STUDY OF ILLNESS CONDITION

ASSESSMENT ORGAN INVOLVED NORMAL FUNCTION PATHOPHYSIOLOGY ANALYSIS

The heart itself is made up of 4 chambers,
The patient is 63 years old, complained of 2 atria and 2 ventricles. De-oxygenated
sudden episode of weakness, shortness of blood returns to the right side of the
heart via the venous circulation. It is
breath for the past 3 days which has gotten
pumped into the right ventricle and then
progressively worst. Her shortness of breath
to the lungs where carbon dioxide is
worse when lying down and with exertion. released and oxygen is absorbed. The
oxygenated blood then travels back to
Vital Signs: the left side of the heart into the left
BP: 210/100mmhg atria, then into the left ventricle from
T:36.5 where it is pumped into the aorta and
P:98 arterial circulation.
RR:26
The pressure created in the arteries by
SPO2:94%
the contraction of the left ventricle is the
systolic blood pressure. Once the left
Lab results: ventricle has fully contracted it begins to
CBC:Leukocyte count = 8,4000/mm3 with relax and refill with blood from the left
normal differential count, Hemoglobin atria. The pressure in the arteries falls
14.6g/dL, Hematocrit 40%,Platelet count whilst the ventricle refills. This is the
290,000/mm3Chemistries:Glucose diastolic blood pressure. The atrio-
112mg/dL (non-fasting); BUN 33mg/dL; ventricular septum completely separates
Creatinine 1.6mg/dL; Total Bilirubin the 2 sides of the heart. Unless there is a
septal defect, the 2 sides of the heart
1.9gm/dL, Direct Bilirubin 0.3mg/dL; Total
never directly communicate. Blood
Protein 5.8g/dL, Albumin 3.1g/dL; travels from right side to left side via the
Electrolytes: Sodium 132mEq/L, Chloride lungs only. However the chambers
93mEq/L, Potassium 4.0mEq/L, Bicarbonate themselves work together. The 2 atria
23mEq/L; Urine: Specific Gravity 1.032, 1 contract simultaneously, and the 2
plus protein, hyaline casts ventricles contract simultaneously.
Congestive heart failure is a
syndrome that can be caused by a
variety of abnormalities, including
pressure and volume overload, loss
of muscle, primary muscle disease
or excessive peripheral demands
such as high output failure. In the
usual form of heart failure, the
heart muscle has reduced
contractility. This produces a
reduction in cardiac output, which
then becomes inadequate to meet
the peripheral demands of the
body. The 4 primary determinants
of left ventricular (LV) performance
are generally altered as follows: (1)
There is an intrinsic decrease in
muscle contractility. (2) Preload or
left atrial filling pressure is
increased, resulting in pulmonary
congestion and dyspnea. (3)
Although systemic blood pressure is
often reduced, there is an increase
in systemic vascular resistance
(afterload), which can further
reduce cardiac output. (4) Heart
rate is generally increased as part of
a compensatory mechanism
associated with an increase in
sympathetic tone and circulating
catecholamines. In patients with
coronary disease, there is often an
imbalance between myocardial
oxygen supply and demand. An
increase in heart size may be
particularly deleterious by
increasing wall tension because of
the Laplace relation and increasing
myocardial oxygen consumption.
Heart failure often develo
after other conditions hav
damaged or weakened yo
heart. However, the heart
doesn't need to be weake
to cause heart failure. It c
also occur if the heart
becomes too stiff.
In heart failure, the main
pumping chambers of you
heart (the ventricles) may
become stiff and not fill
properly between beats. I
some cases of heart failur
your heart muscle may
become damaged and
weakened, and the ventri
stretch (dilate) to the poin
that the heart can't pump
blood efficiently througho
your body.
Over time, the heart can n
longer keep up with the
normal demands placed o
to pump blood to the rest
your body.
An ejection fraction is an
important measurement o
how well your heart is
pumping and is used to he
classify heart failure and g
treatment. In a healthy he
the ejection fraction is 50
percent or higher — mean
that more than half of the
 blood that fills the ventric
pumped out with each be
But heart failure can occu
even with a normal ejectio
fraction. This happens if th
heart muscle becomes sti
from conditions such as h
blood pressure.
Heart failure can involve t
left side (left ventricle), rig
side (right ventricle) or bo
sides of your heart. Gener
heart failure begins with t
left side, specifically the le
ventricle — your heart's m
pumping chamber.

