Task Solutions Of Anatomical And Physiological Changes:CNA772

Running head; NURSING ESSAY
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Management of a …

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Running head; NURSING ESSAY
Name of the student
Name of the university
Author notes
Management of acutely ill patients, is one of the significant as well as challenging tasks
for the health care providers. In this context, appropriate vital sign assessment, considering
patient health history, assessing anatomical and physiological changes, and evaluating existing
medication charts are important aspects in the care procedure (Nadim et al. 2016). In this paper,
the discussion is based on acase study of managing an acutely ill patient. In order to manage any
deteriorating health condition, assessment of the underlying pathophysiological changes has a
significant role. Appropriate understanding of pathophysiology, helps in making relevant and
effective care plan or strategies (Regitz-Zagrosek et al. 2018) .The patient is a65 years old
female has been admitted to the emergency department of the hospital by ambulance; with
symptoms of: chest pain, palpitation, vomiting as well as diaphoresis. Findings from the
assessment of the patient’s deteriorating condition, will be shortly described in the first portion of
the essay. Management strategies which are significant and relevant in this context will be
discussed so that acute condition of the patient can be addressed. Administrating Metoprolol IV
5mg +5mg to address cardiovascular deterioration, the blood test is another relevant strategy
that has been used for this purpose. Electrolyte assessment and management strategy have been
used as the patient is suffering from hypotension, and the other two strategies are management of
hypoxia and referring to the cardiology department. In the end, acomprehensive conclusion will
be added.
The 65 years old, female patient was admitted to the emergency department for chest
pain with other significant signs and symptoms of health deterioration like diaphoresis and
tendency to vomit. After abasic assessment of the patient’s condition, significant physiological
changes have been observed, including the patient suffering from hypotension. According to his
vital signs assessment, the findings are increased heart rate (160 bpm, whereas the normal range
of care varies between 60 to 100 bpm), low oxygen saturation level, blood pressure 120/90, chest
clear, mean arterial blood pressure was 48 warm peripheries, and other vital signs were normal
(Brekke et al. 2019) .According to laboratory results, an acidotic condition was observed through
the results of carbon dioxide levels which was 55 and apH value of 7.16. However, he had no
peripheral edema. According to the finding of the ECG report, narrow complex tachy with mild
interventricular conduction delay has been observed, LAD, heart rate of 160 and depression of
lateral ST and STE in aVR also found. However, pwaves or flutter waves were not seen in the
Assessment of patient health history is another important part of asuccessful assessment
procedure (Haga and Orlando 2020) .In this case study, several significant pieces of information
have been found from the health history. The patient is prevalent towards hypertrophic
obstructive cardiomyopathy condition. Previously treated atrial tachycardia present. The patient
has ahistory of post DCR, PEA arrest in the month of July 2021. Besides that, the patient is
suffering from several comorbidities, including type 2diabetes, chronic kidney disease, as well
as mild coronary artery disease (CAD).
Hyper-obstructive cardiomyopathy (HOCM) is acondition of disease or ailment in which
the heart becomes thick abnormally and itis the thickened heart muscle which itdifficult for the
heart to pump blood. The genetic factors giving rise to this condition are mutation of sarcomeric
proteins. Mostly patients with HOCM passes undiagnosed because they usually do not find any
abnormal signs and symptoms. However, in some patients the thickening of the heart muscle
results in shortness of breathe along with pain in the chest or complications in the electrical
system of the heart (Geske, Ommen and Gersh 2018). This eventually leads to irregular beating
of the heart, acondition which is known as arrhythmias. The degree of obstruction is dependent
on the extent of the hypertrophy in the patient. The pathophysiology of HOCM is complex
depicting dynamic outflow of the obstruction that mostly occurs due to systolic anterior motions
of the mitral valve. This happens because leaflets of the mitral valve is subjected to impingment
on the basal septum that is hypertrophied. The obstruction of the outflow tract in such acase
becomes dynamic and occurs due to agradient of pressure that pulls the anterior leaflet of the
mitral valve towards an anterior position which further aggravates obstruction of outflow tract
(Hayashi 2020). Sometimes, the degree of obstruction is also dependent upon the contractility
and conditions of loading.
