Adult Nursing - Management of Long Term Conditions

Adult Nursing - Management of Long Term Conditions

CASE STUDY OF EDITH WITH HEART FAILURE

 Introduction

In this essay, the focus is on a patient living with a long-term condition (LTC) of heart failure. It focuses on Edith's case, an 83-year-old lady, to demonstrate some of the key features of LTC and their impacts on the patients physical, social and psychological state. The paper briefly identifies the underlying pathophysiology of heart failure and applies relevant literature to discuss its impacts. It also explores relevant assessment and management strategies concerning the needs of this service user. Besides, the essay considers person-centred care approaches to promote self-management of this LTC and service user’s (SU’s) independence. Finally, the paper identifies and analyses the role of the nurse in managing SU's long-term needs.

Pathophysiology of heart failure

Heart failure is a condition resulting from some abnormality in myocardial function (Katz and Konstam, 2012). It affects normal body functioning in various ways, depending on its type. The abnormality inhibits the heart from delivering enough oxygenated blood to meet the body’s metabolic needs.

Acute Heart failure is caused by various conditions such as valve rupture, myocardial infarction, cardiac tamponade, and acute viral myocarditis, results in an abrupt reduction of cardiac output hence causing systemic hypotension.  Consequently, hypoxia to the cerebral and cardiogenic shock presents. On the other hand, the gradual development of chronic Heart failure is due to atherosclerosis of the coronary arteries resulting in myocardial ischemia,  arterial hypertension, and progressive acute heart failure into chronic; its pathophysiology depends on the side of the heart it affects (Katz and Konstam, 2012).

Left-sided heart failure is brought about by mitral and aortic stenosis, systemic hypertension, ischaemic heart disease, and restrictive pericarditis; its pathophysiology is due to decreased left ventricular output. This results in the accumulation of fluid in the lungs resulting in pulmonary congestion. Pulmonary congestion presents itself with dyspnoea and orthopnea (Katz and Konstam, 2012).

A decrease in the left ventricular output leads to hypoperfusion of tissues, such as the brain(causes hypoxic encephalopathy); kidneys(causes ischaemic acute tubular necrosis). Right-sided Heart failure occurs following Left-sided heart failure; its clinical manifestations are portal venous congestion and reduced cardiac output. Venous congestion occurs in various tissues, such as congestion of the kidneys, ascites, liver, leg veins, and hydrothorax. This manifests itself as oedema. The reduction in cardiac output leads to anoxia, cyanosis, and cold extremities (Sperelakis, 2012).

Backward Heart Failure is due to a shoot in the end-diastole volume due to ventricles' failure to eject blood under normal circumstances. The atria consequently increase in pressure and volume and transmit the force into the veins leading to their distension. In Forward Heart Failure, the clinical manifestations result from the heart failing to directly pump blood, leading to a decrease in the blood flow to various tissues. This results in diminished renal perfusion.

Impacts of heart failure

Heart failure causes many complications and affects patients in various ways (Katz and Konstam, 2012). It can be challenging for the individual with this pathological condition to manage the disease and deal with the complications that may arise both physically and mentally. It also impacts the individual's daily life activities, including social, family, and spiritual involvement. Often, individuals have to disrupt their routine to seek medical help when symptoms arise (Nicole and Hollowood, 2019). The health effects on the lives of the individual cause discomfort. Vital organs in the body, such as the lungs and kidneys, are greatly affected. The lungs play a crucial part in the oxygenation of the blood. Edemas are formed when the heart weakens, and it cannot pump enough blood effectively. With a deficiency of oxygen-rich blood reaching the kidney, swelling occurs in the ankles, feet, and legs. The kidneys cannot cycle out excess water and waste products effectively. Fluid also forms in the lungs; a condition is known as pleural effusion. Some of the manifestations of fluid accumulation include shortness of breath when carrying out activities and during the night, wheezing, especially at night and at times a cough, progressive fatigue due to depletion of energy levels, swellings in the abdomen and legs, and a sharp rise in body weight. Heart failure patients often present with chest pain and fatigue since the heart valves are greatly affected. In heart failure episodes, the heart valves either narrow or do