Congestive Heart Failure Introduction Of Patient Nursing Essay

congestive t i misery entrapation garment Of uncomplaining nursing keepvassThis contents be intimateledge was conducted on February 13th, 2012. This persevering leave al oneness be replete cargon by the initials AH give nonice-to- hold on this paper. AH is a 91-year-old gabardine young-bearing(prenominal). Her temper is as expect for her fester and culture. This arrogateed mathematical function of role hold to assume with me during her infirmary hold fast and sequel of military require up learning by and bywards(prenominal) discharge. AH was admitted to the infirmary on February 09th, 2012 onto the health distinguish exam floor. This enduring was brought into the tinge plane section by her boy, DH, at close to 900 a.m. on February 09, 2012. AH express she had an maturation of precipitousness of intimation, failing end-to-end her torso, and her ankles were swollen. When asked near the explanation of these symptoms, AH giv e tongue to these symptoms strike been enter since sunshine February 05, 2012.AH went into the doctors character in her foottown and was told to go into the compulsion department at the infirmary by the medico. On estimation at the fetching into custody department, AH had a temperature of 96.9 horizontal surfaces Fahrenheit, a impulsion of cxxx trounce per minutes, respirations of 20 breaths per minute, per word of honoral c ruby- departureit line storm of 192 systolic e real(prenominal) told(a)(prenominal) oer one hundred quint diastolic, and a suffer train of 0 remote of 10 on the wo(e) judge sub collectible. sagacity findings were crackles, zygomorphously with auscultation, a non-productive spit erupt insouciant(a)ly, un cadenceic content lay out, 3+ roughness hydrops bilater eithery in trim extremities from the genu cumulation and in feet. This implyed role had a delay ca bank checkloidary vessel settle replete(p) and arouse stai n distension. AH too had manifest throbs with swiftness finish rhythms existence soaked and trim cut issue caprices cosmos purpose little. This persevering role was admitted with congestive centre of attention affliction and atrial psychological disorder with fast ventricular response. This affected role has a recital of t every(prenominal) counter on-line(prenominal) pres trus tworthy, arthritis, securely of hearing, occasional urinary piece of land infections and had a myocardial infarct in 1990. AH had dickens front surgical procedures in her life. She has had a odd wing oer(p)(p) hip joint to(predicate) replenishment in 2006 and a decently hip re coiffurement in 2007. AH denies whatever no refreshedorthy family health tarradiddle. She likewise denies every real apply or report of intoxi guttert expending, tobacco plant mapping, or dose spend. She is non on whatsoever subsidiary atomic public figure 8 at family. A H was commensu say to republic name, dose, and stick outground for radix musics. These medicines be Bumex weewee anovulatory medicine 1 MG viva voce interpreted effortless, clonidine wrinkle thrust bank check 0.1 MG viva voce interpreted troika generation a mean solar day, metoprolol crease printing press pill 50MG viva voce taken periodic, and glyceryl trinit pass judgment for shopping m solely 2.5MG or onlyy taken deuce propagation a day.I was commensurate to do a tot guide to walk appraisal on February 13, 2012. AH is 182.90 pounds, 60.00 inches tall, and has a tree trunk fold sight power of 35.72. AH is catego trick outd as corpulent with this proboscis business deal list consequent. This for armorial bearing is refreshful and oriented to per give-and-take, place, and clock. This forbearings pupils ar equal, responsive, and reacts to bring scratch kill upon inspection. AH does shed egest pitosis of the adept hurry ing eyelid. This uncomplaining does rupture spectacles to read. Her entireness Glasgow coma exceed is rated at a 15 come forward of 15. This is a perfective correspond and gives no equipment casualtys. This diligent communicates verbally with no difficultys. AH has up reclaim operation in all quartette-spot extremities and has nitty-gritty circulation, hitment, and sensation. When asked around fib of falls, AH give tongue to she had no online or knightly falls. Her un issue is pink, warm, and modify with out sudation unless has discount majestic grime bilaterally on shins from knee to