Efforts are made by the body to compensate for the heart failing either on the left or right side. In either forms of heart failure, the heart is unable to pump an adequate blood supply to the body’s organs, therefore not receiving a sufficient amount of oxygen and nutrients, and waste products are slowly expelled. Eventually, the body systems begin to shut down (University of Maryland Medical Centre, 2011).
Mr. Smith has been diagnosed with acute left ventricular heart failure. This essay will discuss the pathophysiology and relevant assessments linked to Mr.
Smith’s signs and symptoms, in conjunction with the appropriate nursing interventions and pharmacological therapy for Mr. Smith. Pathophysiology The heart is divided into two chambers. The left side receives oxygenated blood from the lungs and sends it out to tissues and cells of the body. The right side of the heart receives the deoxygenated blood from the body and pumps it to the lungs to gather oxygen, and the cycle continues (heart failure Online, 2010).
Problems can arise with either the right or left side of the heart alone, but this will ultimately lead to complications for the other side of the heart.
It is evident with the symptoms Mr. Smith is portraying, he is suffering from acute pulmonary oedema secondary to acute left ventricular heart failure. Left sided heart failure occurs as a result of ineffective left ventricular contractile function. As the pumping ability of the left ventricle fails, cardiac output falls (Farrell & Dempsey, 2011).
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The failure can be a result of abnormal systolic (contraction) or diastolic (relaxation) action (Bibbins-Domingo et al, 2009).
It is concluded that Mr. Smith has systolic heart failure. In systolic heart failure, the heart muscles weaken and cannot pump enough blood throughout the body.
The left ventricle is usually stretched or dilated (Brown & Edwards, 2012).
As blood is no longer effectively pumped out into the body, it backs up into the left atrium and then into the lungs, causing pulmonary congestion, dyspnea and activity intolerance, symptoms displayed by Mr. Smith. If the condition persists, pulmonary oedema and right-sided heart failure may occur. Common causes of left ventricular heart failure include left ventricular infarction, hypertension, and aortic and mitral valve stenosis. Overtime these conditions increase the workload to the heart itself, reducing the force of contraction.
In heart failure the ventricle is loaded with blood to the point where the heart muscle contraction becomes less efficient. In an attempt to improve contractility, hypertrophy (increase in physical size) is possible. This may contribute to an increased stiffness and decreased ability to relax during diastole. In addition, enlargement of the ventricles also causes a reduction in stroke volume due to the mechanical and contractile inefficiency (Farrell & Dempsey, 2011).
Since the heart has to work harder to meet the metabolic demands, for example exercise, there becomes a reduced spare capacity.
This is evident with Mr. Smith as he suffers from activity intolerance, meaning his heart is not capable of meeting the metabolic needs. This translates to the loss of one’s cardiac reserve. Increased heart rate that is stimulated by the sympathetic nervous system is activated in order to maintain cardiac output, however, in heart failure; it places further strain on the myocardium, increasing coronary perfusion requirements. Thus can lead to worsening of ischemic heart disease, and may also cause potentially fatal arrhythmias (News Medical, 2013).
Congestive Heart Failure is not a disease, but a condition in which the heart is unable to pump enough blood needed to meet the cardiac demands of the body and facilitate systemic circulation. Congestive Heart Failure can be right or left-sided, and is mainly a fluid issue, in which there is a decreased amount of blood to the kidneys. In children, CHF can be long term and is most common in infants ...
It is evident Mr.
Smith has left ventricular heart failure as he is experiencing these symptoms in conjunction with acute pulmonary oedema. Most commonly evident with left ventricular heart failure is systolic dysfunction. This occurs when the left ventricle cannot pump enough blood out of the systemic circulation during systole and the ejection fraction falls (less than 45%).
The strength of ventricular contraction is reduced and inadequate for creating an adequate stroke volume, resulting in inadequate cardiac output. In general, this is caused by dysfunction or destruction of cardiac myocytes or their molecular components (News Medical, 2013).
Consequently, blood backs up into the pulmonary circulation and pressure increases in the pulmonary venous system. Cardiac output falls, therefore, weakness, fatigue, and shortness of breath may occur, as highlighted with Mr. Smith. Causes of systolic dysfunction include Myocardial Ischemia, hypertension and dilated cardiomyopathy (Farrell & Dempsey, 2011).
Systolic heart failure typically occurs in men between the ages of 50 – 70 years who have had a heart attack (Bibbins-Domingo et al, 2009).
