NUR 606 Discussion 1 Develop Visual Aid/Educational Presentation

Two disorders of the cardiovascular system that affect stroke volume, heart rate and blood pressure are congestive heart failure and congenital defects such as Ventricular Septal Defect (VSD).

Congestive heart failure occurs when the heart is unable to pump sufficient blood to meet the needs of the body (VanMeter & Huber, 2018). In CHF, the cardiac output and stroke volume decreases, and this results in less blood flow to the organs and tissues. Compensation occurs with increased HR. CHF is frequently caused by chronic elevated blood pressure, hypertension.

Brown. (n.d.).

Ventricular Septal Defect (VSD) is the most common congenital heart defect and is an opening in the interventricular septum (VanMeter & Huber, 2018). Small openings do not affect cardiac function, but large openings allow a left to right shunt (left ventricle to right ventricle) which leaves less blood in the left ventricle decreasing the stroke volume and cardiac output. As a compensatory method to decreased SV, an increase in HR occurs. With the decreased stroke volume comes decreased blood volume (decreased blood pressure).

Children’s Heart Federation. (2018).

3. Describe how these changes can result in cardiac remodeling. What signs and symptoms do patients experience as this occurs?

Cardiac remodeling is defined as a group of changes that consist of molecular, cellular and interstitial changes that usually changes size, mass and function of the heart after injury and results in a poor prognosis with ventricular dysfunction and arrythmias (Azevedo, et al., 2016). It is the replacement of necrotic heart tissue with scar tissue and can result in severe ventricular arrythmias due to the prolonged QT intervals after the increased collagen fibers which disrupt electrical impulses. With ventricular dysthymias a patient may exhibits some symptoms such as lightheadedness, dizziness or dyspnea and some signs would be syncope, decreased blood pressure and ventricular rhythms on the monitor (V-tach or V-fib).

Azevedo et al. (2021).

4. Discuss whether this remodeling is reversible and/or preventable. What can be done to correct the pathologic process and return the cardiovascular system to its homeostatic state.

Cardiac remodeling occurs after an infarct of heart issue like an MI. According to VanMeter & Huber (2018), if blood supply can be restored in the first 20 to 30 minutes irreversible damage can be prevented. Cardiac remodeling can be prevented if necrotic tissue is lessened with emergent resuscitation. According to Reis et al. (2015), modeling can be reserved with optimized treatment and several studies have confirmed that drugs or procedures, which modify ventricular remodeling that prevent or delay cardiac dilation are linked to improved outcomes. ACE inhibitors and beta blockers have demonstrated a decreased rate of cardiac dilation and improve the process of remodeling (Reis et al., 2015). Some procedures such as cardiac resynchronization promote reversal of cardiac dilation as well.

NUR 606 Discussion 1 Develop Visual Aid Educational Presentation

Abcam. (2021).

References:

Abcam. (2021). Cardiac atrophy and heart remodeling. Retrieved from https://www.abcam.com/research-areas/cardiac-atrophy-and-heart-remodeling.

Azevedo, P. S., Polegato, B. F., Minicucci, M. F., Paiva, S. A., & Zornoff, L. A. (2016). Cardiac Remodeling: Concepts, Clinical Impact, Pathophysiological Mechanisms and Pharmacologic Treatment. Arquivos brasileiros de cardiologia, 106(1), 62–69. https://doi.org/10.5935/abc.20160005

Boundless. (n.d.). Boundless anatomy and physiology. Lumen. Retrieved from: https://courses.lumenlearning.com/boundless-ap/chapter/control-of-blood-pressure/.

Brown. (n.d.). Normal circulation and congestive heart failure. Retrieved from: https://www.brown.edu/Courses/Bio_281-cardio/cardio/handout1.htm.

Children’s Heart Federation. (2018). Ventricular septal defect (VSD). Retrieved from https://chfed.org.uk/how-we-help/information-service/heart-conditions/ventricular-septal-defect-vsd/.

