Case Study of Mrs Valerie-Free-Samples for Students-Myassignment

Question: Analyse the vital signs and Pathology report to understand the reasons for abnormalities and their impact. Answer: Introduction: Evidence based practice is the process of integrating best evidence in nursing practice to address specific clinical issues of patient and improve their health outcome. A nurse has the duty and responsibility to carry out patient assessment, interpret patients information and engage in critical decision making to determine the appropriate nursing intervention or specific clinical condition (DiCenso, Guyatt, Ciliska, 2014).The process of assessment and planning of nursing intervention is demonstrated in this essay through the case of Mrs. Valerie Jackson. She is a 65 year old patient who has been recently diagnosed with cardiac arrthymia. She had been transferred to the HDU for open large bowel resection. Based on patients current symptoms and pathological information, the essay explains the reasons for the condition by means of discussion on the pathophysiology of cardiac arrhythmia. Secondly, the essay analyses the vital signs and pathology report to understand the reasons for abno rmalities and their impact. Based on this discussion, the specific assessment needs of patient are determined and three nursing interventions to improve Valeries condition is discussed. Pathophysiology of presenting problem: Mrs. Valerie has been diagnosed with cardiac arrhythmia. It is a condition associated with abnormal heart rhythm. In some case, the heart beat is too fast that normal rate-100 beats per minute (tachycardia) or too slow than normal rate- 60 beats per minute (bradycardia). This change in heart beat is seen due to the change in the normal sequence of electrical impulses (Schwartz, 2014). These impulses generate eratically resulting in too fast or too slow heart beat. The pathophysiological explanation for this is explained by the process of enhanced or suppressed automaticity and triggered activity. Automaticity is the normal property of all myocytes and this property gets hampered due to ageing, ischemia, effect of certain medications and other factors (Tse, 2016). The advancing age of Valerie might be a reason for change in property of automaticity. The condition of suppressed automaticity leads to dysfunction of sinus node and the enhanced automaticity leads to multiple arrhythmia (Y abluchansky et al., 2016). This condition can be identified in patient by the symptoms of dizziness, loss of consciousness, shortness of breath and chest discomfort. Triggered activity is another condition or mechanism behind cardiac arrhythmia. It is the initiation of impulse on the basis of afterdepolarization. However, triggered activity occurs when both early depolarization and after depolarization initiates at the same time. This form of abnormal impulse excitation results in reentrant excitation (Antzelevitch et al., 2014). In contrast with the condition of cardiac arrhythmia, normal cardiac rhythm is seen when spontaneous impulse is generated from the sinoatrial node and transmitted to the myocardium (Ruthruff Lien, 2016). Hence, in normal condition, impulse formation and transmission to the atrial and ventricular mycocardium occurs in a synchronous pattern. However, myocardial disease and certain cardioactive drugs disrupts the normal cardiac rhythm and changes the activity of the sinus node. Major changes is observed in automaticity of the myocardium that results in compromised cardiac function and adverse symptoms in patients like Vale ria (van der Lende et al., 2015). Interpretation of rhytm: The examination of the rhythm strips of Mrs. Valerie indicates the condition of sinus tachycardia or abrupt increase of heart rhythm. This is defined by a value greater than 100 beats/minute. The event is traced by the PQRST wave on the rhythm strip. P wave represents the discharge of the SA node and depolarization of the atria. The pattern of the wave indicates condition of tachycardia in Mrs. Valerie and this might have occurred because of increase in demand of oxygen due to stress, infection or blood loss. Mrs. Valerie might be presenting with this condition because she had a bowel resection and it might have lead to