Assessments Primary Assessment Our present healthcare system requires the nurse to solve problems accurately, thoroughly and quickly.
The nurse must be able to review information from a variety of sources and make a critical judgment (Crisp & Taylor, 2009).
Upon Mr. Smith’s arrival to the High Dependency Unit (HDU), the nurse should begin a systematic primary assessment to determine and treat any immediate life-threatening conditions or injuries (Brown & Edwards, 2012).
The assessment approach begins with a primary survey focusing on airway, breathing and circulation disability; this can usually be conducted reasonably quickly to get an overall presentation of the patient, mostly conducted via an across the room assessment (Brown & Edwards, 2012).
In relation to Mr. Smith, the nurse would have removed all dangers from the surrounding area and gathered an immediate responsive status from Mr. Smith. This is identified through visual contact and verbal communication to determine his conscious state prior to further assessments (Crisp & Taylor, 2009).
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Furthermore, the first area of assessment looks at Mr. Smith’s airways and breathing. As he is sitting up talking to the nurses, it is evident that he has an open airway and able to breath, speaking in short sentences, obviously short of breath (Meet Herbert, 2013).
Vocalization is a ign that the airway is open and also gives some reassurance about the level of responsiveness. Airways are assessed by observing the patient’s voice, breath sounds and work of breathing. Work of breathing can be determined by a patients position; tripod position, intercostal recession, cyanosis and may even have pursed lips (Brown & Edwards, 2012).
Assessment of breathing includes assessment of respiratory rate, pulse and oxygen saturation, chest inspection for movement, bilateral auscultation of the chest and use of accessory muscles (Farrell & Dempsey, 2011).
Additionally, circulation should be assessed in combination with airway and breathing. This involves the palpation of major pulses, assessment of capillary refill, skin colour, warmth and moisture of mucosa membranes, which are all key indicators for adequate circulation (Brown & Edwards, 2012).
Assessing Mr. Smith’s skin perfusion is particularly important as abnormal changes provide key indications into different conditions such as sepsis, anaphylaxis and shock (De Backer, 2011).
Once these three systems have been assessed and any immediate life-threatening conditions have been identified and managed, the nurse should continue a primary assessment observing for disability, such as altered neurological functioning or consciousness, as this can also affect airways, breathing and circulation (Brown& Edwards, 2012).
Alterations in consciousness can quickly be assessed using the acronym AVPU; (A) is the patient alert, (V) responsive to voice, (P) responsive to pain or (U) are they unresponsive, in conjunction with papillary size, shape, equality and reaction to light (Curtis & Ramsden, 2011).
Any change in this initial assessment, Mr. Smiths would require an immediate reassessment of airway, breathing, circulation and disability. If any or all-individual assessments of Mr. Smith were differing to the initial or previous assessment, help would be immediately sought out, a reassessment of the cardiac rhythm may indicate the cause. Secondary Assessment Secondary survey includes the physical assessment; this is only undertaken when all elements of the primary survey are stable. A secondary assessment is conducted to establish the full extent of injury or damage and any other areas needing intervention (Brown & Edwards, 2008).
People entering assessment all have individual needs. Someone these needs can be affected by physical or mental disability or other aspects of their personal make up. These factors can affect a person’s ability and capacity to interact with assessments so care should be taken to ensure that these factors are taken into account when they are assessed. Assessments should not just be made available ...
With regards to Mr. Smith, the nurse has already conducted most of the secondary assessment including appropriate environment, vital signs, ECG, and head-to-toe physical examination. These assessments highlighted that Mr. Smith has atrial fibrillation, hypotension, a rapid irregular pulse, high respiratory rate, low oxygen saturations and crackles and wheezing through lung auscultation. However, Mr. Smith needs further investigations into his assessment. In addition, weight, fluid restriction, in the general vicinity of 1. litres;to be determined by treating Doctor, and a Glasgow Coma Scale score should be obtained. This is essential as a baseline on admission (Brown & Edwards, 2012).
Mr. Smith needs to be reassured throughout the assessment process; therefore, comfort measures are vital including analgesia, reassurance and correct positioning. A history had already been taken from Mr. Smith’s however, a more focused and comprehensive assessment should include, time or onset of symptoms, and any pre-hospital care is also imperative (Brown & Edwards, 2012).
Other important information includes Mr. Smith’s medical history including existing conditions, medications, including over the counter (OTC) and prescription medications and allergies. Alongside questions of nutrition, elimination, activity, sleep, cognition, and stress tolerance (Brown & Edwards, 2012).