Maidment et al. (2020) suggested that older people are involved in multiple medications
for treatment of their comorbid conditions. Adverse health conditions related to medication
management are thus common. Hence, aproper treatment or management of this condition is
extremely crucial to prevent worsening of further conditions. The main aim of therapeutic
intervention in this condition is to bring about reduction in dynamic obstruction. As an integral
part of the plan, Metoprolol has to be administered in an intravenous manner to the patient.
Metoprolol is abeta-blocker which impacts the circulation of blood in and out of the heart. This
is an effective medication for treatment of HOCM conditions as they efficiently restricts the
worsening of the obstruction which can occur with physical activity. Thus, itcan be understood
that Metoprolol as atreatment measure will bring down the symptoms of HOCM in the patient.
On administering Metoprolol to the patient in an intravenous manner, Metoprolol will result in
reduction of the velocity of maximal contraction which would bring about alterations in the
degree of the systolic anterior movement. It will also change the magnitude of the left ventricular
outflow from the outflow tract in the patient. Different types of beta-blockers are employed for
the treatment of HOCM and its potentiality in rendering standard care cannot be undermined.
The exact condition of the patient along with the stability is considered before deciding the
dosage (Jahan and Shah 2022). The medicine must administered intravenously as itis bound to
have amore pronounced effects that would lead to resolve the condition of pressure gradient.
Another effectiveness of administering Metoprolol is resolving the condition of tacchyarrhthmia
while bringing down the discomfort in chest.
According to the research conducted by Cap et al. (2018) ithas been indicated that
damage control resuscitation (DCR) can be considered as aresuscitation approach used to
quickly restore homeostasis in individuals suffering from hemorrhagic shock. As per the case
study chosen the patient ’splan included DCR in case of unastable condition. Blood product
transfusion including whole blood or component therapy that closely resembles whole blood,
constricted use of crystalloid to prevent dilutional coagulopathy, hypotensive resuscitation until
bleeding control is attained, empiric use of tranexamic acid, acidosis and hypothermia prevention,
and rapid definitive surgical control of bleeding are all priorities.
According to the study conducted by Leibner et al. (2020) the fatal “triad” of
coagulopathy, hypothermia, and metabolic alkalosis is common in severely wounded individuals
who lose aconsiderable amount of blood. Each of these disruptions causes more of the same,
resulting in permanent shock. A complicated sequence of up-regulated innate immunity gene and
down-regulated adaptive immunity genes results with significant blood loss, tissue damage, or
hypoperfusion. Changes in mitochondrial DNA and the release of formyl peptides occur as a
result of activated protein C, increased plasmin, and aslew of other proinflammatory chemicals.
Non-mechanical bleeding is aclinical symptom of acute traumatic coagulopathy. Damage
control resuscitation (DCR) is aconcept that understands that in order to get the greatest results,
surgical haemorrhage control and resuscitation must occur at the same time.
There are several medical history of the patient which can be correlated with the current
medical condiction of the patient and those included atrial tachycardia, hypertension,
hypercholesterolemia, mild stage of coronary artery disease and events cardiovascular
impairments. In this regard, itcan be said that hypertension and poor management of
cardiovascular disorders might have induced recent chest pain and associated symptoms.
Accordingg to the research conducted by Weiss, Paugam-Burtz and Jaber (2018) ithas been
indicated that hypertension increases the risk of shock under any pathophysiological
circumstances and that might become difficult to manage.
DCR includes, hypotensive resuscitation as well. Hypotensive resuscitation, limits the
use of crystalloid fluids, enabling blood pressure to stay below normal and reducing additional
blood loss till initial hemostasis is achieved. It’s long been known that accepting alower blood
pressure during trauma resuscitation is beneficial. However, professionals often find it
paradoxical to keep blood pressure low due to the misunderstanding, that blood pressure always
equals organ perfusion. Hence, this process can be one of the necessary managemennet plan for
the patient. In the given case scenario, the patient has been on diuretics medication and as action
of these medication excessive fluid might have been excreted from the patients ’body. This can
be related to hypovolemia that the patient had been experiencing.