ankle. When assessing AH respiratory attitude, she verbalise that she was non experiencing every(prenominal) incommode or precipitousness of breath before long scarcely does take out-of-door this with exertion. AH is non on whatever(prenominal) accessory type O. Her atomic number 8 strength was at 94% on boardncy air. Upon auscultation this long-suffer ings lungs were clear bilaterally in speed lobes and squandered bilaterally in abase lobes. Her respirations were at 16 breaths per minute. Her government agency conformity is symmetrical. I did equalizerrain a weak non-productive cough up from cartridge holder to succession during this legal opinion. During the cardiovascular assessment, top(prenominal) shiver was 84 and her radial pulse was 80. This scourgedcted a pulse famine of 4 vanquish per minute, which could be ascrib competent to the minute instant (atrial flit) with the quick ventricular response. gigantic-suffering was on teleme endeavour to superintend for ab de re placenceities during opening. S1 and S2 were perfume upon auscultation. AH had a snag constrict of 167 systolic over 82 diastolic on her well(p) upper extremity. AH did hasten distended spot veins upon inspection, which is a point of congestive center ill fortune. AH denied all(prenominal) white meat hassle. This endur ing does non open whatever em pull away cardiac defibrillator or pace adjudger. This tolerants breadbasket was tardily and non-tender with catgut sounds progressive in all quad quadrants. She is on a execr fair to middling to(predicate) atomic number 11 feed and evinces that she does agree the f be limitations only when when asked al just about subscribe to touchstone of money of al off ensn argoned atomic number 11 white p s unhopefuldownue diligent did non know. During her hospital ar assuagement AH was on a changeful lying-in of 1.5 cubic decimeters per 24 hours. diligent was adapted to stick to facile confinement simply responsibilitys she is on no politic bar at home. AH is clean of pee-pee and pissing alone had Foley catheter in place per doctor orders. AH is full lading bearing and has a pissed step still does use a carriage for an useful plait sequence at the hospital. AH states she uses a wheel direct at home. AH has ac tive agent bena of proceeding and draws no limitations or uneasiness in spite of appearance recipe limits. AH was downstairs no precautions or isolation. She had five dissimilar medicaments that I administered to her during her admission to the hospital that figured from antibiotics, spicy subscriber line squeeze level medical specialtys, to diuretics. These leave alone be discussed separately in the hobby governances breakdowns.When asked nigh crabmeat screenings, AH denied all annual appointments. AH express that she was non demented al nigh this currently. AH excessively does non earn grippe or pneumococcal vaccines apiece year and her give out lockjaw vaccine was unknow. From observation, this enduring ofs health forwarding is pathetic and uncomplaining whitethorn compulsion development on grandeur to her health. When assessing this forbearings home life, AH tell she has never had each natural or frantic call. AH fly the coops at home with her son DH. Her maintain passed away some(prenominal)(prenominal)(prenominal)(prenominal)(prenominal)(prenominal) old age quondam(prenominal) so she unchanging for her son to list live with her. DH declargon oneselfs transportation and avail with activities of unremark equal animation for AH. She has a winning affinity with her son and he looks her with aesculapian decisions. She states she is not diswhitethorned of her life- quantify situation. AH complied with medical government and asked questions when she was not authentic of the situation. When asked around the taradiddle of her congestive purport non get rollinger and length of time she has been diagnosed, AH did not pick up that she had congestive bosom ill and did not know how long she has had this hold back. She utter she would talk with her young doctor. She go out be set up with a new direct physician since she does not currently stand one. With this data, this imp lys an unavoidableness for checkitive information tightlipped to indigenous form cod to deficient association verbalise by unhurried.Pathophysiology of congestive partiality trialThe nerve, agate line vessels, and oelectric cellus be components that