blood loss (Baruscotti et al., 2016). Sinus Tachycardia is a condition of rhythm in which rate of impulse generating from the sinoatrial node increases. This kind of rhythm is mostly seen in patient with cardiovascular disease. The normal heart beat is seen in an individual due to the mechanism of systematic interplay between sympathetic and parasympathetic nervous sy stem (Ruthruff Lien, 2016).. However, this system is significantly affected by ageing. Due to ageing, the property of heart muscles cells and walls changes. The wall of the arteries becomes thicker and elasticity is lost (Ho Snchez-Quintana, 2016). Hence, damage to heart tissue might the reason for the abnormal heart rhythm in Mrs. Valerie. It is very likely that this condition might have occurred in patient due to advancing age. Strait Lakatta (2012) also gives the evidence that aging is one of the major risk factor for cardiovascular disease because of declining cardioprotective system. Ageing leads to many type of changes in older people. Firstly, structural changes in vascular wall and heart are seen due to aging. Secondly, functional changes reduce the ability to respond to workload and cardiac mechanism for protection from injury is become defective. These factors might be the reason for the presentation of bradycardia in heart rhythm strips. Discussion of normal or abnormal pathology results: The pathology results of Mrs. Valerie gave the following outcome: Sodium- 148 mmol/L Potassium- 3.1 mmol/L Chloride- 90 mmol/L Bicarbonate- 20mmol/L Magnesium- 0.50 mmol/L Phosphate- 0.60 mmol/L The normal level of sodium in blood is between 135mmol/L to 145mmmol/L, however Mrs. Valeries sodium level was 148 mmmol/L which is slight high. A high sodium level may lead to the condition of hypernatremia. This kind of electrolyte imbalance may be caused by dehydration, endocrine disease, hyperventilation and use of drugs like steroids and blood pressure lowering medication (Hauptman et al., 2013). Due to this condition, Mrs. Valerie may have symptoms of sweating, fever, dizziness and diarrhea. She might exhibit this condition due to decrease in water excretion. This might lead to hazardous complication in patient and heart rate variability. High salt is likely to increase blood pressure, decrease heart rate and increase the frequency of changes in heart rate (McNeely, Windham, Anderson, 2008). Hence, hypernatremia is a major clinical presentation for patients with high blood sodium levels. Symptoms may range from mild signs like nausea and vomiting to severe signs like seizures and coma. Magnesium and potassium plays an important role in the development of cardiac arrthythmia in patient. The magnesium and potassium level in blood of Mrs. Valerie was 3.3 mmol/L and 0.50 mmol/L respectively. Both values are below the normal threshold value as normal volume of magnesium and potassium in blood are 3.5 to 5.0 mmol/L and 0.7 to 1.10 mmol/L. Low magnesium level may lead to the clinical presentation of hypomagnesium in patient. Normal magnesium level is important for maintenance of heart and nervous system function. The condition may be caused by low magnesium in diet, renal damage, endocrine disorder and high excretion of magnesium from the body. Magnesium depletion is the major cause of diagnosis of arrhythmias in patient (Efstratiadis, Sarigianni, Gougourelas, 2006). Magnesium maintains intracellular concentration and the depletion of the same leads to cardiovascular impairments. Loop diuretics also result in loss of potassium and magnesium from the body which ultimately impairs cardiovascular functions (Agus, 2016). The pathological results of Mrs. Valerie also indicate low chloride and bicarbonate level as it was 90mmol/L and 20mmol/L. Both the values are below the normal value. This might also lead to electrolyte imbalance issue. Hypocholermia is also mainly caused by the effect of diuretics and laxatives. As Mrs. Valerie has open large bowel section, the electrolyte imbalance might be the reason for her decreased urine output. Low chloride level might lead to the condition of dehydration, high fever or no symptoms too. The fluctuation in the sodium level will have a major impact on the heart rate of Mrs. Valerie. This is because heart rate is regulated