In acutely ill patients such as described in the case study are at higher risk of
experiencing fatal consequences due to their comorbidity status. Elderly individuals are more
likely to experience shock due to their declined body functioning status and due to their
comorbidities. Hypovolemic shock is characterised by severe hypovolemia and areduction in
peripheral perfusion. These individuals may acquire ischemia harm to key organs, which can
lead to multi-system organ failure if not addressed. The first question to ask is whether the
hypovolemic shock is due to bleeding or fluid loss, as this will determine how to proceed.
Because they have less physiologic reserve, elderly people are more susceptible to undergo
hypovolemic shock as aresult of fluid losses. Hypovolemic shock is caused by adecrease in
intravascular volume, which can be caused by either extracellular fluid or blood loss. The
diagnosis of hypovolemic shock is frequently made based on the patient’s medical history, and
physical exam. A history of trauma or recent surgery is evident in people who have hemorrhagic
shock (Taghavi and Askari 2021 ).Early use of blood products over crystalloid resuscitation
improves outcomes for patients with hemorrhagic shock. Hemostasis is improved when plasma,
platelets, and packed red blood cells are transfused in a1:1:1 or 1:1:2 ratio. Hence itis highy
necessary to initiate treatment at an initial stage.
Hence itcan be concluded that one of the most important and difficult duties for health
care practitioners is the management of severely unwell patients. Appropriate vital sign
assessment, consideration of the patient’s medical history, assessment of anatomical and
physiological changes, and evaluation of current drug records are all crucial aspects in the
treatment approach in this context. The 65-year-old female patient, was sent to the emergency
room with chest discomfort and other indications and symptoms of health worsening such as
diaphoresis and adesire to vomit; hyper-obstructive cardiomyopathy (HOCM) is adisease or
sickness in which the heart muscle thickens excessively, making itdifficult for the heart to pump
blood. Mutations in sarcomeric proteins are the genetic causes that cause this disease. Metoprolol
is an useful drug for the treatment of HOCM situations because iteffectively prevents the
blockage from deteriorating as aresult of physical activity. Management of acutely ill patients,
should be considered asignificant responsibility for the health care professionals. In this regard,
asessment of vital sign, obtainibg data from the health history of patients, exploring the
anatomical and physiological alterations, and evaluation of the prescribed medication charts are
important aspects in the care procedure. Electrolyte assessment and management strategy have
been used as the patient is suffering from hypotension, and the other two strategies included
DCR and refferal to the cardiology department.
Damage control resuscitation (DCR) has been described as aconcept that recognises that
surgical haemorrhage control and resuscitation must occur at the same time in order to get the
best outcomes. Elderly adults are more prone to hypovolemic shock as aresult of fluid loss since
they have less physiologic reserve. A reduction in intravascular volume, which can be produced
by extracellular fluid or blood loss, causes hypovolemic shock. Hypotensive resuscitation is also
included in DCR. Hypotensive resuscitation restricts the use of crystalloid fluids, keeping blood
pressure below normal and preventing further blood loss until first haemostasis is established.
Management of hypoxia
In order to manage hypoxia in the patient, anurse must consider initiation of oxygen
therapy. The oxygen saturation level in the patient was lower than the normal limit, and acidosis
was also indicated by apH value of 7.16. In this situation implementation of oxygen therapy
might be effective in terms of replenishing the oxygen deficit. Hypoxia can be described as a
clinical emergency which require prompt intervention. In case the oxygen deficiency remains
persistent, itmight lead to hypoxemia and impaired functioning of the organ system. According
to the study conducted by Rheims et al. (2019) administration of oxygen therapy has astrong
preventive effect on hypoxemia prevention and thus can be facilitated in patient suffering from
It has been evidenced that stroke patient might encounter brain death if hypoxia prolongs
and thus anurse must facilitate mitigating the oxygen needs in the patient. Administering oxygen
to the stroke patient could plausibly be beneficial in order to reduce brain damage in the patient.