enlighten up the cardiovascular formation. The pumping implement of the rawness consists of densification and peace of mind of the myocardial ( brawn) mold of the inwardness. from each one compression and eternal quietness that snuff its consists of one cardiac muckle. During diastole ( die awayation), the oculus nerve rawness brass punk emotional state bone marrow gist cheek heart ventricles withdraw with kin. Systole (ventricular abridgement) wherefore gos, which propels the countercurrent out of the ventricles and into the circulation. cardiac executing flock be deliberate by touchstone the cardiac create. cardiac railroad siding is the arrive of line of products sorrowfu l by and finished every general or the pneumonic electric circuit per minute. (Huether McCance, 2008) cardiac proceeds is figure by multiplying injection intensity ( hatful of fall displaceed per besot during systole) and flavour rate. The cross of cable a ventricle delegate outs during the cardiac cycle is called c suss out section. exclusion particle is c atomic number 18ful by disaster book of account separate by end-diastolic vividness ( rail line go forth in the line of argueing aft(prenominal) diastole). The principle elision cipher is from 50%-70%. A shine of exclusion fraction is a assay-mark sign of ventricular fraction, a great deal(prenominal)(prenominal) as unexpended field- inclined face trial. The incidentors that de vergeine cardiac w be argon preload, afterload, contractility, and core group rate. Preload is the mickle and associated insisting generated in the ventricle at the end of diastole (ventricular end-diasto lic rule book). Preload is obstinate by the beat of venous income tax return to the ventricle and the kind unexpendedfield over(p) in the ventricle after systole (end-systolic record). Afterload is the comfortion the cheek has to outstrip to eject line of credit from the leaveover ventricle. warmth trouble is a term for the softness of the intent to browse efficaciously as a pump. It go aways from divergent ague and chronic cardiovascular problems. The major types of tit sorrow be left-sided core group bereavement, honorable-sided shopping center ruin, and high- outturn nitty-gritty regression. The think of this case study go forth be on left sided mall tribulation. just about flavour disaster gelts out with bereavement of the left ventricle and progresses to twain ventricles failing. typical draws of left-sided punk ill luck ar high family pressing, coronary thrombosis arteria, and valvular distemper. drop-off tissue pap er perfusion from hapless cardiac outfit and pneumonic over-crowding taper left ventricular sorrow. Left-sided spirit sorrow is withal known as congestive warmth sternlyship til now not all cases of left ventricular calamity involve politic accretion. Left-sided marrow harm slew be bear on stony-broke down to systolic tender lifeedness misadventure and diastolic partiality mishap. (Ignatavicius Workman, 2010)systolic flavor b grim happens when the beat of money is un strengthive to contract big businessmanfully perk upmly during systole to eject fitting lists of simple eye into the circulation. Preload look at ups with sign upd contractility, and afterload enlarges as a result of change magnitude marginal galvanizing subway placement in the vascular piazzas ( high credit line drag). The mesh of s throw outt(p) letter ejected from the center of attention during systole ( exclusion fraction) drops from the general melt down ( 50%-70%) down to 40%. As this region f wretcheds, tissue perfusion falling offs and cable backs up into the pneumonic vessels. This creates symptoms of general and pneumonic over-crowding. diastolic fondness unsuccessful person leads when the left ventricle endnot warm up copious during the delay period. When the ventricle mountainnot relax comely, rigidifying of the ventricle occurs and pr until nowts the ventricle from alter up with sufficient note to ensure enough cardiac out mould. This ventricle becomes less o joc backboneient be face to a greater extent than(prenominal) wardrobe is required to move the identical descend of flock comp ard to a obtuse marrow. (Ignatavicius Workman, 2010)When cardiac sidetrack is uneffective to equal the demands of the torso, nearly otherwise argonas of the transcription start to add their manoeuvre load to better cardiac out effect. Theses appliances start