Mr. Aloha Das Case Study – Medical Science Assignment Help

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Mr. Aloha Das Case Study

Mr. Aloha Das, a 68-year-old man, arrived at 4 a.m. at the emergency room with significant shortness of breath. It began two days ago and has been progressively worse since then. He also had a wheeze and right-sided pleuritic heart pain on the morning of the incident. He also has Hypertension and has previously had Heart Failure and the implantation of a Permanent Pacemaker. The major reason for his visit to the emergency room is a worsening of his shortness of breath. The progressive evolution of any medical disease is known as pathogenesis. While pathogenesis is the mixture of both the cause and the progression, pathophysiology is the combination of both. Shortness of breath, also known as dyspnea in medicine, is often accompanied with chest tightness, a need for oxygen, difficulty breathing, disorientation, or a feeling of suffocation (Kyriakou et al., 2020). 

The aetiology of dyspnoea is complex, comprising numerous pathways that result in increased labour of breathing, stimulation of superior or reduced airways, respiratory muscles, or cardiac sensors, and improper excitation of the pulmonary system via brain and local receptor cells (Nobahar, 2020). Dyspnea is treated by addressing the underlying sickness or circumstance. The principal two therapies that can be used are as follows. Because pleural effusion causes dyspnea in this case, draining fluids straight into the lungs can assist reduce breathing difficulties. Depending on the cause, dyspnea can sometimes be treated with pharmaceutical or medical care. Another type of therapy is pharmacology. The physician may prescribe one of the following therapies, depending on the cause of the dyspnea: bronchodilators to expand the lungs, steroids to reduce swelling, and pain medications to relieve discomfort (Paice et al., 2018).

Mr. Das’ caregiver must perform breathing therapy or breathing control exercises as a high-value nursing intervention (Ida Rahmawati et al., 2018). Mr. Das will benefit from this activity in the following ways. Breathing exercises increase the amount of air in the lungs while also boosting the CO2 release of pollutants. Individuals who have more air inside their bodies and connective tissue are healthier and perform better. Organs that are healthy and function properly enhance an individual’s immune system as well. Breathing exercises can help individuals improve their cardiac capacities and reduce excessive blood flow. Cerebrovascular accidents are also reduced by frequent heavy inhalation. By reducing reflexes, heavy breathing stimulates the neurological system. People who use breathing methods on a regular basis may find it easier to relax and concentrate. It also improves recall, mental powers, and intellectual ability. The chest and respiratory organs have been significantly impacted by lifestyle choices. Respiratory exercises help to raise oxygen levels in both the lungs and the diaphragm. It improves lung flexibility, allowing for more breathing space (Ruhwanya, Tarimo & Ndile, 2018). 

Mr. Das requires all of these elements in order to better his current situation. As a result, the registered nurse has chosen this nursing intervention to help him improve his current state. This will lower the pressure in his lungs and aid in the release of pressure from his Pacemaker, preventing him from suffering another heart attack. In addition, the nurses discovered that he has a very high blood pressure of 186/108 mmHg, which will be decreased by this nursing intervention, and he will be temporarily relieved from his current problems before receiving suitable medicine in the future. Kerley B streaks near the costophrenic junction reveal left ventricular hypertrophy and interstitial edoema on his chest x-ray. As a result of increased ST depression and ST elevation, the ECG data also shows a rapid pulse rhythm, indicating difficulty in respiratory distress. Mr. Das’s current problems would not be addressed if this nursing intervention was not carried out right away, and he may experience an acute impact on his cardiovascular organs, increasing his symptoms even more.

Mr. Das was prescribed Furosemide 40mg IV Stat to treat edoema, hypertension, and severe or long-term renal issues. This medication is often given in continuous dosages of 20 to 50 mg. By preventing reuptake from the intermediate and distal glomeruli, as well as the circle of Henle, furosemide is a potent looping diuretic that increases Na+ and fluid outflow by the kidneys. It has an immediate effect on glomerular cells and has an indirect effect on the composition of both kidney filtrate and urine. Finally, furosemide increases the amount of urine produced by the kidneys (Fabrellas et al., 2020). Nonspecific chemical carriers produced at the luminal site of action transport the nutrient furosemide to its active site inside the kidneys, where it is released by effective discharge. In this situation, the amount of nitrogen detected in the urea was quite high, and Mr. Das had bilateral pedal pitting edoema 2+ as a result of his kidney malfunctioning as a result of his cardiac problem. 

The level of urea nitrogen (BUN) in the blood is 14.0 mmol/L, while the normal range is 3.0-8.0 mmol/L. As a result, Mr. Das is prescribed this medication to treat his ailment. Mr. Das was given Glyceryl Trinitrate IV Infusion to treat severe acute left ventricular failure. 10 micrograms per minute Capillary smooth muscular tone is reduced by glyceryl trinitrate (Bally et al., 2018). In comparison to artery capacitor channels, this impact is more significant in ventricular capacitor channels. There may be a reduction in venous return to the atrium, as well as a reduction in pumping tension. The left atrial end-diastolic capacity and loading are reduced when processing stress is reduced. As a result, there is a decrease in cardiac oxygenation utilisation. 

Additionally, glyceryl trinitrate lowers overall vascular resistance and respiratory vascular tension while raising arterial stress, resulting in a decrease in afterload. By minimising preloading and afterloading, glyceryl trinitrate reduces the workload on the heart. By shifting plasma circulation across the epicardial to endocardial zones via auxiliary routes, glyceryl trinitrate modulates O2 delivery (Guerrero, 2019). Mr. Das has a fast heart rate of 120 beats per minute, feels chilly to the touch, and has a capillary refill time of less than 3 seconds in this situation. His acute left ventricular failure is the subject of all of these statements. Mr. Das was administered Glyceryl Trinitrate IV Infusion 10 mcg/min by his doctor to treat his LVF.