Pathopharmacological Foundations for Advanced Nursing Practice

Introduction

This is an analysis paper that seeks an explanation of the pathophysiology of the heart disease process. The duty of a nurse is to diagnose, treat, and evaluate patients. This duty necessitates a nurse to understand how pathology, regimens, treatment, and psycho-social matters affect patients and the care they receive (McCance & Huether, 2010). Physiopathology or pathophysiology is an amalgamation of physiology with pathology. The latter is the therapeutic discipline that illustrates conditions characteristically experimental during a disease condition, whereas physiology is the biological regulation that describes procedures or mechanisms functioning within an organism (McCance & Huether, 2010).

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Ailments of the cardiovascular system recurrently confront the physician concerned in the daily care of patients. Understanding of the fundamental pathophysiologic processes connected with diseases of the heart and blood vessels offers a critical structure for patient management. Heart disease is a wide expression used to explain a range of ailments that affect individuals’ hearts. There are different diseases that are associated with heart disease, including:

  • (a) diseases of a person’s blood vessels, like coronary artery ailment;
  • (b) heart rhythm failures (arrhythmias);
  • (c) heart infections;
  • (d) heart malfunction the individual is born with (congenital heart defects).

The Pathophysiology of Heart Disease

Heart disease is broad, and its pathophysiology will depend on any heart complications. Heart failure is one of such variations; it is a clinical disease that happens when the heart is incapable to supply enough blood flow to maintain metabolic needs or contain systemic venous return (McCance & Huether, 2010). As the heart collapses, patients experience symptoms that comprise dyspnea from pulmonary blocking, and peripheral ascites and edema from the damaged venous return. Constitutional signs of heart failure, such as the lack of appetite, nausea, and fatigue, are common.

Treatment methodologies have been created based upon the comprehension of these compensatory methodologies. Medical therapy comprises of diuresis, repression of the overactive neurohormonal mechanism, and expansion of contractility. Surgical strategies are composed of ventricular resynchronization treatment, surgical ventricular restructuring, heart transplantation, and ventricular support device implantation. Regardless of noteworthy comprehension of the underlying pathophysiological strategies in heart malfunction, this disease presents considerable morbidity and comprises the fifty percent 5-year mortality.

Chronic heart malfunction is a multifaceted clinical disease that can result from any functional or structural cardiac disarray that damages the capability of the ventricle to supply with or expel blood. Systolic heart failure is associated with a compromise in the contractility of the heart and is referred to as a left ventricular expulsion fraction of more than forty-five percent. Diastolic dysfunction obstructs the heart’s capability to shrink and fill with blood.

The Standard of Practice for the Heart Disease Process

The standard practice is geared at ensuring the heart disease conditions are maintained as appropriate. The process involves:

  • (a) taking a complete medical history;
  • (b) comprising documentation of patients’ symptoms;
  • (c) physical assessment, including conducting an EKG or ECG (electrocardiogram) to seek for findings indicative of heart failure, and order blood examinations, comprising those that evidence the heart muscle impairs.

Another examination process may also be conducted, comprising a chest X-ray. The first treatment may be based on nitrates such as sublingual administered under the tongue, oxygen, nitroglycerin, aspirin, and pain medication like morphine (Aschenbrenner & Venable, 2012).

The purpose of lysing the thrombus (thrombolytic) therapy in severe myocardial infarction is meant to dissolve (lyse) the coronary clot (thrombus) and permit the oxygenated blood to arrive at the heart veins as fast as necessary. The objective is that intervention early in the procedure of infarction will restrict infarct size, conserve left ventricular operation, prevent pump stoppage, and eventually avoid death. The four thrombolytic components that have been assessed comprehensively in severe infarction are: tissue plasminogen activator (t-PA), streptokinase, anistreplase (APSAC) and reteplase (Aschenbrenner & Venable, 2012).

It is debatable which one is more effective. However, an overbidding consideration is their early usage. Various medical centers currently control acute myocardial infarction with the initial angioplasty of the impaired coronary artery (Horan, Barrett, Mulqueen, Maurer, Quigley & McDonald 2000).

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The Evidence-Based Pharmacological Treatments

Evidence-based pharmacological treatments comprise the usage of known practices to manage heart disease. Doctors are scientists and must operate in harmony with the established facts. Considering the matter of therapeutic components, medication has to be founded on drugs with verified efficacy for the treatment needed, such as the evidence-based medication. Contemplation of pharmacotherapy of ischemic heart disease from the feature of enhancement of the long-term diagnosis reveals that nitrates and calcium antagonists, for which there is no proof of the enhanced long-term death, are usually prescribed.

On the other hand, the prescription of beta-blockers, for which there is apparent evidence of enhancement, holdups well in Western nations (Aschenbrenner & Venable, 2012). In the 1980s, the period when the effectiveness of beta-blockers was established in Western nations, calcium antagonists initially emerged. It was apparent that both physicians and patients tended to employ these antagonists due to the excellent results.