Reis Filho, J. R., Cardoso, J. N., Cardoso, C. M., & Pereira-Barretto, A. C. (2015). Reverse Cardiac Remodeling: A Marker of Better Prognosis in Heart Failure. Arquivos brasileiros de cardiologia, 104(6), 502–506. https://doi.org/10.5935/abc.20150025

Click here to ORDER an A++ paper from our Verified MASTERS and DOCTORATE WRITERS NUR 606 Discussion 1 Develop Visual Aid/Educational Presentation:

1. State three major functions of plasma proteins and list the component responsible for each.

The major plasma proteins include albumin, globulin, and fibrinogen. Albumin is important for the maintenance of colloid osmotic pressure of the blood and transportation of drugs, hormones, and fatty acids. Globulins come in three flavors which are alpha, beta, and gamma. Alpha-globulins are high-density lipoproteins that are integral to carrying fats to the cells to be used as energy. low-density lipoproteins are better globulins that help transport fat to the cells for cell membrane synthesis. Gamma globulins are antibodies or immunoglobulins and are produced by the B lymphocytes. Fibrinogen is a glycoprotein coping that is made in the liver and is important for creating fibrin clots to occlude blood vessels if they are broken open and are bleeding (Surinova, Schiess, Hüttenhain, Cerciello, Wollscheid, & Aebersold, 2018).

2. Explain the difference between petechiae and ecchymoses. Identify one condition where each may occur.

Petechiae are tiny round purple spots that occur on the skin and are the result of bleeding underneath the skin from trauma. An example of this is an adolescent tying a sweater around their neck and cutting off circulation. They would appear to have petechiae on their face after the event. Mickey Mouse this is a bruise. Ecchymosis is discoloration of the skin that results from bleeding underneath, also known as a bruise. Bruises can occur from bumping your arm on the table as you walk by it. The main difference between petechiae and ecchymoses is how they manifest, petechiae is scattered tiny dots, while a bruise is a localized area (VanMeter & Hubert, 2018).

3. Explain how a deep vein thrombosis in a large vein in the leg can result in a life-threatening condition such as a stroke or myocardial infarction.

A thrombus forms in a valve pocket of the vein in the leg and is composed of fibrin and red blood cells. According to the CDC, a DVT is not likely to cause a stroke or a myocardial infarction due to the fact it is in a vein and artery. Not sure if this was a trick question. But there is a risk of developing a pulmonary embolism where the cloud will break off and go into the lung (CDC, 2020).

4. Katie has been diagnosed with leukemia and she is wondering if it is safe to go to the dentist. Her WBC and platelet counts are still low from chemotherapy. What are the risks associated with invasive procedures while her counts are decreased? How would you explain these to Katie? Include a discussion of why bleeding and multiple opportunistic infections are common in patients with leukemia.

There is associated with having a dental procedure done with a low WBC and platelet count is the risk of infection and bleeding. if Katie develops an infection from the dental procedure, it would be very difficult to treat the infection due to the state of her immunocompromised condition from chemotherapy. People who have leukemia are subjected to multiple opportunistic infections because they have nonfunctional WBCs so they cannot fight off the infectious agents. The problem with her having low platelets increases her risk for bleeding that would be difficult to stop, spontaneous hemorrhaging, which could have very serious health outcomes (VanMeter & Hubert, 2018). If Katie would like a dental visit it would need to be planned out around her therapy and she may need to take prophylactic antibiotics.

References:

Blood Clots (Deep Vein Thrombosis). (2020, May 28). Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/survivors/patients/blood-clots.htm
https://doi.org/10.1080/01612840.2019.167808
Surinova, S., Schiess, R., Hüttenhain, R., Cerciello, F., Wollscheid, B., & Aebersold, R. (2018). On the Development of Plasma Protein Biomarkers. Journal of Proteome Research, 10(1), 5–16. https://doi.org/10.1021/pr1008515
VanMeter, K. C., & Hubert, R. J. (2018). Gould’s pathophysiology for the health professions. (6th ed.). Elsevier Saunders.