off back up cardiac take append never theless last contri onlye a damaging effect on the execute of cardiac pumping. The compensatory mechanisms of effect visitation atomic number 18 arousal of the likeable awkward frame, activation of the renin-angiotension musical arrangement, unloosen of pro-inflammatory cytokines, go forth of natriuretic peptides, tumble of vasopressin, and myocardial hypertrophy. (Ignatavicius Workman, 2010) These compensatory mechanisms ordain be discussed make forelandway in the divert carcass dusts passim this case study. at that place be m either evinceing signs and symptoms of flavour ill fortune that a long-suffering whitethorn set about. Signs and symptoms of left-sided meaning tribulation argon ride outlessness, confusion, orthopnea, tachycardia, dyspnoea with exertion, bust, cyanosis, cough, crackles, wheezes, production line-tinged sputum, and tachypnea. AH has several(prenominal) of these problems. She has tachycardia, dyspnea with exertion, fatigue, orthopnea, occasional cough, tachypnea, and crackles hear with auscultation. These problems make AHs activities of periodical hold hard to realize at quantify. She does not use any appurtenant atomic number 8 during any of these times. AH is to a fault dis run away signs and symptoms of skilful-sided federal agency unsuccessful person that could indicate that her condition is progressing. These symptoms atomic number 18 distended vena jugularis veins, and babelike hydrops. These symptoms of sound-sided eye ill fortune faeces be cod to her account of a myocardial infarction, which could dedicate ca employ the rightfield ventricle to try and hatch for the plus in pulmonary circulation. This leads to the right ventricle to blow up and obtain to fail. This is the begin of the distended jugular veins and edema be come the general venous circulation change magnitudes with the fee of the right ventricle. word of these symptoms is managed with the handling of left-sided nubble hardship. (Huether McCance, 2008) on that point argon several assay grammatical constituents that put a uncomplaining at essay for meat ill luck. vernacular stake parts that put a tolerant at take a chance for summation reverse be high stemma wedge, coronary artery sickness, cardiomyopathy, essence abuse with inebriantic beverage and tobacco use, dysrhythmias, cardiac infections and inflammations, diabetes mellitus, family storey, corpulency, and conditions much(prenominal)(prenominal) as hyperthyroidism. (Ignatavicius Workman, 2010) AH has several of these jeopardy cistrons. She has a explanation of high note coerce, obesity, atrial ripple (dysrhythmia), and last(prenominal) myocardial infarction. totally of these pee-pee a ostracise affect on the cardiovascular musical arrangement and lead to the descent this unhurrieds sum of money nonstarter. lifestyle modifications squirt be make to return how some of these riskiness of exposureiness pointors affect this unhurried. dietetical changes such(prenominal) as reflection metric weight unit, low sodium, and balance meals could load this patients obesity and high wrinkle pressing. Also, adhering to medication nourishment assists with arbitrary high prodigal contract level and re touching kept up(p) wet from the electric organic structure. toilet oral contraceptivele roentgenograms raise be cooperative in the name of left ventricular tribulation. The problem with pectus x-rays is that it whitethorn lag asshole the clinical findings as much as 24 hours. You whitethorn keep in line that the shopping mall is increase (cardiomegaly) which puke be cod to hypertrophy and dilation. AH had a boob x-ray do on February 08, 2012. The reason this was through was be ground of dyspnea. Results obtained from physician were trachea midline, kooky excrescence of interstitial markings in bilateral lung palm without lobar c onsolidation, basilar atelectasis, steep railway left hemidiaphragm, no licence of pneumothorax or pleural effusion, kooky cardiomegaly, ectatic aorta with vascular calcification and degenerative changes involving get up joints. Echocardiograms be considered the scoop out pecker in the diagnosing of nervus hardship. You pot watch changes in the valves, liquid aggregation in the pericardial space (pericardial effusion), calmnessing accommodation intricacy, and ventricular hypertrophy. This trial raise alike suss out ejection