As Mr. Smith stated during his history, he is quite short of breath majority of the time, worsening with exertion (Meet Herbert, 2013).
If for any reason Mr. Smith is unable to give this information the nurse may ask a spouse or family member (Brown & Edwards, 2012).
Further investigations that are needed for Mr. Smith include a full blood count (FBE), group and hold (G&H), electrolyte concentration (UNE) and venous/arterial blood gas (VBE/ABG) urinalysis, oxygen therapy; further investigating orientation, electrocardiogram (ECG), chest x-rays, continuous cardiac monitoring, continuous oxygen saturation monitoring. Mr. Smith may require two large bore cannulas insitu, and possibly need an arterial line, central venous catheter, nasogastric tube (NGT) or indwelling urinary catheter (IDC) (Jarvis, 2012).
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A focused cardiovascular assessment is indicated following the findings of a comprehensive assessment indicating a potential cardiovascular problem. The focused cardiovascular assessment is also indicated when an interval or abbreviated assessment shows a change in status from your previous assessment or the report you received, when a new symptom emerges, or the patient develops any distress (Brown & Edwards, 2012).
The nurse would gather a cardiac related history including previous illnesses, family history, medications, side effects, signs and symptoms and modifiable risk factors of Mr. Smith.
Assessing chest pain with the PQRST mnemonic is very useful, highlighting descriptive words such as squeezing, crushing, radiating, tightening and burning around the chest. Including questions about the associated symptoms and timing of chest pain is important. This can guide health professionals to the correct diagnosis. The nurse should use a numerical pain scale as a baseline for admission. The nurse should question Mr. Smith and observe for orthopnea, cough, fatigue, oedema, cyanosis, pallor and nocturia as they are closely related to the cardiovascular system (Farrell & Dempsey, 2011).
When assessing the cardiovascular system the respiratory system needs assessed to provide a comprehensive and holistic picture. Beginning with an assessment of respiratory includes use of the neck muscles, which would be inspected for abnormalities. The most important observation to be made in the neck region is the assessment of jugular venous pulse and carotid artery as these vessels reflect the efficiency of cardiac function (Jarvis, 2012).
From the jugular veins you can estimate central venous pressure (CVP) and estimate the heart’s efficiency as a pump.
Assessing the airway should be completed without moving the neck if possible however; the head does need to be tilted in order to open the airways for unconscious patients (Farrell & Dempsey, 2011).
A heart attack occurs when the blood supply to a portion of the heart muscle is severely reduced or stopped. This happens when one of the arteries that supply blood to the heart muscle is blocked by an obstruction. This blockage can be due to a condition called atherosclerosis (a build up of fatty like substance along the wall of the artery), a blood clot or a coronary vessel spasm along with a ...
Ensuring that Mr. Smith is breathing adequately is important, as insufficient or compromised breathing can lead to hypoxia and inadequate gas exchange. Mr. Smith has an oxygen saturation rate of 88%, which is considerably low, and a respiratory rate of 32, which is high. This determines gas exchange is inadequate and he is compensating for the decreased oxygen by increasing his respirations; Mr. Smith with fatigue quickly.
VBG/ABG would be seen to deteriorate, PO2 would decrease and PCO2 would increase, leaving Mr. Smith with a low pH; in a respiratory acidosis state. Auscultation of the lungs is imperative to ascertain equal air entry to all lobes, as well as any abnormal sounds (Brown & Edwards, 2012).
Lung and cardiac sounds must also be assessed from the front and back, assessing them for character and quality as well as for the presence or absence of appropriate sounds. (Brown & Edwards, 2012).
Performing a visual assessment of the circulatory system is an important component of a comprehensive cardiovascular assessment.
Areas for evaluation you should inspect include skin colour, location of any lesions, bruises or rash, symmetry of motion, size of body parts, and any abnormal findings, sounds, and odours. Begin by inspecting the patient’s skin for colour, warmth, and moisture. Pallor can result from anemia or increased peripheral vascular resistance caused by atherosclerosis and cool, clammy skin results from vasoconstriction, which are both evident in Mr. Smith (Meet Herbert, 2013).
Evident in a respiratory assessment pulmonary oedema should be evident at this stage of the assessment of Mr.
