heart failure (McCance & Huether, 2019). With decreased cardiac output causing an increased retention of sodium and water from RAAS activation and increased venous pressure due to vasoconstriction, increased pulmonary congestion occurs with blood backing up into the lungs from inadequate blood pumping into the systemic circulation, causing the shortness of breath the patient is exhibiting (Rogers & Bush, 2015). Her symptom of awakening in the middle of the night to prop herself up on pillows is considered orthopnea, which is shortness of breath that occurs when the patient lays flat because of increased fluid redistribution of fluid towards the central circulation and exertion of pressure on respiratory muscles from abdominal contents, which causes a further increase in pulmonary pressure and congestion on an already overworked heart (McCance & Huether, 2019; Rogers & Bush, 2015).

Systolic heart dysfunction is characterized by a reduced ejection fraction (EF) of less than 40% and decreased contractility of the heart muscle, which results in a dilated heart muscle that is unable to produce an adequate cardiac output (Rogers & Bush, 2015). Diastolic heart dysfunction is characterized as having an EF greater than 50% and occurs secondary to a loss of elasticity of the heart, which leads to decreased filling from impaired ventricular function (McCance & Huether, 2019; Rogers & Bush, 2015). This leads to hypertrophy of the left ventricle, which causes a decreased ability of heart cells to pump calcium from the cytosol, leading to impaired relaxation of the heart (McCance & Huether, 2019; Rogers & Bush, 2015).

Teaching points for this patient would involve lifestyle changes to prevent further heart failure and control symptoms. Education on a heart health diet, such as reducing sodium intake, would be important to decrease fluid retention, edema, blood pressure, and shortness of breath, which would prevent further cell damage and worsening heart failure (Rogers & Bush, 2015). Since obesity and coronary artery disease are risk factors of heart failure, reducing fat intake and increasing omega 3 fatty acids are important dietary measures to educate on to prevent further vascular resistance, as well as the importance of increasing activity level to reduce mortality, improve functional ability, and reduce complications (Rogers & Bush, 2015). Educating the patient to monitor her weight regularly to assess for any weight gain that may be related to fluid retention is important to keep her condition stable (Hopper & Easton, 2017).

Hopper, I., & Easton, K. (2017). Chronic heart failure. Australian Prescriber, 40(4), 128–136. doi:10.18773/austprescr.2017.044

McCance, K. L., & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Elsevier.

Rogers, C., & Bush, N. (2015). Heart Failure. Pathophysiology, diagnosis, medical treatment guidelines, and nursing management. Nursing Clinics of North America, 50, 787–799. doi:10.1016/j.cnur.2015.07.012