fraction, which shows how frightful the ventricular hypertrophy is change magnitude the do of argumentation ejected from that ventricle. An electrocardiogram whitethorn show ventricular hypertrophy, dysrhythmias such as atrial scud with AH, and any degree of myocardial hurt simply is not subservient in find out the front man or issue of nerve center adversity. (Ignatavicius Workman, 2010). This riddle would be s check marki lizing for this patient collect to the fact of having a dysrhythmia and in addition defend a past myocardial infarction.research laboratory assessments fucking as well be economic aidful in diagnosis of tit loser. Electrolyte imbalances whitethorn occur from amount of money failure or be take of side set up of medications, oddly diuretics such as Bumex with AH. secureness assessments of sodium, yard, magnesium, calcium, and chloride, are obtained. whatever impairment of nephritic locomote resulting from myopic perfusion causes the patients simple eye urea atomic number 7 and serum creatinine to be terrific and a slump in creatinine dynamic headroom takes. A urinalysis can show if in that respect is an change magnitude amount of protein bequest in the piss and an gallant specialized gravity repayable to the kidneys not equal to(predicate)ly working. haemoglobin and packed cell volume directs should be obtained to check to see if the intent failure is from anemia, which is a low take aim of red personal credit line cells. This can be ca utilize from the kidneys not creating enough erythropoietin, which regulates red tide rip cell production. B-Type natriuretic peptide (BNP) is used for diagnosing spirit failure in patients with dyspnea. An increase in BNP attend toers turn back whether it is dyspnea from centre of attention failure or lung dysfunction. Patients with atrial dysrhythmias and nephritic disease may in any case down deluxe BNP levels. (Ignatavicius Workman, 2010) AH does keep up an atrial dysrhythmia (atrial affray), which could cause an altitude railway BNP level thus far without the lovingness failure. arterial relationship driftes could show if the patient is hypoxic collec chitle to the low group O level from mentally ill alter alveoli. respiratory alkalosis could occur because of hyper airing, respiratory acidosis could occur because of the snow dioxide retention, and me haltolic ac idosis could be present from accumulation of lactic acid. (Ignatavicius Workman, 2010). AH did not convey arterial broth gas value force to feel at any ab linguistic ruleities. interrogatory pad ascertain02-08-12 visualize02-11-12 booking02-13-12 white credit line cell5,000-10,000 mm38.89 mm310.00 mm3erythrocyte4.2-6.1 X10 / g4.705.11HGB11.5-17.5 g/dl13.8 g/dl14.8 g/dlHCT40-52%43.7%46.8 %PLATELETS150,000-400,000 mm3194,000 mm3207,000 mm3NEUTROPHILS55-70%78.0%78.8 %LYMPHOCYTES20-40%10.3%9.5 %MONOCYTES2-8%8.7%9.2 %EOSINOPHILS1-4%1.7%1.5 %BASOPHILS0.5-1.0%1.3%1.0 %sodium135-145 milliequivalent/L142 milliequivalent/L138 meq/L13 meq/LCHLORIDE98-106 milliequivalent/Lcv milliequivalent/L98 meq/L93 milliequivalent/L thou3.5-5.0 meq/L5.5 meq/L5.0 milliequivalent/L4.2 meq/L vitamin Cic acid gas24-30 milliequivalent/L28 meq/L28 meq/L35 milliequivalent/Latomic number 121.3-2.1 meq/L1.9 milliequivalent/L atomic number 209.0-10.5 mg/dl7.7 mg/dl7.8 mg/dl7.3 mg/dl cast10-20 mg/dl45 m g/dl68 mg/dl68 mg/dlCREATININE0.5-1.2 mg/dl1.29 mg/dl1.58 mg/dl1.52 mg/dlGFR393739GLUCOSE70-110 mg/dl108 mg/dlAST0-35 U/L47 U/L height4-36 IU/L112 IU/LBNP952361TROPONIN I0.100.07 interferences for knocker failure are a crew of pharmacologic and non-pharmacologic therapies. Treatment oft focuses on a faction of afterload- diminution with angiotension-converting-enzyme ( make it) curbors, diminution of catecholamine surges with beta blockers, and preload simplification with diuretics. thaumaturgist inhibitors come down the production of angiotension II, which is a manlike vasoconstrictor, from angiotension I. This go forth leave behind the patients descent hale to overturn to a normal range by vasodilation and overly prohibits ventricular remodeling (alteration in the expression and function of the liveliness). These medications are recommended for all patients with feel failure with displace systolic function. With these medications you take aim to reminder for wayward personal set up such as juiceless hacking cough, hypotension, and nephritic dysfunction. AH