Smith. Inspect Mr. Smith’s hair distribution on his skin as lack of hair may also indicate arterial insufficiency. An inspection for peripheral oedema should also be performed, possibly indicating right ventricular heart failure. The nurse must manually auscultate Mr. Smith’s blood pressure, which is a low 88/50mmHg, and a high and irregular pulse rate of 110bpm highlighting impaired circulation. Maintaining adequate blood pressure is imperative as hypotension is directly linked to decreased circulation (Brown& Edwards, 2012).
Additionally, palpation of peripheral arteries including the brachial, radial, femoral and dorsalis pedis and record the contour and amplitude of each pulsation, these should feel similar bilaterally (Brown & Edwards, 2012).
Furthermore, auscultation of the pericardium is essential. The nurse would be assessing for the sound of the “lub” and the “dub. ” The “lub” or first heart sound is known as S1. The “dub” or the second heart sound is known as S2 (Brown & Edwards, 2012).
If a pathological third heart sound is detected, it is usually a marker for severe impairment of the left entricular function (Rimmer, Riiley &Rubin, 2007).
It is important to accurately and thoroughly record and document findings from the cardiovascular exam. Standardization of documentation ensures that all members of the healthcare team interpret the findings accurately. Integrating the cardiovascular health history and physical exam takes practice (Farrell & Dempsey, 2011).
Nursing Interventions The goal of our interventions for heart failure is to decrease patient symptoms, reverse ventricular re-modeling, improve quality of life and decrease mortality and morbidity (Brown & Edwards, 2012).
Improve oxygen perfusion According to Brown & Edwards, (2012) immediate management begins by maintaining an open and clear airway. This may be difficult for some patients because of a decreased level of consciousness or decreased gag and swallowing reflexes. Oxygen therapy should be applied via Hudson Mask or nasal prongs, artificial airway insertion, intubation or mechanical ventilation as required, to ensure optimal oxygenation of the cells and avoid hypoxia. Reperfusion can rescue tissue, which is functionally inactive but still viable.
Establish IV access with normal saline in order to have a faster drug and fluid administration as required. This will ensure that Mr. Smith is kept adequately hydrated to promote perfusion and decrease further heart injury (Brown & Edwards, 2012).
Administration of oxygen helps increase the percentage of oxygen in the inspired air. In relation to Mr. Smith, he needs oxygen therapy to increase his saturations from a low 88%. Thereby, improving gas exchange (Brown & Edwards, 2008).
Ultimately aiming for oxygen saturations of >95% via Hudson mask or nasal prongs as required. Improve patient education By having increased knowledge, Mr.
Smith will be able to adopt a healthier lifestyle to address risk factors and conditions contributing to the development and progression of heart failure. He will understand the effect of heart failure on personal energy levels, mood, depression, sleep disturbance and sexual function, and develop strategies to cope with changes and emotions related to family, work and social roles. Mr. Smith should be informed to consider wearing an alert bracelet with details of current condition. The ongoing use of a diary to record daily weight, blood pressure, pulse (regular or irregular) and medications could also be suggested.
The importance of daily weight monitoring is to monitor fluid retention, as well as weight reduction (Brown & Edwards, 2008).
It is vital to define and state the limited desired for blood pressure, explaining hypertension and hypotension and its effects on the heart, brain, blood vessels and kidneys (Brown & Edwards, 2012).
Many services should be made available immediately for Mr. Smith, such as Heart Support Australia, Cardiomyopathy Association of Australia, home help and financial assistance; access to consumer resources. Referral to the hospital social worker can assist with Mr. Smith in accessing these services.
It is the role of healthcare professionals to reinforce to Mr. Smith the importance of adhering to his treatment regimen and attending follow up appointments. This needs to be effectively explained to Mr. Smith in a clear and straightforward language for him to understand, as misunderstanding can be fatal in situations like Mr. Smiths. Additionally, the healthcare professionals should assist Mr. Smith in identifying modifiable risk factors, such as limiting diet high in sodium, saturated fat, cholesterol, smoking, exercise and alcohol. It needs to be explained to Mr. Smith the reasons for such interventions to ensure adherence.
He should also be instructed to weigh himself the same time every day, preferably before breakfast. This helps ensure valid comparisons from day to day and helps identify early signs of fluid retention (Brown & Edwards, 2008).
Improve activity intolerance Improving activity intolerance for Mr. Smith is vital in enabling him to return to relatively normal lifestyle post his acute left ventricular heart failure. Regular physical activity is now strongly recommended for patients with heart failure. Patients who have regular physical activity have a reduced rate of physical deconditioning (Stroke Foundation, 2010).
