- James Rowe
Assessment 2
- Mr Wright’s admission states that he has heart failure (Congestive Cardiac Failure). Clearly define heart failure. What organs and which body systems are affected by this disorder?
CCF is a condition in which the heart doesn’t pump as it should and therefore has an impaired cardiac output. Causes include MI, ischaemic heart disease and cardiomyopathy. Mainly includes heart and lungs due to fluid back up from the left ventricle. However can cause problems throughout the body.
(Harris and Nagy et al., 2009)
- Give a brief overview of the normal function of the body systems affected by this disorder.
Digestive ïƒ Aids in the absorption of nutrition. When a person suffers CCF an impaired blood supply is received by the digestive system meaning nutrition imbalance is possible. Also constipation.
Circulatory ïƒ When someone suffers from CCF fluid back up in the ventricle can cause circulation problems. Also the fact that the heart is not pumping as effectively as it should means a poor circulatory system.
Repertory ïƒ Fluid back up in the lungs can cause respetory problems. Making it difficult to breath. Also the fluid in the lungs causes impaired gas exchange meaning poor oxygenation of the blood.
Renal ïƒ The renal system is affected because the limited blood supply and poor blood pressure (Before vasoconstriction) mean that there is a poor urine output. This fluid that is normally eliminated from the body builds up as oedema in the limbs.
(Hopkins and Cavaiuolo et al., 2008)
- Define signs and symptoms of heart failure and explain why these signs and symptoms occur.
SOB (Dyspnoea) – Fluid back up in lungs causing impaired gas exchange
Persistent cough/Wheezing (Cough with white or pink sputum) – Due to fluid build up in lungs.
Oedema (Back up of fluid) (Legs if right sided/Lung if Left sided)
Tiredness/Fatigue (Blood diverted to core so weakness in peripheries caused)
Lack of appetite/Nausea (Due to altered blood supply to liver and digestive system)
Confusion/Impaired thinking (Lack of oxygenated blood being pumped effectively)
Increased heart rate (Heart trying to compensate for low blood flow)
Irregular heart beat
(Ucsfhealth. org, 2014)
Reduced ability to exercise (Due to dyspnoea)
Increase need to urinate at night
Swelling of the abdomen
Hypertension (Blood vessel constrict to increase the BP to increase oxygenation around the body)
Chest pain (If caused by heart attack)
(Mayoclinic. org, 2014)
Orthopnoea (SOB when lying flat) – Caused because the heart can’t cope with the excess blood returning to the heart
Cardiomegaly – Increased size of the heart muscle due to the compensation of working harder
- List the information taken on his admission that demonstrates these signs and symptoms.
A low SPO² reading – This is because of the decrease of oxygen in the blood. Possibly due to fluid back up in the lungs that is creating impaired gas exchange in the alveoli.
Cyanotic – Due to the decrease in oxygen in the blood stream this would make Pt slightly cyanotic
Slight confusion – Due to impaired gas exchange there could possibly be a build up of Carbon Dioxide in the blood that would lead to slight confusion in the Pt.
Low BP – This could be due to the fact the blood vessels have not yet constricted to increase blood pressure (Blood pressure increase when CCF occurs to increase oxygenation around the body)
High pulse – The heart is trying to compensate for the low oxygen in the body and is also compensating for the fluid being left in the ventricles. This means it beats faster to try and increase the rate in which the blood travels around the body.
- Do you think his diabetes is related to his left ulcer and amputated left toe? Explain.
The left ulcer may be due to poorly managed diabetes causing neuropathy. This is where the nerve is damaged. People with diabetes have a greatly increased risk of developing neuropathy in the lower extremities. Making the Pt unaware of any trauma or damage to the foot, also because the foot has very little sensation it is often neglected causing ulcers to occur due to the break down in the tissue. ( Nfb. org, 2014)
Diabetes affects blood supply to the extrematies of the body. This results in the lower portion of the body being deprived of oxygen. In some cases the circulation becomes so bad that the limbs become necrotic and need amputation. Often the first sign of a circulation problem is with the toes. This could be a contributing factor to why the Pt needed a toe amputation.(Netdoctor, 2014)
Another possible reason as to why the Pt needed an amputation is because of the high level of uric acid in the blood. Due to the poor circulation the body often does not get blood through the kidneys before a high level of metabolic waste has built up in the blood. This means that high concentration levels of these metabolic waste build up in blood. One of the main metabolic waste is uric acid. This builds up in the blood and crystallises. This then travels to the lowest part of the body. Due to gravity. Often building up in the toes leaving it ischaemic.( Thegoutkiller. com, 2014)
- One of the medication he is taking is Lasix. What is the action of Lasix? Which body systems are affected by it? Explain why you think Mr Wright is ordered Lasix. (Your answer need only be brief)
Lasix (Frusemide) is a drug that helps for fluid and electrolyte balance. The action of Lasix is that it inhibits reabsorption at the loop of Henle in the kidney. This is so that the body is not absorbing the fluid passing through the loop of Henle. The reason why Mr Wright would be ordered an anti-diuretic drug is to prevent his body from absorbing water and thus removing the risk that he will develop an oedema in his legs.