References: https://www.ncbi.nlm.nih.gov/pubmed/4014051, https://emedicine.medscape.com/article/163062-overview

NURSING CARE PLAN

ASSESSMENT NURSING OBJECTIVE OF CARE INTERVENTION RATIONALE IMPLEMENTATION EVALUATION
DIAGNOSIS
Subjective: Activity 1. Participate in desired 1. Check vital signs before 1. Orthostatic hypotension 1. Checked vital signs . Participated in desired
The patient is 63 years old, Intolerance r/t activities; meet and immediately after can occur with activity before and immediately activities; meet own self-
complained of sudden Imbalance own self-care needs. activity, especially if because of medication after activity, especially if care needs.
episode of weakness, patient is receiving effect (vasodilation), fluid patient is receiving
between oxygen
shortness of breath for the vasodilators, diuretics, or shifts (diuresis), or vasodilators, diuretics, or
supply/demand 2. Achieve measurable
past 3 days which has gotten
increase in activity beta-blockers. compromised cardiac beta-blockers. 2. Achieved measurable
progressively worst. Her
shortness of breath worse tolerance, evidenced by 2. Document pumping function. 2. Documented increased in activity
when lying down and with reduced fatigue and cardiopulmonary response 2. Compromised cardiopulmonary response tolerance, evidenced by
exertion. weakness and by vital to activity. Note myocardium and/or to activity. Note reduced fatigue and
signs within acceptable tachycardia, dysrhythmias, inability to tachycardia, dysrhythmias, weakness and by vital signs
limits during activity. dyspnea, diaphoresis, increase stroke volume dyspnea, diaphoresis, within acceptable limits
Objective: pallor. during activity may cause pallor. during activity.
3. Assess for other causes an immediate increase in 3. Assessed for other
Vital Signs: of fatigue (treatments, heart rate and oxygen causes of fatigue
BP: 210/100mmhg pain, medications). demands, thereby (treatments, pain,
T:36.5 4. Assess patient’s general aggravating weakness and medications).
P:98 condition. fatigue. 4. Assessed patient’s
RR:26 5. Evaluate accelerating 3. Fatigue is a side effect general condition.
SPO2:94% activity intolerance. of some medications 5. Evaluated accelerating
6. Provide assistance with (beta-blockers, activity intolerance.
Lab results:
CBC:Leukocyte count = self-care activities as tranquilizers, and 6. Provided assistance with
8,4000/mm3 with normal indicated. Intersperse sedatives). Pain and self-care activities as
differential count, activity periods with rest stressful regimens also indicated. Intersperse
Hemoglobin 14.6g/dL, periods. extract energy and activity periods with rest
Hematocrit 40%,Platelet 7. Implement graded produce fatigue. periods.
count cardiac rehabilitation 4. To note for any 7. Implemented graded
290,000/mm3Chemistries:Gl program. abnormalities and cardiac rehabilitation