Physical activity has been shown to improve functional capacity, symptoms and neurohormonal abnormalities (Stroke Foundation, 2010).
When medically stable, Mr. Smith should be considered for referral to a specifically designed physical activity program that will be tailored to his individual capacity, and may include walking, bicycling, light weight-bearing exercise and stretches. Referral to a physiotherapist would be appropriate at this time. Mr. Smith should be monitored carefully during physical activity to ensure his oxygen saturations, blood pressure and heart rate changes.
Patients should be educated to achieve realistic and sustainable levels of physical activity. Nursing staff should communicate with an occupational therapist to assist Mr. Smith with any difficulties with acts of daily living. Occupational therapists formulate plans to assist patients in performing daily tasks. Recommendations are made, documented and communicated to medical staff. They can recommend and arrange any necessary equipment or aids to maximize the outcome for Mr. Smith (Stroke Foundation, 2010).
On discharge occupational therapy can assess Mr. Smiths home and determine any modifications or devices he may require.
Decrease pre-load & after-load By decreasing intravascular volume with the use of diuretics reduces venous return, therefore decreasing pressure on the heart. By decreasing venous return to the left ventricle (LV) thereby reducing the preload, the overfilled left ventricle may contract more efficiently and improve cardiac output (CO).
This will increase the left ventricular function, decrease pulmonary vascular pressures and improve gas exchange (Brown & Edwards, 2008).
Thus ultimately enables Mr. Smith to feel less short of breath reduce the crackles and wheezing, and reducing the pressure and heaviness felt on the chest.
Decreasing venous return, known as preload, reduces the amount of volume returned to the LV during diastole. This can also be assisted by Mr. Smith assuming a high fowler’s position with feet horizontal to the bed, or hanging off the bedside. This position help to decrease venous return by letting gravity keep the blood in the extremities. This position also increases the thoracic capacity, allowing improved ventilation. Therefore, Mr. Smith would reduce the work of breathing and ease the pressure in the chest cavity (Brown & Edwards, 2008).
Reduce patient anxiety
Reduction of anxiety is an important nursing function, since anxiety may increase the sympathetic nervous system response and further increase myocardial workload (Brown & Edwards, 2008).
Reducing anxiety may be facilitated by a variety of nursing interventions such as relaxation, breathing techniques, presence of family members, support and the use of medication. The use of sedative medication, such as morphine or benzodiazepines are effective for anxiety, however, is not a first option. When morphine is used, the patient often experiences relief from dyspnoea and the anxiety associated therefore, it may be be appropriate for Mr.
Smith. Nursing care focuses’ on continual physical assessment, hemodynamic monitoring and evaluating Mr. Smith response to treatment (Brown & Edwards, 2008).
Pharmacology The optimal treatment of acute heart failure remains a challenge and an important area of research today. General therapeutic objectives for drug management of heart failure include the identification of the type of heart failure and underlying causes, correction of sodium and water retention and volume overload, reduction of cardiac workload, improvement of myocardial contractility and control of precipitating and complicating factors (Brown & Edwards, 2008).
The aims of treating heart failure are to improve symptoms, minimize side effects of treatment, prevent morbidity and prolong survival. Current therapeutic approaches include the use of ACE inhibitors, Diuretics, Inotropic drugs and Vasodilator drugs. Diuretic Intravenous frusemide Diuretics inhibit sodium potassium reabsorption in the ascending limb of the loop of Henle; directly treating the retention found in heart failure. When given intravenously, the loop diuretic frusemide brings about rapid symptomatic relief, by increasing urinary sodium and water output by up to 30 min (Jhund, McMurray & Davie, 2000).
By giving Mr. Smith a diuretic, it is reducing the fluid in the alveolar space, and thereby improving gas exchange. Considerations need to be taken when administering a diuretic because it actually increases systemic vascular resistance (after load), decreases preload, and causes electrolyte imbalances (Brown & Edwards, 2008).
Mr. Smith needs to be monitored for orthostatic hypotension and electrolyte abnormalities. Vasodilator Glyceryl Trinitrate Glyceryl Trinitrate (GTN) relaxes arterial and venous smooth muscle reducing preload and sinus ventricular rhythm. At low doses it causes vasodilatation.
With higher doses, dilation of arteries occurs, resulting in reduction of arterial pressure. GTN also dilate regular coronary vessels, increasing perfusion. This allows for more efficient and effective oxygen delivery and a more effective distribution of blood to the myocardium (Bullock, Manias & Galbraith, 2010).
