SCIN255 Principles Of Pathophysiology And Pharmacology

1. Reason and thinking

Nursing assessment is the process that nurses gather information about the physiological, psychological, sociological as well as the spiritual condition of the patient who presents at the clinic. This is usually the initial step in any nursing process. Between thinking and reasoning, it is thinking that usually comes first and not reason. Nurses should always critically think of the appropriate interventions that will assist the patient. Reasoning should therefore come after thinking. Not just the literal thinking but the nurse should think from the critical perspective.

2. Important data after filtering

The most important data in this case study or rather assessment include creatinine results since they indicate the malfunction of the kidney as well as the magnesium, calcium and potassium levels. Other relevant data include the hormone produced by the left ventricles as it usually indicates heart failure.

3. Main symptoms that prompted the patient enter the ED

In any case study or rather during assessment by the nurses, there are always certain signs and symptoms that necessitate the enrollment or rather presentation at the emergency department. Based on this case study, the vital signs and symptoms that made the patient visit the emergency department include a systolic heart failure that was secondary to ischemic cardiomyopathy with an ejection fraction of only 15%.An ejection fraction of only 15% is a clear indication of the end stage heart failure which the nurses should recognize. The fact that it was an end stage heart failure therefore necessitated the need for the patient to be enrolled at the emergency department. Besides the ejection fraction, shortness of breath is another key symptom that necessitates presentation at the emergency department. The Discomforts she has been feeling is also a red flag as well as the increased swelling in her lower legs and the excessive weight she has gained.

4. Laboratory Values that are not within the normal range

From the laboratory results, there are some values that are not within the normal range. Some of the values include that sodium where the results were 133mEq/L and the normal range is between 153-145 mEq/L.This therefore means that the sodium was very low. Potassium is another salt whose value of 4.9 mEq/L is relatively higher than the normal. Creatinine results are also out of the normal range at 2-9mg/dl.

5. Values that relate to the kidney functions

That value that relates to kidney function in this case is creatinine. Creatinine is the end product of muscle breakdown. Individuals with more muscle mass make more creatinine. Healthy kidneys should have the ability to remove excess creatinine from the blood.In case there is high creatinine in the serum or blood, chances are very high the kidney is impaired. The normal creatinine levels are 0.6-1.1 mg/dl for women and 0.7-1.3 mg/dl for men. In this assessment, the serum creatinine was recorded as 2.9 mg/dl which is higher than the normal and therefore indicates that the kidney is impaired to some extent.

6. Hormone produced by the left ventricle

The left ventricle usually produce the B-type Natriuretic Peptide (BNP) The hormone is made up of 29 amino acids. In this case the BNP was recorded as being high at 1855 ng/l. The normal values should fall below 100 ng/l.

7. Vital signs to the patient relevant to the health problem

The vital signs that are usually relevant to the heart failure include shortness of breath which is otherwise known as dyspnea. Buildup of excess fluids or edema is another vital sign, finally it is fatigue and increased heart rate. Going by this scenario, all this were exhibited since the legs of the patient were swollen and she also complained of dyspnea.

8. The dominant autonomic nervous system

The pathophysiology of heart failure is associated with hemodynamic abnormalities that usually lead to neurohormonal activation and the imbalance in the autonomic system. The cardiac autonomic system is comprised of the sympathetic and the parasympathetic systems that work in opposing fashions. During heart failure, the sympathetic nervous system is activated while the parasympathetic nervous system is inhibited. This is due to the hemodynamic changes that are associated with the alteration in the cardiac function.

9. Medications prescribed to the patient

The patient in this case was prescribed different medications and they include Carvidilol, Hydralazine and torsemide. Carvidilol is a beta blocker while hydralazine is a vasodilator .Finally, the torsemide is a loop diuretic that inhibit the reabsorption of sodium and chlorine at the loop of Henle.

10. The electrolytes that need reassessment

From this case, there are different electrolytes that need reassessment. They include, sodium, magnesium and calcium. It is normal for patients suffering from heart failure to experience hyponatremia and this is due to the decreased water excretion. Magnesium, potassium and calcium also influence the functioning of the cardiovascular system and should therefore be properly reassessed.