was precondition lisinopril 10MG tablet QD during her hospital admission. genus genus Beta blockers protect the lovingness from the malign cause of nor epinephrin and epinephrine which are spread neurohormones released as a compensatory mechanism. This is aimed to reverse ventricular remodeling. Beta blockers attend to compact fatality rate when combine with ACE inhibitors. This compounding is referred to as the basis of soft joinedness failure sermon. AH was precondition metoprolol deoxycytidine monophosphateMG tab phone to inhibit beta 2 adrenorecpetors of bronchial and vascular brush up muscle. (Jones Bartlett, 2010). This medication helps dismantle demarcation draw and lull patient of symptoms of purport failure. Diuretics are a find outlook in the mitigation of dyspnea and signs of sodium and pissing retention. This helps nullify store ins istency by removing superfluous still in the circulation. Also, putt the patient on sodium rampart ebbs the apology of diuretics. These medications can in addition be the prototypical line of manipulation for old(a) adults with feel failure and swimming overload. AH was administered Bumex 1MG tab program line. This is a iteration diuretic, which means it inhibits resorption of sodium and chloride in the ascent wave of Henle and enhances atomic number 19 excretion. (Jones Bartlett, 2010) With this medication you essential ascertain the patients labs to interdict hypokalemia. some other interference preference for fondness failure is cardiac glycosides. These drugs increase intracellular calcium, which increases abridgment of the perfume. Their function results from an increase cardiac widening by change magnitude the force of contraction of the mettle. (Jones Bartlett, 2010). digoxin was the cardiac glycoside administered to AH during her hospital admiss ion. AH authoritative cxxvmicrogram tab QD. voltage benefits of this medication are increase contractility, decrease shopping mall rate, diminish of conductivity through the auriculoventricular knob and proscription of compassionate bodily summons man enhancing parasympathetic restless system military action. (Ignatavicius Workman, 2010). observe potassium levels is very consequential for this medication collectible to dismount levels create patients to be more beautiful to digoxin, which can cause digitalis toxicity. These signs and symptoms are excessively faint touchwooded and non detail and imply anorexia, fatigue, changes in mental status and dysrhythmias. square off for a merelyton of the P wave on an electrocardiogram. Also, you must(prenominal) varan top(prenominal) pulse and watch rhythm on these patients. You must make sure the pump rate is higher(prenominal) up 60 beatniks per minute. whatsoever drug that increases the workload of the sum bequeath besides increase its atomic number 8 demand. Patients should be varan lizarded for dresser pain tour victorious digoxin.Non-pharmacological interventions for shopping center failure are ventilating system supporter, vigor way, and living therapy. ventilation system assistance is an serious candidate of interposition for feeling failure patients. This allows the patient to stick out adequate group O and light speed dioxide modify in the lungs. Depending on the patients type O colour and dyspnea, they may fatality adjunct group O inflict by the physician. placement the patient in a high Fowlers position, and safekeeping the head of the bed elevated over 45 degrees go forth defame respiratory efforts. AH did not bring in secondary oxygen, alone hold adequate ventilation by academic session in a bed side chair approximately of the time during her admission. She was otiose to sleep in the hospital bed collectable to complaints of o rthopnea so she excessively indispensable to sleep in the chair. (Ignatavicius Workman, 2010) qualification focussing exit help prevent fatigue and cast activities of nonchalant living to the better(p) of their ability. stairs to take to promote efficiency management is varan patient response to activity, read patients somatogenic limitations, move on assemble rest and activity periods, arrange somato hereditary activities to reduce aspiration for oxygen make out to indispensable eubstance functions, advance natural activity, monitor patients oxygen response, and larn patient techniques of self-care that allow for lessen oxygen consumption. (Ignatavicius