ucose 112mg/dL (non- 8. Assist patient with deformities present within program.
fasting); BUN 33mg/dL;
ROM exercises. Check the body 8. Assisted patient with
Creatinine 1.6mg/dL; Total
regularly for calf pain and 5. May denote increasing ROM exercises. Checked
Bilirubin 1.9gm/dL, Direct
Bilirubin 0.3mg/dL; Total tenderness. cardiac decompensation regularly for calf pain and
Protein 5.8g/dL, Albumin 9. Adjust client’s daily rather than overactivity. tenderness.
3.1g/dL; Electrolytes: activities and reduce 6. Meets patient’s 9. Adjusted client’s daily
Sodium 132mEq/L, Chloride intensity of level. personal care needs activities and reduced
93mEq/L, Potassium Discontinue activities that without undue myocardial intensity of level.
4.0mEq/L, Bicarbonate cause undesired stress and excessive Discontinued activities that
23mEq/L; Urine: Specific psychological changes. oxygen demand. cause undesired
Gravity 1.032, 1 plus protein, 10. Instruct client in 7. Strengthens and psychological changes.
hyaline casts
unfamiliar activities and in improves cardiac function 10. Instructed client in
alternate ways of under stress, if cardiac unfamiliar activities and in
conserve energy. dysfunction is not alternate ways of
11. Encourage patient to irreversible. Gradual conserved energy.
 have adequate bed rest increase in activity avoids
and sleep. excessive myocardial
12. Provide the patient workload and oxygen
with a calm and quiet consumption.
environment. 8. To prevent deep vein
13. Assist the client in thrombosis due to
ambulation. vascular congestion.
14. Note presence of 9. Prevents straining and
factors that could overexertion which may
contribute to fatigue. aggravate symptoms.
15. Ascertain client’s 10. Conserves energy and
ability to stand and move promote safety.
about and degree of 11. Relaxes the body and
assistance needed or use promotes comfort.
of equipment. 12. Provides relaxation.
16. Assist the client in a 13. Prevents risk for falls
semi-fowlers position. that could lead to injury.
17. Elevate the head of 14. Fatigue affects both
the bed. the client’s actual and
perceived ability to
participate in activities.
15. Determines current
status and needs
associated with
participation in needed or
desired activities.
16. Promotes easy
breathing.
17. Maintains an open
airway
References: https://nurseslabs.com/heart-failure-nursing-care-plans/2/
DRUG STUDY
GENERIC NAME: LAXIS DOSAGE/FREQUENCY/ROUTE: SIDE EFFECTS/ADVERSE REACTION
11. Encouraged patient to
have adequate bed rest
and sleep.
12. Provided the patient
with a calm and quiet
environment.
13. Assisted the client in
ambulation.
14. Noted presence of
factors that could
contribute to fatigue.
15. Ascertained client’s
ability to stand and move
about and degree of
assistance needed or use of
equipment.
16. Assisted the client in a
semi-fowlers position.
17. Elevated the head of
the bed
NURSING RESPONSIBILITY
 40 mg q6-8hr PO