Mr. Smith may be prescribed with a GTN in order to increase perfusion of the tissues and allow more oxygen to be in the body. The side effects of taking a GTN are headaches, dizziness, especially when getting up from a sitting or lying position, and a fast or fluttering heartbeat (Bryant & Knights, 2011).
Nursing considerations for a patient taking this drug involve impairment to the hepatic or renal system that therefore needs to be monitored regularly. Vital signs, heart rhythm, oxygen saturation, fluid intake and output should be monitored carefully. Inotrope Dobutamine Dobutamine is an inotropic drug that acts directly on heart muscle to increase the force of myocardial contraction. Because of its minimal influence on heart rate and blood pressure (both major determinants of myocardial oxygen demand), it is valuable for use on Mr.
Smith who has a low cardiac output. Dobutamine is administered IV in a short term management of patients with congestive heart failure, like Mr. Smith, cardiogenic shock due or after cardiac surgery. Its beneficial effects include a progressive increase in cardiac output and a decrease in pulmonary capillary pressure, whereby improving ventricular contraction. Evidently, as Mr. Smith has acute left ventricular failure, this drug should be highly beneficial (Tiziani, 2010).
Anti-platelet Aspirin Aspirin inhibits the production of thromboxane.
It has analgesic, antipyretic, anti-inflammatory and antiplatelet effects, also known as known as a non-steroidal anti-inflammatory drugs (NSAID’s).
Antiplatelet agents block the formation of blood clots, preventing the clumping of platelets. Mr. Smith should be given a low dose aspirin in order to prevent a blood clot from forming (Bryant & Knights, 2011).
Common side effects include dyspepsia, nausea, vomiting and gastrointestinal bleeding. Nursing considerations for giving an antiplatelet drug include recognizing the patient’s risk of bleeding.
Therefore, it needs to be monitored and documented regularly along with vital signs. Antihypertensive Ace Inhibitor Angiotensin-converting enzyme (ACE) inhibitors prevent the conversion of angiotensin I to angiotensin II. Angiotensin II is a powerful vasoconstrictor that raises blood pressure and also causes aldosterone release, which results in sodium and water retention (Ravina, 2011).
In the absence of angiotensin II, the blood pressure decreases and the kidneys excrete sodium and fluid (dieresis), ultimately decreasing the oxygen demands on the heart (Smelter, et al. , 2010).
The use of ACE inhibitors in patients with cardiac problems decreases mortality rates and prevents remodeling of myocardial cells that is associated with the onset of heart failure. It is important to ensure that the patient is not hypotensive, hypovolemic or hyperkalemic before administering ACE inhibitors. Blood pressure, urine output, and serum sodium, potassium and creatinine levels need to be monitored closely (Smelter, et al. , 2010).
The side effects that Mathew may experience are hypotension, chest pain, gastrointestinal disturbance and possibly a persistent non-production cough.
Captopril, for example, may interact with other cardiovascular drugs such as beta-blockers, antacids, NSAIDS and diuretics. Take note of any rashes on the body or a sore throat that may indicate a low white blood cell count (Brown & Edwards 2012).
Antihypertensive Beta Blocker Beta-blockers are commonly used to treat heart disease causing chest pain, high blood pressure, heart attacks and arrhythmias. Beta blockers work by slowing the heart rate allowing the left ventricle of the heart to fill more completely increasing the volume of blood that the heart pumps with each heartbeat and giving the heart time to relax between beats. They can also help to vasodilate blood vessels within the body, making them even more useful in patients with heart failure also suffering from high blood pressure. Beta-blockers may sometimes cause a drop in blood pressure when a person stands up resulting in dizziness. Mr. Smith would benefit from beta-blocker therapy, treating his symptoms and workload on the heart. Documentation of the effectiveness is essential (Brown & Edwards 2012).
Conclusion A nurse’s role is to assess and determine urgency of care; allocate appropriate resources and initiate interventions accordingly to patient needs. Mr.
Smith, presenting with shortness of breath, anxiety, pale and clammy skin and dyspnoea, requires a series of differing assessments with left ventricular heart failure, secondary to pulmonary oedema with regards to heart failure, there are many differing assessments such as vitals signs, pain assessments, chest x-ray and such others, in order to effectively gather a diagnosis of heart failure. This is also identifiable with other illnesses. The collaborative approach with teams of health professionals’ play a vital role in their assessment skills and knowledge to identify the appropriate responses for nursing care.