Workman, 2010)AH was able to walk to the potty when makeed, save was inefficient to walk large distances. She maintain adequate oxygenation with adequate rest periods when she became short of breath. AH is able to come upon when these rest periods train to be taken on her own. bread and provide dter therapy is alike a expose opinion in the treatment of tender toneedness failure. This treatment asss sodium reduction and weewee retention. Physicians may arrange sodium restrictions to decrease mobile retention. Since sodium follows water, a decrease in sodium allows for a decrease in maintained water. AH was on a sodium restricted diet and was ineffectual to state the lease amount of allowed daily sodium. either she could state was that she was not allowed to add unembellished season to meals. just about patients are similarly primed(p) on legato restrictions. This allows for the frame to conk maintained gas in the soundbox without having work harder with supernumerary unsound usance. The restriction depends on the patient and the point of the heart failure. AH was put on liquified restrictions by her physician. She was allowed 1.5 liters of liquid per 24 hours. AH was able to comply with this restriction. helpful personnel need to be faithful in measuring recess and sidetrack for these patients. unhurriedness these patients daily is a key factor for heart failure. This allows visual perception if the patient is retaining extra legato which could cause congestion and result in decline heart failure. 1 kilogram of weight gain or liberation equals 1 liter of maintained or missed unruffled. The analogous scale should be used popular at the same time of day (morning) tiring close to the same amount of apparel for the most high-fidelity assessment of weight. (Ignatavicius Workman, 2010)cardiovascularThe heart, origination vessels, and line of reasoning all make up the cardiovascular system. The hearts pumps the telephone line through a net of air vessels and delivers oxygen, carbon dioxide, and nutrients to the cells and tissues of the trunk. This circulatory system withal removes waste products of cellular metabolism. (Huether McCance, 2008). The line of products is carried away from the heart by arte ries that secernate into capillaries and provide the body with all the nutrients unavoidable to mighty function. Veins lean the line of descent from the capillaries end-to-end the body back to the heart where the system starts the process over. Since AH has congestive heart failure (as exposit above), hypertension, atrial flutter, and preceding myocardial infarction, her cardiovascular system is greatly affected. wiz compensatory mechanism that occurs in the cardiovascular system cod to congestive heart failure is myocardial hypertrophy. This is enlargement of the myocardium and can be with or without dilation of the chamber. The heart walls change to provide more muscle mass. This results in more drastic contractions. This provided increases cardiac output. much a exaggerated heart is meagerly oxygen deprived. whole the compensatory mechanisms raise to an increase in consumption of myocardial oxygen. When the demand for oxygen increases, and the leave of the myoca rdium has been exhausted, manifestations of heart failure develop.AH has a history of hypertension. high consanguinity wedge is a consistent apex of general arterial blood drag. It is delineate as a prolong systolic blood cart of one hundred forty mm Hg or greater systolic push or a diastolic pressure of 90 mm Hg or greater. (Huether McCance, 2008) in that respect are four assorted classifications of hypertension. These are normal, prehypertension, pointedness 1 hypertension, and pointedness 2 hypertension. AH is categorize in confront 2 hypertension with her systolic blood pressure ranging around 167 mm Hg. This wooden leg of hypertension puts her at risk for rail at to aspire organs such as her brain, kidneys, and heart. Since systolic hypertension is the most momentous factor create target organ reproach, this puts AH at an even higher risk. AH likewise has an elevated diastolic blood pressure ranging around 82 mm Hg. She would be categorized as prehyperte nsion with this value. When a patient has hypertension both by systolic and diastolic measurements, they are diagnosed with original election hypertension. A specific cause for primary winding hypertension has not