Healthcare and medical guidelines propose the use of evidence-based medicine therapies such as beta-blockers, aspirin, angiotensin, and statins converting angiotensin receptor blockers (ARB) or ACE (enzyme) inhibitors combined with lifestyle transformations for all patients with established coronary artery disease (CAD) (Aschenbrenner & Venable, 2012). Nevertheless, researches in developed and developing nations account that long-term usage of such treatments is suboptimal.

Clinical Guidelines for Assessment, Diagnosis, and Patient Education

Heart failure is a medical disease defined by the occurrence of characteristic symptoms and signs. In modern years, the reliability of conventional symptoms and signs of heart malfunction has been tested in the huge population research and in clinical attempts. This has given evidence confirmation for their helpfulness in the clinical evaluation of the patients who have established or supposed heart failure (Horan et al., 2000).

A diagnosis test. An Electrocardiogram is an uncomplicated, painless examination that senses and records the heart’s electrical mechanism. The test reveals how quickly the heart is pumping and its rhythm. An EKG also documents the potency and timing of electrical activities as they pass via each section of the heart. The EKG can demonstrate symptoms of heart impairment because of the CHD (coronary heart disease) and symptoms of an earlier or present heart attack.

Blood tests. This is another diagnosis process of heart disease. Heart muscle cells die and discharge proteins into the blood vein. Blood tests can assess the quantity of proteins in the bloodstream. When protein levels are higher than normal, the situation suggests a heart attack. Usually used blood tests comprise CK or CK–MB tests, serum myoglobin tests, and troponin tests. Blood tests frequently are repetitive to test the modifications over time.

Coronary angiography. This is a test that employs special X-rays and dye to reveal the interior of patients’ coronary arteries. It is performed during a heart attack to assist in finding obstructions in the coronary arteries. To put the dye into the patient’s coronary arteries, the physician uses a process known as cardiac catheterization. A thin, supple tube – a catheter – is inputted into the bloodstream in the patient’s arm, upper thigh, or neck. The pipe is threaded through the patient’s coronary arteries, and the dye is sprayed into the patient’s bloodstream. Exceptional X-rays are conducted while the dye is moving through the coronary blood vessels. The dye allows the physician to examine the flow of blood inside the heart and blood vessels.

Patient education. It is necessary for patients to understand their condition and how to control it. This assists in increasing their confidence in making transformations to enhance and maintain their health. Answers by Heart is a set of online patient data sheets available in a question-and-answer set-up that is brief, simple to read, and follow. They also offer room for patients to write down necessary queries to ask their physicians. This can assist patients to prepare and get the most needed assistance during their doctor’s appointments. In some scenarios, Answers by Heart allow patients to log and track individual data like cholesterol, blood pressure, weight, and exercise.

Standard Practice for Managing the Disease within the Community

Management of heart diseases cannot be handled by an organization alone. Community care has the subsequent disease and cares administration initiatives every network to manage the disease as possible: e.g. heart disease, diabetes, asthma, and pharmacy management. In addition, providing these initiatives is essential in managing patients with heart diseases as opposed to depending on state or national initiatives that are overwhelmed by a huge number of health issues and insufficient health funds. Community care employs the performance assessments described by the clinical administrators to assess the capability of providers and systems to institute quality procedures and to accomplish quality results for the core program schemes (Couch, 1998). The result indicators are characteristically collected from claims data and the procedure indicators from the exterior chart reviews.

Characteristics and Resources of Heart Disease Management

Atrial fibrillation (AF) is one of the key healthcare matters and a significant basis of healthcare costs. AF care needs specific arrhythmogenic knowledge and complex therapy. It is vital to be acquainted with its real influence on healthcare systems to assign resources and distinguish areas for enhancing the principles of care. The current countrywide, demonstration, observational research involved 233 general practitioners. Every one of them conducted an electronic questionnaire to give information on the scientific profile, treatment methodologies, and resources used to care for clients with AF.

Health indemnity may be hard to get in adulthood due to pre-existing conditions, in spite of the latest federal legislation and due to reservations and misconceptions regarding the cost of care for the elderly with coronary heart disease. The actual expenses of medical care seem to be comparatively low in these patients in contrast with survivors of other chronic ailments that start in infancy. The recent healthcare policy allows a number of heart disease patients to access healthcare as contrasted to the past. Community-based initiatives have also enhanced the accessibility of health care to these patients.

