Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example

Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example

The patient in the case study presents primary symptoms such as labored breathing, palpitations (rapid heartbeats), and pleuritic chest pain.  According to the Center for Disease Control and prevention (CDC) these are symptoms of cardiovascular and pulmonary diseases, particularly venous thromboembolism (VTE) (CDC, 2022). VTE or blood clot is a common cardiovascular and respiratory disorder that includes deep vein thrombosis (DVT) and pulmonary embolism (PE).(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

VTE remains a largely underdiagnosed, serious, and preventable condition that can lead to disability or death. DVT occurs when blood clots in the deep vein of the lower extremities, including the pelvis, leg, or thigh. Conversely, PE occurs when the blot clot in the deep vein (also known as embolus) of the lower extremities loosens and travels in the blood circulation to the lungs, causing a blockage of the artery, pulmonary occlusion, and impaired gaseous exchange (CDC, 2022). Obstruction of the pulmonary artery results in a dead space in the alveolar, leading to increased vascular resistance. DVT rarely expresses symptoms, but it is associated with swelling, pain, tenderness, and erythema of the affected area. It is likely that the patient, in this case, did not show symptoms of DVT and consequently showed symptoms of PE. The fatality of the PE depends on the clot size; large clots stop the blood from reaching the lungs.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

Risk factors such as prior surgery, cancer, prolonged immobilization, or hospitalization are commonly associated with VTE. In this case, the primary risk factor for the client’s symptoms is the damage from surgery. The client complained of shortness of breath is associated with hypoventilation. Hypoventilation is insufficient alveolar ventilation due to metabolic demand when the minute volume is reduced (McCance & Huether, 2019). In this case, the inadequacy of alveolar ventilation could be due to the blockage of an artery in the lungs from a blood clot. Normally, carbon dioxide is removed from the lungs at the same rate as the production in the cellular metabolism, unlike in hypoventilation, when the carbon dioxide removal lags. An increase in carbon dioxide production increases partial carbon dioxide causing hypercapnia, which increases the level of hydrogen dioxide concentration in the blood. (Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

Consequently, the patient presents an alteration in breathing pattern, which can be overlooked since ventilator rate, breathing pattern, and blood gas analysis may appear normal. However, the atrial fibrillation causes irregular muscle wall spasms, ST depression and T wave inversion, and consequent right ventricular strain, as shown by the client’s EKG results. On the other hand, pleuritic chest pain experienced by the patient originates from the pleurae or chest wall. Pleuritic chest pain could result from the irregular muscle wall spasm due to pleural friction or pulmonary hypotension with exercise (McCance & Huether, 2019). Besides, the potential infection and inflammation of the parietal pleura and bronchi or trachea can contribute to chest pain with pleurae stretch or cough, respectively. The pain is localized and sharp or stabbing and emanates from around the infraction.  (Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

The palpitations experienced by the patient are due to abnormal breathing patterns. Palpitations are irregular or abnormally rapid heartbeats other than normal rhythmic and effortless breathing (Goyal et al., 2021). However, depending on the physiologic and pathological conditions, the rate, depth, regularity, and effort of breathing have characteristic alternations and patterns adjusted to optimize the functions of the respiratory muscles. In this case, the patient is experiencing labored breathing, which results from increased work of breathing due to obstructed airways caused by pulmonary embolism (McCance & Huether, 2019). Obstructed airways increase rapid ventilator rate, labored breathing, prolonged expiration, and small tidal volume.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

VTE is quite common in the United States. About a third of hospitalized patients in the United States are at risk of developing VTE (Turetz et al., 2017). About 600000 cases of VTE are diagnosed annually in the United States. About 117 in 100000 people are diagnosed with VTE. The incidence is three times higher among the elderly aged 70+ years compared to those aged between 45 and 69. The latter age bracket also experiences three times higher incidence than those between 20 and 44. Moreover, up to 10% of in-hospital mortality is related to PE in the United States. Besides age and surgery-related risks, racial or ethnic variables may impact physiological functioning, predisposing some individuals to higher risks of VTE than others.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