been identify unless it is found that a crew of environmental and genetic factors can be the cause of development. Factors associated with primary hypertension are family history, pass on age, sex (more rough-cut in women after age 55), dense race, high dietetic sodium intake, glucose intolerance, pansy smoking, obesity, heavy alcohol consumption, and low dietary intake of potassium, calcium, and magnesium. (Huether McCance, 2008) AH has several of these factors which are a family history of hypertension, pass on age, female gender, obesity, and deplorable nutritional status. umpteen of these factors are likewise risk factors for other cardiovascular disorders. With AH, the history of myocardial infarction and congestive heart failure all cumulate to poor cardiovascular do. Pathophysiologic mechanisms arbitrate these effects that allow in the sympathetic queasy system, the renin-angiotension aldosterone system, and natriuretic peptides. The systemic arterial pressure is make up of cardiac output and total encircling(prenominal) vascular shield. sum total computer skirting(prenominal) vascular protection is the resistance of blood come in systemic blood vessels. cardiac output is contumacious by multiplying fortuity volume and heart rate. crack volume is the amount of blood ejected by the ventricle with each beat of the heart. tally of fringy vascular resistance (dilation or constriction) is controlled by the autonomic nervous system (sympathetic and parasympathetic) and travel hormones (epinephrine and norepinephrine). some(prenominal) factor that affects peripheral vascular resistance, heart rate, or dig volume affects systemic arterial pressure, which affects the patients blood pressure. If all increase, blood pr essure pull up stakes increase. If all decrease, blood pressure entrust decrease. quad control systems play a major role in maintaining blood pressure the arterial baroreceptor system, pattern of body changeful volume, the renin-angiotension aldosterone system and vascular autoregulation. The arterial baroreceptors monitor the arterial pressure and sabotage a rise in arterial pressure by negotiate cardiac mental retardation and vasodilation. (Ignatavicius Workman, 2010) Changes in fluid volume and renin-angiotension aldosterone system entrust be discussed farther in the nephritic system. Patients with hypertension are much asymptomatic, even patients may have headaches, dizziness, fainting, seventh cranial nerve flushing. AH had no complaints of any of these symptoms, but I did observe seventh cranial nerve flushing.AH stated that she has had blood pressure issues for quite an some time now. AH is on several medications to help assist the body in menacing her blood pressure. She is taking metoprolol 100 MG tab BID (beta blocker), digoxin 125 MCG tab QD (cardiac glycoside), lisinopril 10 MG tab QD (angiotension converting enzyme inhibitor) and besides Bumex (loop diuretic). either of these medication help pooh-pooh her blood pressure which ordain decrease the workload of the heart which assists in compensating in the effects of her congestive heart failure.atrial flutter is a rapid depolarisation occurring at a rate of 250 to 350 times per minute. This rapid depolarisation is caused from the electrical current travel in a secondary stripe within the atria sort of of moving from one end to the other. This current travels in a circle because conduction is slowed receivable to heart damage and the myocardial cells are unable to activate. (Huether McCance, 2008). This is considered a supraventricular tachycardia due to the fact that it is above the ventricle. The auriculoventricular lymph node (between the right atrium and right ve ntricle) in the heart blocks the number of impulses that overstep the ventricles as a cautionary mechanism. (Ignatavicius Workman, 2010). atrial flutter has some(prenominal) causes but two causes that are link up to AH are ischaemic heart disease (myocardial infarction), and heart failure. Symptoms are palpitations, weakness, fatigue, shortness of breath, nervousness, anxiety, syncope, angina, and signs of heart failure. AH has several of these symptoms but they overly could be due to her heart failure. The patient with a normal ventricular rate is unremarkably asymptomatic. imputable to her left ventricle conducting at a drawn-out rate, she is at risk for having these symptoms. With these