However, increased levels of oxygen might also be harmful and may induce constriction of the
blood vessels, and further reduction in blood flow to brain cells. Hence itis important for the
nurse to initiate oxygen therapy in the patient very carefully.
Brekke, I.J., Puntervoll, L.H., Pedersen, P.B., Kellett, J. and Brabrand, M., 2019. The value of
vital sign trends in predicting and monitoring clinical deterioration: A systematic review. PloS
one ,14 (1), p.e0210875.
Cap, A.P., Pidcoke, H.F., Spinella, P., Strandenes, G., Borgman, M.A., Schreiber, M., Holcomb,
J., Tien, H.C.N., Beckett, A.N., Doughty, H. and Woolley, T., 2018. Damage control
resuscitation. Military medicine ,183 (suppl_2), pp.36-43.
Geske, J.B., Ommen, S.R. and Gersh, B.J., 2018. Hypertrophic cardiomyopathy: clinical
update. JACC: heart failure ,6(5), pp.364-375.
Haga, S.B. and Orlando, L.A., 2020. The enduring importance of family health history in the era
of genomic medicine and risk assessment. Personalized Medicine ,17 (3), pp.229-239.
Hayashi, T., 2020. Hypertrophic cardiomyopathy: Diverse pathophysiology revealed by genetic
research, toward future therapy. The Keio Journal of Medicine ,69 (4), pp.77-87.
Jahan, N. and Shah, Z.A., 2022. Effectiveness of Beta Blockers against Hypertrophic
Cardiomyopathy. Pakistan Journal of Medical & Health Sciences ,16 (02), pp.121-121.
Leibner, E., Andreae, M., Galvagno Jr, S.M. and Scalea, T., 2020. Damage control
resuscitation. Clinical and Experimental Emergency Medicine ,7(1), p.5.
Maidment, I.D., Lawson, S., Wong, G., Booth, A., Watson, A., McKeown, J., Zaman, H., Mullan,
J. and Bailey, S., 2020. Medication management in older people: the MEMORABLE realist
synthesis. Health Services and Delivery Research ,8(26).
Nadim, M.K., Durand, F., Kellum, J.A., Levitsky, J., O’Leary, J.G., Karvellas, C.J., Bajaj, J.S.,
Davenport, A., Jalan, R., Angeli, P. and Caldwell, S.H., 2016. Management of the critically ill
patient with cirrhosis: amultidisciplinary perspective. Journal of hepatology ,64 (3), pp.717-735
Regitz-Zagrosek, V., Roos-Hesselink, J.W., Bauersachs, J., Blomstr öm-Lundqvist, C., Cifkova,
R., De Bonis, M., Iung, B., Johnson, M.R., Kintscher, U., Kranke, P. and Lang, I.M., 2018. 2018
ESC guidelines for the management of cardiovascular diseases during pregnancy: the task force
for the management of cardiovascular diseases during pregnancy of the European Society of
Cardiology (ESC). European heart journal ,39 (34), pp.3165-3241.
Rheims, S., Alvarez, B.M., Alexandre, V., Curot, J., Maillard, L., Bartolomei, F., Derambure, P., Hirsch, E.,
Michel, V., Chassoux, F. and Tourniaire, D., 2019. Hypoxemia following generalized convulsive seizures:
risk factors and effect of oxygen therapy. Neurology ,92 (3), pp.e183-e193.
Taghavi, S. and Askari, R., 2021. Hypovolemic shock. In StatPearls [Internet] .StatPearls
Weiss, E., Paugam-Burtz, C. and Jaber, S., 2018, October. Shock etiologies and fluid
management in liver failure. In Seminars in Respiratory and Critical Care Medicine (Vol. 39,
No. 05, pp. 538-545). Thieme Medical Publishers.


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