The objective of managing cardiovascular disease is frequently to open congested arteries that cause heart failure symptoms. Depending on how acute the obstructions in the patient’s arteries are, therapy may comprise:

  • (a) medications;
  • (b) lifestyle changes;
  • (c) vagal maneuvers;
  • (d) medical procedures or surgery;
  • (e) pacemakers or implantable cardioverter-defibrillators (ICDs);
  • (f) heart transplant;
  • (g) balloon valvuloplasty and valve repair or replacement (Aschenbrenner & Venable, 2012).
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Heart Diseases Management Performed Nationally and Internationally

In 2003, The Public Health Action Plan to Prevent Stroke and Heart Disease was enacted. It involved policy and environmental transformations affecting the whole US residents as a method to alter adverse behavioral lifestyle as the initial objective of an inclusive public health approach to prevent heart disease and stroke. Public health procedures are conducted at many stages – from local to nationwide and global ones. The agencies and organizations devoted to public health at these diverse levels share the same operations comprising dis­ease observation, provision of access to health care, and guiding principle development.

Agencies of precise interest to pharmacists like the Food and Drug management are emphasized. The World Health Organization (WHO) is the main international public health association. The responsibility of the WHO in community health can be distinctive by its core operations of:

  • providing management and engaging associates in issues of critical significance to health;
  • encouraging areas of study and making sure findings are distributed widely;
  • generating principles and encouraging their use;
  • encouraging the employment of ethical and evidence-based choices;
  • assessing and monitoring health and trends;
  • generating its own capability to make certain that its work can be continued (Newman, Steed & Mulligan, 2009).

Factors Facilitating the Heart Disease Patients’ Management

These factors are comprised of financial resources, access to care, insured/uninsured, Medicare/Medicaid. Heart disease treatment is costly and needs specialized personnel to administer treatment plus acknowledgeable health care provision. The healthcare policy and regulations have made the treatment affordable through insurance policies. The Affordable Care Act (ACA) was enacted into regulation in early 2010 and subsequently approved by the American Supreme Court in mid-2012 (Lubkin & Larsen, 2013).

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It is apparent that a number of necessities have benefitted Americans with stroke and heart disease. Although no regulation is ideal, the ACA mainly aligns with the organization’s six patient-oriented standards for reform. The accomplishment of the ACA plays a significant responsibility in assisting the American Heart Association ( AHA) to achieve its 2020 objectives to enhance the cardiovascular wellbeing of every American while minimizing deaths from heart disease and stroke.

In the importance of encouraging high-quality patient-oriented care and responsibility, the Centers for Medicare and Medicaid Services (CMS) and Hospital Quality Alliance (HQA) initiated openly reporting the 30-day mortality assessments for acute myocardial infarction (AMI) and heart failure (HF) in June 2007. Publicly reporting these matters augments the transparency of health care, gives useful information for clients selecting the care, and helps hospitals in their quality enhancement efforts (Lubkin & Larsen, 2013). The apparent outcome would have been a more mortality rate concerning heart disease complications since these factors were not considered by respective health stakeholders.

Characteristics of the unmanaged heart disease patients have been discovered to associate with health deterioration. The patient is vulnerable to other chronic diseases that are associated with heart diseases, such as stroke, diabetes, and other health complications. Unmanaged patients incur more costs when it comes to treatment than managed patients, and fatality chances are increased on these patients (Bushnell, 1992).

Heart disease affects the family of the patients in a number of ways. The financial challenges of maintaining a heart disease patient are very high and mean the family has to forego some requirements to sustain the patients. Healthcare provision for such patients is stressful and needs constant monitoring. The productivity of the patient is reduced and, if one has a family, the financial provision for the family for other needs is adversely affected. Community productive human resources are affected by heart disease and initiatives must be enacted to maintain the treatment of these patients. It is costly to implement health care initiatives (Newman, Steed & Mulligan, 2009).

The best practice for managing heart disease in current care organizations is to encourage people to undertake regular medical checkups. This will assist in early diagnosis that is easier to manage than the late one, as well as sensitize the patient with the disease of care available and their personal responsibilities.

Three Strategies of Implementing Best Practice

  1. Encouraging EBP Implementation

Evidence-based practice (EBP) is the careful and sensible use of modern best evidence in combination with clinical knowledge and patient principles to steer health care decisions. Best evidence comprises empirical confirmation from randomized controlled experiments, evidence from other methodical techniques, like descriptive and qualitative study, as well as employment of information from case documentations, scientific values, and the expert’s view.

  1. Encouraging the Self-Management Strategy

Multidisciplinary heart failure procedures comprising patient education and self-management approaches such as every day documenting of body weight and employing a patient record, which reduces hospital readmissions and enhances the quality of health (Bushnell, 1992).

  1. Adoption of Community Initiatives

Community initiatives assist in managing patients more than an organization. This will assist the health organization in improving the managed heart disease patients’ numbers.

An appropriate method for evaluating the above strategies of best practice implementation would involve patients’ status assessment periodically. By assessing the conditions of patients, it will be easy to note whether the methods are productive or not.

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