507 week 2

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School

Chamberlain University College of Nursing *

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NR507

Subject

Nursing

Date

May 24, 2024

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docx

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2

Uploaded by MagistrateIbex2967

Week 2 Discussion Questions Differentiate between systolic and diastolic heart failure. In systolic heart failure, the left ventricle of the heart cannot contract fully or adequately. This condition is characterized by a reduced ejection fraction, which refers to the percentage of blood pumped out of the left ventricle with each heartbeat. As a result, less blood is pumped out of the heart with each beat, resulting in decreased cardiac output and associated symptoms like fatigue, shortness of breath, and fluid backing up into the lungs and body (Savarese et al., 2022). In diastolic heart failure, the heart's left ventricle cannot relax fully due to stiffness in the heart tissues. The primary problem in diastolic heart failure is impaired relaxation and filling of the heart during the resting phase of the cardiac cycle (Obokata et al., 2020). Hence, If the left ventricle cannot fully relax, it cannot hold the amount of blood that the body needs, thus leading to high pressure within the chambers of the heart and, in turn, increased pressure in the lungs. State whether the patient is in systolic or diastolic heart failure. In the case scenario, there is a mention of decreased wall motion of the anterior wall of the heart and an ejection fraction of 25%. The symptoms reported, such as shortness of breath, leg swelling, and fatigue, align with manifestations of systolic heart failure. Explain the pathophysiology associated with each of the following symptoms: dyspnea on exertion, pitting edema, jugular vein distention, and orthopnea. Dyspnea (shortness of breath) occurs when the body’s oxygen demand increases due to doing an activity. The body responds by increasing the respiratory rate and depth to enhance oxygen intake. The dyspnea on exertion manifests the mismatch between oxygen demand and supply (Schwinger,2021). Pitting edema is the accumulation of fluid in the tissues, typically in the lower extremities. In heart failure, the weakened pumping action of the heart results in reduced blood flow from the veins to the heart (McCance & Huether,2019). As a result, it leads to an increase in pressure within the veins and capillaries. The elevated pressure causes fluid to leak into the surrounding tissues, leading to edema. Jugular vein distention (JVD) is the visible bulging of the jugular veins in the neck (Schwinger,2021). In heart failure, particularly right-sided heart failure, this inability leads to blood getting backed up into the pulmonary vein and then into the lungs. The right ventricle pumps blood into the lungs as well. Therefore, the right ventricle becomes weaker due to the backup of blood into the lungs (Schwinger, 2021).
Orthopnea refers to difficulty breathing while lying flat and is often relieved by sitting up or standing (Schwinger,2021). In heart failure, fluid accumulation in the lungs (pulmonary congestion) is typical. The patient reports using three pillows propped to sleep in the case scenario. This subjective data supports orthopnea. Explain the significance of the presence of a 3rd heart sound and ejection fraction of 25%. The presence of a third heart sound (S3) is significant because it can indicate the presence of cardiac dysfunction. An ejection fraction of 25% means that the heart is not pumping as efficiently as it should be, which can be due to various factors, including heart disease. Reference: McCance, K., & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier Health Sciences Obokata, M., Reddy, Y. N., & Borlaug, B. A. (2020). Diastolic Dysfunction and Heart Failure With Preserved Ejection Fraction: Understanding Mechanisms by Using Noninvasive Methods. JACC: Cardiovascular Imaging , 13 (1), 245-257. https://doi.org/10.1016/j.jcmg.2018.12.034 Schwinger R. H. G. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy , 11 (1), 263–276. https://doi.org/10.21037/cdt-20-302 Savarese, G., Stolfo, D., Sinagra, G., & Lund, L. H. (2022). Heart failure with mid-range or mildly reduced ejection fraction. Nature Reviews Cardiology , 19 (2), 100-116. https://doi.org/10.1038/s41569-021-00605-5
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