Describe the condition of lymphedema. Discuss the etiology, pathophysiology, signs, symptoms, and strategies to return to homeostasis.

Lymphedema is the swelling of the tissues in the extremities due to obstruction of the lymphatic vessels. To understand the pathophysiology of lymphedema, it is important to understand lymphatic circulation. As fluid leaves the blood system and into the interstitial space, the fluid is picked up by lymph capillaries, filtered by lymph nodes, and returned to the circulatory system (Hubert & VanMeter, 2018, p. 215). This system helps maintain a fluid balance in the body. If this system is obstructed or damaged in any way, lymph begins to accumulate initiating the swelling of the lymph tissue. The cause of lymphedema can be either congenital (primary) or from another disease or process such as cancer, cancer treatment, surgery, accidents, or chronic venous insufficiency (secondary) (Li et al., 2020).

The accumulation of the interstitial, or lymph, fluid creates swelling. In the first stages, swelling may be soft and the limb may begin to feel heavy. As the swelling progresses, the limb may become firm and tender. When the skin becomes hard and thick, it is known as skin fibrosis. The lymph fluid contains proteins predisposing this condition to infection, such as cellulitis (Hubert & VanMeter, 2018, p. 221).

The key to treating lymphedema is trying to remove some of the fluid that has built up. Ways of trying to do this include exercising, compression stockings, manual lymphatic drainage, elevation of the affect limb, and diuretic therapy. A newer option for patients suffering with lymphedema is pneumatic compression devices (PCD), or Flexitouch. PCD’s are sleeves that are placed on the swollen extremity that inflate and deflate creating gentle pressure that pushes the lymphatic fluid to other parts of the body (Karaca et al., 2017). Surgery is also used for treatment to either remove the tissue or place a shunt to drain the fluid.

Reply 2 to Team C

The video you displayed was very informative. In my future practice as an Advanced Practicing Registered Nurse (APRN), I may encounter patients with this condition. The Flexitouch system sleeves look like an essential treatment for symptoms of lymphedema. Knowing that lymphedema can be from a primary or secondary cause, one would think treatments would be different. However, treatments are the same depending on the severity of the condition.

Upon physical examination, I may observe edema or swelling that progresses over time and hardening of the skin, also known as fibrosis (CDC,2021). A patient may complain of symptoms are heaviness, tight skin, tenderness, and overall discomfort (Mayo Clinic,2021). Moreover, the Flexitouch system provides at-home pneumatic compression therapy for daily management and symptom relief in thirty-two minutes ( Rider et al., 2019).

Furthermore, the Flexitouch compression system has fifteen treatment options that will facilitate adequate drainage as it compresses the fluid from the unhealthy region back to the healthy areas. A study done by Rider et al. (2019) revealed that physical examination revealed a change in the number of swollen sites and swelling severity from baseline to treatment.

Thank you for a great post and the opportunity to learn about lymphedema and treatment options such as the Flexitouch system that, as studies show, gives patients a better quality of life.

Reference:

Center for Disease Control and Prevention (CDC). (2021). Cancer Survivors: Lymphedema https://www.cdc.gov/cancer/survivors/patients/lymphedema.htm

Mayo Clinic. (2021). Lymphedema: Symptoms and Causes https://www.mayoclinic.org/diseases-conditions/lymphedema/symptoms-causes/syc-20374682

Ridner, S., Dietrich, M., Deng, J., Ettema, S., & Murphy. B.(2019). Advanced pneumatic compression for treatment of lymphedema of the head and neck: a randomized wait-list controlled trial. Supportive Care in Cancer https://tactilemedical.com/wp-content/uploads/2020/12/Ridner2020_Article_AdvancedPneumaticCompressionFo.pdf

NUR 606 Discussion 1 Develop Visual Aid/Educational Presentation