(Mckenna, 2010)
- List three conditions in Mr Wrights medical history that are commonly associated with age.
Glaucoma – This is an increased pressure in the optic that can limit blood flow. Therefore the reduced blood flow causes degeneration and vision loss. The pressure also effects the optic nerve so messages from the eye to the brain become impaired. The condition is rare in younger people, but is associated with aging .(Harris and Nagy et al., 2009)
Arthritis – Arthritis is an umbrella term used to describe over 100 types of an illness. Arthritis affects the musclo-skeletal system at the point where two joints meet. Symptoms include pain, stiffness and in some cases inflammation .(Arthritisaustralia. com. au, 2014)
Constipated – This could be related to the CCF and the body keeping blood supply to the main organs and therefore being a decreased amount of blood going to the digestive tract causing constipation.
- Using Mr Wrights admission history and assessment, list the factors that may impact his safety whilst in hospital and when he returns home.
Confusion
Poor Mobility
Loss of appetite
Poor vision
Condition of leg ulcer (On return home)
- What other health professionals will be involved in his care and what service can they provide for Mr Wright.
OT ïƒ Could asses Mr Wright in his mobility and offer him more support than his stick may offer. Such as a 4WW.
Social Service ïƒ Could asses Mr Wrights home to see if he needs any more home aids. Could also link Mr Wright into local community through community centres.
Asthma Nurse ïƒ Would be used to educate Mr Wright with his asthma condition. Could teach him possible early warning signs of asthma so he knows the early warning signs.
Diabetic Nurse ïƒ Education for his diabetes. Could teach Mr Wright ways of managing his diabetic state.
Dietician ïƒ Could come up with a diabetic diet plan for Mr Wright therefore reducing the amount of self medication Mr Wright has to do.
Cardiologist ïƒ Monitor condition of CCF.
- List the nursing documentation that you would expect to be used in the care of MR Wright.
FBC (Fluid balance chart) ïƒ For the oedema R/T CCF
OBS chart ïƒ Monitor oxygen levels, pulse and resp rate R/T CCF
Limb Obs ïƒ Monitor blood flow to lower limbs below the point of trauma to check for blood supply.
Medication chart ïƒ Monitor what medication Mr Wright is on R/T CCF and Diabetes.
References
Arthritisaustralia. com. au. 2014. What is arthritis . [online] Available at: http://www. arthritisaustralia. com. au/index. php/arthritis-information/what-is-arthritis. html[Accessed: 9 Apr 2014].
Diabetes. co. uk. 2014. Diabetes and Amputation . [online] Available at: http://www. diabetes. co. uk/diabetes-and-amputation. html[Accessed: 9 Apr 2014].
Harris, P., Nagy, S. and Vardaxis, N. J. 2009. Mosby’s dictionary of medicine, nursing and health professions . Chatswood, N. S. W.: Elsevier Australia.
Hopkins, S., Cavaiuolo, J. and Gotting, M. 2008. Diploma of nursing . Adelaide, S. Aust.: DFEEST.
Mayoclinic. org. 2014. Heart failure Symptoms – Diseases and Conditions – Mayo Clinic . [online] Available at: http://www. mayoclinic. org/diseases-conditions/heart-failure/basics/symptoms/con-20029801[Accessed: 8 Apr 2014].
Mckenna, L. 2010. Australia New Zealand nursing & midwifery drug handbook . Broadway, N. S. W.: Lippincott Williams & Wilkins.
Netdoctor. 2014. Amputation of the toe . [online] Available at: http://www. netdoctor. co. uk/surgical-procedures/amputation-toe. htm[Accessed: 9 Apr 2014].
Nfb. org. 2014. DIABETIC FOOT PAIN . [online] Available at: https://nfb. org/images/nfb/publications/vod/vodsum0403. htm[Accessed: 9 Apr 2014].
Thegoutkiller. com. 2014. Diabetes and Gout . . . twins? Where you find one, you see the other?. [online] Available at: http://thegoutkiller. com/blog/uric-acid/diabetes-and-high-uric-acid-levels/[Accessed: 9 Apr 2014].
Ucsfhealth. org. 2014. Heart Failure Signs and Symptoms | Conditions & Treatments | UCSF Medical Center . [online] Available at: http://www. ucsfhealth. org/conditions/heart_failure/signs_and_symptoms. html[Accessed: 8 Apr 2014].