by the mechanism of sympathetic and parasympathetic system. Sodium outside the cell and potassium inside the cell functions to initiate nerve impulse (DeMorais Biondo, 2012). However, decreased sodium level causes low blood pressure and increased heart rate. Hence, the cardiac rhythm strip may change due to changes in sodium level. On the othe r hand, changes in bicarbonate level might lead to acidosis in patient. Urso, Brucculeri, Caimi, (2015) explains that electrolyte and acid base abnormalities cause fatal complications in patients with heart disorder. This is because of the alteration of the neurohumoral activation. This might lead to adverse event during diuretic therapy and play a major role in the development of cardiac arrhythmias too. Discussion on assessment criteria and nursing interventions On the examination of the pathological results of Mrs. Valerie and summary of her fluid balance after the open large bowel resection, it is understood that the patient is prone to many complications like loss of consciousness, changes in heart rate, decreased urine output and impaired cardiovascular functions. She is also at risk of fall due to symptoms of dizziness due to the electrolyte imbalance in her body. To manage her condition and promote health and wellbeing of patient, many nursing assessment is required. Firstly, the vital signs of patients needs to be closely monitored since the patients has high chance of fluctuations in vital signs due to electrolyte imbalance. Secondly, Mrs. Valeria is under nasogastric tube on free drainage, so the nurse needs to assess the position and potency of the tube. Patients with bowel resection are also prone to infection so checking the colour and amount of drainage from surgical site is necessary. In addition to manage the condition of card iac arrhythmia in patient, it is necessary to routinely assess the pulse rate and heart rate of patient. ECG tracing, vital signs assessment, need for more pathological test and hemodynamic monitoring will also be an important assessment criteria for nurse. The main issue present in Mrs. Valerie is the diagnosis of cardiac arrhythmia and the issue in fluid balance after bowel resection. To manage these issues, three nursing intervention is necessary for Mrs. Valerie. Firstly, the nurse needs to provide preoperative nursing intervention for the care of bowel resection. This is importance because patient is important to prevent infection in patient and promote quick recovery. The nurse will have to ensure the patency of the nasogastric tube as it will provide comfort to patient and result in healing. To prevention any type of infection after surgery, it is critical for the nurse to manage change in colour and amount of drainage. While on nasogastric tube, the patient is at high risk of sodium, potassium and chloride imbalance (Joseph, Vaughan, Strand, 2015). Hence, the nursing intervention of maintaining intravenous fluid is most important. This can be done by providing replacement fluids and adequate electrolytes to patient. After critically reviewing the blood results of Mrs. Valerie, great fluctuation in electrolyte level was found. As electrolyte imbalance is the factor that results in complications of heart rate and cardiovascular dysfunction, nursing interventions related to electrolyte balance is important. The care plan for electrolyte imbalance would be to monitor heart rate and respiratory rate regularly. The patient must be encouraged to take deep breath to avoid respiratory complications. Secondly, due to greater likelihood of symptoms of dizziness, the nurse has a role in assessment of consciousness and neuromuscular function (Williams Hopper, 2015).Mrs. Valerie particularly has problem of decreased output and taking steps regarding this is important. Based on the risk of different conditions like hypernatremia or hypomagnesia, providing the required electrolyte will be important. The third nursing intervention is related to the management of the condition of cardiac arrhythmia. For this, it is necessary to control the erratic fluctuation of heart rate in patient. In this situation, it will be necessary for the nurse to monitor pulse rate regularly. ECG tracing and evaluation of ECG by regular consultation