Question

A 64-year-old woman presents to the primary care office with shortness

of breath, leg swelling, and fatigue. She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration in bilateral bases. The cardiac exam reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI.
A- Discuss the pathophysiological mechanisms that can lead to heart failure.
B- Differentiate between systolic and diastolic heart dysfunction
C- 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.
D- Include two points of teaching for this patient
E- Support your response with at least one current evidence based resource.
F- Students must post a minimum of three times in each graded discussion (see participation guidelines below).

Answer 1

Answer: seen below

Step-by-step explanation:

A) Heart failure develops when the human heart, via an abnormality of cardiac function (which is either detectable or not), fails to pump blood at a rate similar with the requirements of the metabolizing tissues or is able to do so only with an elevated diastolic filling pressure. In heart failure, the heart may not provide the body tissues with adequate blood for it metabolic needs, and cardiac-related elevation of pulmonary or systemic venous pressures may result in organ congestion. This condition can result from abnormalities of either systolic or diastolic function or, commonly, both.

B) Differences between systolic and diastolic heart dysfunction is that systolic is characterized by a reduced ejection flow fraction and an enlarged left ventricular chamber,it is clinically associated with left ventricular failure in the presence of marked cardiomegaly while diastolic is an increased resistance to filling with increased filling pressures. This dysfunction is accompanied by pulmonary congestion together with a normal or only slightly enlarged ventricle. In simpler terms If you have systolic heart failure, it means your heart isn't contracting well during heartbeats. If you have diastolic heart failure, it means your heart isn't able to relax normally between heartbeats.

C) the cause of the patient's shortness of breath, awakening in the middle of the night and the need to prop herself up on three pillows is due to excess fluid that backs up in her lungs causing dyspnea propping the the patient to increase the number of pillows. This excess fluid is as a result of increased pressure of the pulmonary veins because the heart is unable to supply the lungs with the needed oxygen Which causes the shortness of breath during walking.

D,E and F) two points of teaching for this patient include educating patient on the disease process is very important using an evidence based resource like the American Heart association to enlighten patient. Educate both patient and nurses for follow up care to help improve management of disease and self care.

Answer 2

A- Heart failure may be caused by different health problems including high blood pressure or coronary artery disease

B- Systolic heart dysfunction is caused by the absence of normal heart contractions, while diastolic dysfunction is produced by dysfunction in the period of relaxation

C-These symptoms are because the heart can't pump blood well

D-The patient needs to eat low amounts of salt and saturated fats in order to decrease blood pressure

E- It has been shown that a low-salt diet helps to maintain a normal blood pressure. You can read this article by Hummel et al. (2009): "Recommendation of low-salt diet and short-term outcomes in heart failure with preserved systolic function. The American journal of medicine, 122(11), 1029-1036"