NURS 6501 Assignment: Advanced Pathophysiology

NURS 6501 Assignment: Advanced Pathophysiology

NURS 6501 Assignment: Advanced Pathophysiology

The case concerns a 76-year-old female who reports having dyspnea, weight gain, peripheral edema, and abdominal swelling. Her medical history is positive for congestive heart failure (CHF), but she is not compliant with her diuretic therapy because of the associated urinary frequency. The client reports that she sleeps on two pillows to ease her breathing. The purpose of this paper is to explore the pathophysiologic processes in the cardiovascular and cardiopulmonary systems causing the symptoms and racial/ethnic factors that may affect physiological functioning.

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Cardiovascular and Cardiopulmonary Pathophysiologic Processes

The patient’s symptoms can be attributed to pulmonary and systemic congestion that occurs in CHF. The patient’s cardiac output (CO) is diminished, causing impaired tissue perfusion and anaerobic metabolism. Perfusion to the myocardium is usually impaired due to left ventricular failure, particularly with cardiac hypertrophy (Easa et al., 2021). The amount of blood ejected from the left ventricle reduces, resulting in a hydrostatic pressure build-up in the pulmonary venous system and eventually fluid-filled alveoli and pulmonary congestion (Easa et al., 2021). The patient’s shortness of breath and orthopnea (dyspnea in a flat lying position) can be attributed to elevated pulmonary venous pressure and congestion.

The patient has signs of systemic congestion, which can be attributed to failure of the right ventricle. When the right ventricle fails, it cannot empty completely. Consequently, fluid retention occurs, resulting in increased volume and pressure building up in the venous system. As a result, edema develops in the peripheries and may progress to the abdominal wall (Schwinger, 2021). Thus, the patient’s symptoms of weight gain, peripheral edema, and abdominal swelling can result from elevated systemic venous pressures and congestion.

Racial/Ethnic Variables That May Impact Physiological Functioning

African-Americans and Hispanics have a higher prevalence of CHF compared to their White counterparts. Besides, African-American females have the highest incidence of CHF in the US. Mwansa et al. (2021) explain that the high prevalence is linked to African Americans having a lower ejection fraction than other ethnic groups. In addition, they have a high prevalence of cardiovascular disease risk factors like diabetes mellitus, hypertension, and obesity. Diabetes speeds up the advancement of atherosclerosis and increases the risk of ischemic heart failure and myocardial infarction in African Americans (Mwansa et al., 2021). African Americans with left ventricular systolic dysfunction have a greater risk of progressing to CHF than Whites. If the above patient is an African American female, her ethnicity and race may have contributed to the progression of the CHF.

How the Processes Interact To Affect the Patient

The cardiovascular and cardiopulmonary pathophysiologic processes impair the patient’s functioning, including the ability to perform activities of daily living and the quality of life. Reduced cardiac output and increased pulmonary venous pressure have led to the patient’s shortness of breath and breathing difficulties when sleeping (Easa et al., 2021). Besides, elevated systemic venous pressures and congestion have affected the patient by causing weight gain, polyuria at night, peripheral edema, and a distended abdomen.

Conclusion

The patient has right-sided and left-sided heart failure, which has led to pulmonary and systemic congestion. Pulmonary congestion has contributed to shortness of breath and orthopnea, while systemic congestion has led to edema, abdominal swelling, and weight gain. African Americans have a higher prevalence of CHF due to increased cardiovascular risk factors.

References

Easa, J., Chappell, J., & Warriner, D. (2021). Understanding the pathogenesis of heart failure. Practice Nursing, 32(2), 54-58. https://doi.org/10.12968/pnur.2021.32.2.54

Mwansa, H., Lewsey, S., Mazimba, S., & Breathett, K. (2021). Racial/ethnic and gender disparities in heart failure with reduced ejection fraction. Current heart failure reports 1-11. https://doi.org/10.1007/s11897-021-00502-5

Schwinger, R. (2021). Pathophysiology of heart failure. Cardiovascular diagnosis and therapy, 11(1), 263–276. https://doi.org/10.21037/cdt-20-302