with physician is also critical to manage adverse symptoms of patients. As the clinical issue of electrolyte imbalance is mainly caused by the effect of certain drugs, it will be necessary to closely assess each medication before giving to patient. Monitoring signs of drug toxicity is important to recognize irregular rhythm and control them (Jurgens et al., 2015) . Conclusion The essay evaluated the condition of Mrs, Valerie, a patient with cardiac arrhythmia and bowel resection through the discussion on the pathophysiology of the condition. The vital signs of patient post operation and pathological results gave indication about the range of risk and abnormalties in patient. The reasons for abnormality were adequately discussed with support from evidence. Based on the examination of electrolyte imbalance issue and other risk in patient, nursing interventions were adequately planned and summarized. This work form the basis of evidenced based practice as all issues and care plan has been supported with evidence based practice. References Agus, Z. S. (2016). Mechanisms and causes of hypomagnesemia.Current opinion in nephrology and hypertension,25(4), 301-307.lar block.Heart Rhythm,12(3), 498-505. Antzelevitch, C., Nesterenko, V., Shryock, J. C., Rajamani, S., Song, Y., Belardinelli, L. (2014). The role of late I Na in development of cardiac arrhythmias. InVoltage Gated Sodium Channels(pp. 137-168). Springer Berlin Heidelberg. Baruscotti, M., Bianco, E., Bucchi, A., DiFrancesco, D. (2016). Current understanding of the pathophysiological mechanisms responsible for inappropriate sinus tachycardia: role of the If funny current.Journal of Interventional Cardiac Electrophysiology,46(1), 19-28. DiCenso, A., Guyatt, G., Ciliska, D. (2014).Evidence-Based Nursing-E-Book: A Guide to Clinical Practice. Elsevier Health Sciences. Efstratiadis, G., Sarigianni, M., Gougourelas, I. (2006). Hypomagnesemia and cardiovascular system.Hippokratia,10(4), 147. Hauptman, P. J., Burnett, J., Gheorghiade, M., Grinfeld, L., Konstam, M. A., Kostic, D., ... Zannad, F. (2013). Clinical course of patients with hyponatremia and decompensated systolic heart failure and the effect of vasopressin receptor antagonism with tolvaptan.Journal of cardiac failure,19(6), 390-397. Ho, S. Y., Snchez-Quintana, D. (2016). Anatomy and pathology of the sinus node.Journal of Interventional Cardiac Electrophysiology,46(1), 3-8. Joseph, J., Vaughan, R., Strand, H. (2015). Effectiveness of nurse-performed endoscopy in colorectal cancer screening: a systematic review.Gastrointestinal Nursing,13(4). Jurgens, C. Y., Goodlin, S., Dolansky, M., Ahmed, A., Fonarow, G. C., Boxer, R., ... Fleg, J. L. (2015). Heart failure management in skilled nursing facilities.Circulation: Heart Failure,8(3), 655-687. van der Lende, M., Surges, R., Sander, J. W., Thijs, R. D. (2015). Cardiac arrhythmias during or after epileptic seizures.J Neurol Neurosurg Psychiatry, jnnp-2015. McNeely, J. D., Windham, B. G., Anderson, D. E. (2008). Dietary sodium effects on heart rate variability in salt sensitivity of blood pressure.Psychophysiology,45(3), 405-411. Olshansky, B., Sullivan, R. M. (2013). Inappropriate sinus tachycardia.Journal of the American College of Cardiology,61(8), 793-801. Ruthruff, E., Lien, M. C. (2016). Aging and Attention. Schwartz, P. J. (2014). Cardiac sympathetic denervation to prevent life-threatening arrhythmias.Nature reviews Cardiology,11(6), 346-353. Strait, J. B., Lakatta, E. G. (2012). Aging-associated cardiovascular changes and their relationship to heart failure.Heart failure clinics,8(1), 143-164. Tse, G. (2016). Mechanisms of cardiac arrhythmias.Journal of arrhythmia,32(2), 75-81. Urso, C., Brucculeri, S., Caimi, G. (2015). Acidbase and electrolyte abnormalities in heart failure: pathophysiology and implications.Heart failure reviews,20(4), 493-503. DeMorais, H. A., Biondo, A. W. (2012). Disorders of chloride: hyperchloremia and hypochloremia.Fluid, Electrolyte and Acid-Base Disorders in Small Animal Practice. 4th ed. Elsevier, St Louis, 80-91. Williams, L. S., Hopper, P. D. (2015).Understanding medical surgical nursing. FA Davis.nce Yabluchansky, M., Bogun, L., Martymianova, L., Bychkova, O., Lysenko, N., Makienko, N. (2016). Heart rhythm disturbances.