Hyperuricemia (40%)  Assess fluid status.

BRAND NAME: Furosemide INDICATION: Hypokalemia (14-60%) Monitor daily weight,
LASIX is indicated in adults and pediatric patients Anaphylaxis intake and output ratios,
for the treatment of edema associated Anemia amount and location of
with congestive heart failure, cirrhosis of the liver Anorexia edema, lung sounds, skin
and renal disease, including the nephrotic Diarrhea turgor, and mucous
syndrome. LASIX is particularly useful when an Dizziness membranes. Notify
agent with greater diuretic potential is desired. Glucose intolerance health care professional
CLASSIFICATION: CONTRAINDICATION: Glycosuria if thirst, dry mouth,
Lasix (furosemide) is a loop diuretic Headache lethargy, weakness,
(water pill) that prevents your body Hearing impairment hypotension, or oliguria
from absorbing too much salt. This Furosemide is contraindicated in patients with Hyperuricemia occurs.
allows the salt to instead be passed in anuria. It should be used cautiously in any patient Hypocalcemia
your urine. Lasix is used to treat fluid with renal disease such as severe renal Hypokalemia  Monitor BP and pulse
retention (edema) in people with impairment or renal failure. Drug-induced Hypomagnesemia before and during
congestive heart failure, liver disease, hypovolemia can precipitate azotemia in these Hypotension administration. Monitor
or a kidney disorder such as nephrotic patients. Increased patent ductus arteriosus frequency of prescription
syndrome. during neonatal period refills to determine
Muscle cramps compliance in patients
MECHANISM OF ACTION: Nausea treated for hypertension.
Photosensitivity
Furosemide promotes diuresis by Rash  Geri:  Diuretic use is
blocking tubular reabsorption of Restlessness associated with
sodium and chloride in the proximal Tinnitus increased risk for falls in
and distal tubules, as well as in the Urinary frequency older adults. Assess falls
thick ascending loop of Henle. This Urticaria risk and implement fall
diuretic effect is achieved through the Vertigo prevention strategies.
competitive inhibition of sodium- Weakness  Assess patients receiving
potassium-chloride cotransporters digoxin for anorexia,
(NKCC2) expressed along these nausea, vomiting, muscle
tubules in the nephron, preventing cramps, paresthesia, and
the transport of sodium ions from the confusion. Patients
lumenal side into the basolateral side taking digoxin are at
for reabsorption. This inhibition increased risk of digoxin
results in increased excretion of water toxicity because of the
along with sodium, chloride, potassium-depleting
magnesium, calcium, hydrogen, and effect of the diuretic.
potassium ions. As with other loop Potassium supplements
diuretics, furosemide decreases the or potassium-sparing
excretion of uric acid. diuretics may be used
 Furosemide exerts direct vasodilatory concurrently to prevent
effects, which results in its therapeutic hypokalemia.
effectiveness in the treatment of  Assess patient for
acute pulmonary edema. Vasodilation tinnitus and hearing loss.
leads to reduced responsiveness to Audiometry is
vasoconstrictors, such as angiotensin recommended for
II and noradrenaline, and decreased patients receiving
production of endogenous natriuretic prolonged high-dose IV
hormones with vasoconstricting therapy. Hearing loss is
properties. It also leads to increased most common after
production of prostaglandins with rapid or high-dose IV
vasodilating properties. Furosemide administration in
may also open potassium channels in patients with decreased
resistance arteries. The main renal function or those
mechanism of action of furosemide is taking other ototoxic
independent of its inhibitory effect on drugs.
carbonic anhydrase and aldosterone.  Assess for allergy to
sulfonamides.
 Assess patient for skin
rash frequently during
therapy. Discontinue
furosemide at first sign
of rash; may be life-
threatening. Stevens-
Johnson syndrome, toxic
epidermal necrolysis, or
erythema multiforme
may develop. Treat
symptomatically; may
recur once treatment is
stopped.

