Question

You are the nurse on the telemetry unit. This is the report you receive from the emergency department nurse: Jerry Williams is a 62-year old obese (BMI 35.2) Caucasian male with a history of heart failure, coronary artery disease and type II diabetes. He came into the emergency department early this morning because he woke up this morning with increased difficulty breathing and his wife called 911. He also reports that he was having difficulty breathing with activity yesterday and he has swelling in his lower legs, worse than ever before.

Paramedics report that his initial VS: HR: 92 RR: 28 BP: 172/88 O2 sat: 80% on room air with crackles over the lower ½ of the lung fields. In the ambulance, he was placed on oxygen by nasal cannula at 6 L/m. Then his SaO2 improved to 92% and his respiratory rate decreased to 24 breaths per minute.

what is the primary problem pathophysiology?

what is the secondary problem?

Answer 1

congestive heart failure is the primary problem

pathophysiology of congestive heart failure

• In order to maintain normal cardiac output, several compensatory mechanisms play a role as under: Compensatory enlargement in the form of cardiac hypertrophy, cardiac dilatation, or both.
• Tachycardia (increased heart rate) due to activation of neurohumoral system e.g. release of norepinephrine and atrial natrouretic peptide, activation of renin-angiotensin aldosterone mechanism.
• Achieving Ventricular end diastolic volume by increasing the sarcomeres in dilated heart
• Increases the myocardial contractility and thereby attempts to maintain stroke volume
• Heart failure results in DEPRESSION of the ventricular function curve
• COMPENSATION in the form of stretching of myocardial fibres results
• Stretching leads to cardiac dilatation which occurs when the left ventricle fails to eject its normal end diastolic volume

secondary problem is the the difficulty in breathing

pathophysiology of difficulty in breathing

breathing dificulty and swelling of lower leg are symptoms of congestive heart failure.due to the heart failure cardiac output decreases and the muscles of the lungs gets effected and lung needs more energy to breath. there by decrease in respiratory rate, and increased blood pressure occurs