References:
https://www.drugbank.ca/drugs/DB00695
https://reference.medscape.com/drug/lasix-furosemide-342423
https://www.rxlist.com/lasix-drug.htm#description
DRUG STUDY
GENERIC NAME: Metoprolol
BRAND NAME: Lopressor
CLASSIFICATION:
Metoprolol is used with or without
other medications to treat high blood
pressure (hypertension). Lowering high
blood pressure helps prevent
strokes, heart attacks, and kidney
problems. This medication is also used
to treat chest pain (angina) and to
improve survival after a heart attack.
Metoprolol belongs to a class of drugs
known as beta blockers. It works by
blocking the action of certain natural
chemicals in your body, such
as epinephrine, on
the heart and blood vessels. This effect
lowers the heart rate, blood pressure,
and strain on the heart.
MECHANISM OF ACTION:
DOSAGE/FREQUENCY/ROUTE:
12.5 mg orally once a day
INDICATION:
Metoprolol is indicated for the treatment of
angina, heart failure, myocardial infarction, atrial
fibrillation, atrial flutter and hypertension.
Some off-label uses of metoprolol include
supraventricular tachycardia and thyroid storm.
All the indications of metoprolol are part of
cardiovascular diseases. These conditions
correspond to a number of diseases that involve
the function of the heart and blood vessels. The
underlying causes of these conditions are variable
and can be due to genetic disposition, lifestyle
decisions such as smoking, obesity, diet, and lack
of exercise, and comorbidity with other
conditions such as diabetes. The cardiovascular
diseases are the leading cause of death on a
global scale.
CONTRAINDICATION:
Because beta-blockers depress conduction
through the AV node, metoprolol is
contraindicated in patients with severe
bradycardia, sick sinus syndrome, or advanced AV
block (second or third-degree AV block) unless a
functioning pacemaker is present.
SIDE EFFECTS/ADVERSE REACTION NURSING RESPONSIBILITY
Drowsiness, dizziness, 1. Always check patients
tiredness, diarrhea, and slow apical pulse
heartbeat may occur. Decreased 2. Monitor BP
sexual ability has been reported 3. Store drug at room
rarely. If any of these effects persist or temperature.
worsen, tell your doctor 4. Inform patient about the side
or pharmacist promptly. effects and adverse effects of the
To reduce the risk of dizziness medication.
and light-headedness, get up slowly 5. Advise patient to take it with
when rising from a sitting or lying meals.
position. 6. Tell patient to report if he/she
This drug may reduce blood flow to feels shortness of breath.
your hands and feet, causing them to 7. Tell patient that metoprolol is
feel cold. Smoking may worsen this not advisable to breastfeeding
effect. Dress warmly and mothers.
avoid tobacco use. 8. Advise not to withdrawn drug
Remember that your doctor has abruptly.
prescribed this medication because he
or she has judged that the benefit to
you is greater than the risk of side
effects. Many people using this
medication do not have serious side
effects.
Tell your doctor right away if any of
these unlikely but serious side effects
occur: very slow heartbeat, severe
dizziness, fainting, blue
fingers/toes, trouble breathing, new or
worsening symptoms of heart
failure (such as shortness of breath,
swelling ankles/feet, unusual
tiredness, unusual/sudden weight
gain), mental/mood changes (such as
confusion, mood swings, depression).
A very serious allergic reaction to this
drug is rare. However, get medical
help right away if you notice any
symptoms of a serious allergic
reaction,
including: rash, itching/swelling
 Metoprolol is a beta-1-adrenergic (especially of the face/tongue/throat),
receptor inhibitor specific to cardiac severe dizziness, trouble breathing.
cells with negligible effect on beta-2
receptors. This inhibition decreases
cardiac output by producing negative
chronotropic and inotropic effects
without presenting activity towards
membrane stabilization nor intrinsic
sympathomimetics.

References:
https://www.scribd.com/doc/38234158/DRUG-STUDY-Metoprolol
https://www.webmd.com/drugs/2/drug-6879/lopressor-oral/details#
https://www.drugbank.ca/drugs/DB00264
 DRUG STUDY

GENERIC NAME: Ferrous Gluconate DOSAGE/FREQUENCY/ROUTE: SIDE EFFECTS/ADVERSE REACTION NURSING RESPONSIBILITY

 27 mg elemental Fe PO qDay GI irritation 1. Observe for signs of

BRAND NAME: Ferate INDICATION: Nausea adverse effects and/or
Stomach cramping toxicity. Keep in mind
Staining of teeth gastro-intestinal upset
Used in preventing and treating iron-deficiency Heartburn may be dose related.
anemia. Vomiting
CLASSIFICATION: CONTRAINDICATION: Constipation 2. Observe stools. Check for
Ferrous gluconate is a L-alpha-D- Diarrhea constipation.
Hepp-(1->7)-L-alpha-D-Hepp-(1->3)-L- Discoloration of urine
alpha-D-Hepp-(1->5)-alpha-Kdo. Iron i Contraindicated in patients receiving repeated Dark color stools
s an essential heavy metal that is blood transfusions and those with peptic
included in many over-the-counter ulceration, regional enteritis, ulcerative colitis,
multivitamin and mineral supplements hemosiderosis, primary hemochromatosis, or
and is used therapeutically in higher hemolytic anemia unless iron
doses to treat or prevent iron deficiency anemia is also present.
deficiency anemia.

MECHANISM OF ACTION:

Iron is necessary for the production of

hemoglobin. Iron-deficiency can lead
to decreased production of
hemoglobin and a microcytic,
hypochromic anemia.

References:
https://reference.medscape.com/drug/fergon-ferrous-gluconate-999567#0
https://www.drugbank.ca/drugs/DB14488