VTE varied significantly across different racial and ethnic groups. The variation is due to the differences in clinical, physiological, and genetic factors, which are minimally understood. However, studies have shown higher incidences of VTE among individuals of African American descent than in other ethnic or racial affiliations (Folsom et al., 2019). These findings suggest that individuals of African American descent are more likely to be diagnosed with PE following exposure to risk factors. However, the incidence of VTE is significantly less among Pacific/Asian Icelanders. Owens et al. (2018) showed that the incidence of VTE among blacks is between 30 and 60% compared to whites across all age groups. Moreover, incidences of outpatient PE are three times higher among blacks (18%) compared to whites (10%).(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

The disproportionate incidence of VTE among ethnic groups could be attributed to different factors, including a history of thrombosis and genetic factors. VTE genetic risk factors, e.g., V Leiden and prothrombin G20210A mutations, are not similar to those found in blacks, suggesting a different combination of genetic factors predisposing blacks to VTE (National Hearts, Lung and Blood Institute, 2022). Moreover, the inheritance of hemoglobin S is common among blacks and confers a risk of thrombosis. Weze et al. (2022) found that higher incidence of severe chronic conditions such as diabetes, kidney disease, and hypertension among blacks , suggesting their contribution to the higher risks of VTE in this community.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

Pulmonary embolism can be disabling and fatal. The increased level of hydrogen concentration in the blood, also knowns as respiratory acidosis, can affect surrounding tissues (McCance & Huether, 2019). Hypoventilation can lead to somnolence and secondary hypoxemia. An unpredictable, irregular rhythm may indicate heart disease or conduction system impairment (e.g., atrial fibrillation). Moreover, laughing or coughing could worsen the pleuritic chest pain, leading to tissue death around the infraction. Due to labored breathing, the brain gets insufficient oxygen, also known as cerebral hypoxia, characterized by gasping respiration. Gasping respirations include irregular, quick inspirations and expiratory pauses (McCance & Huether, 2019). Consequently, labored breathing could lower the impulses sending information to the regions in the brain controlling respiration. (Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

References

Ball, J. W., Dains, J. E., Flynn, J. A., Solomon, B. S., & Stewart, R. W. (2021). Seidel’s Guide to Physical Examination-E-Book: An Interprofessional Approach. Elsevier Health Sciences.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

Centers for Disease Control and Prevention (June 2022). What is Venous Thromboembolism? Available at: https://www.cdc.gov/ncbddd/dvt/facts.html (Accessed 15 September 2022)(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)

Folsom, A. R., Basu, S., Hong, C. P., Heckbert, S. R., Lutsey, P. L., Rosamond, W. D., & Cushman, M. (2019). Reasons for differences in the incidence of venous thromboembolism in black versus white Americans. The American Journal of Medicine, 132(8), 970-976. https://doi.org/10.1016%2Fj.amjmed.2019.03.021

Hernandez, W., Gamazon, E. R., Smithberger, E., O’Brien, T. J., Harralson, A. F., Tuck, M., … & Perera, M. A. (2016). Novel genetic predictors of venous thromboembolism risk in African Americans. Blood, The Journal of the American Society of Hematology, 127(15), 1923-1929. https://doi.org/10.1182/blood-2015-09-668525

McCance, K. L. & Huether, S. E. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). St. Louis, MO: Mosby/Elsevier.(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)
 Goyal, A., Robinson, K. J., Katta, S., & Sanchack, K. E. (2021). Palpitations. In StatPearls [Internet]. StatPearls Publishing. (Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example)https://www.ncbi.nlm.nih.gov/books/NBK436016/

National Hearts, Lung and Blood Institute (March 2022). Venous Thromboembolism: Causes and Risk Factors. Available at: https://www.nhlbi.nih.gov/health/venous-thromboembolism/causes (Accessed 15 September 2022)

Owens, J. M., Bedard, N. A., Dowdle, S. B., Gao, Y., & Callaghan, J. J. (2018). Venous thromboembolism following total knee arthroplasty: does race matter? The Journal of Arthroplasty, 33(7), S239-S243(Concepts of Cardiovascular and Respiratory Disorders Comprehensive Nursing Paper Example). https://doi.org/10.1016/j.arth.2018.01.045

Turetz, M., Sideris, A. T., Friedman, O. A., Triphathi, N., & Horowitz, J. M. (June 2018). Epidemiology, pathophysiology, and natural history of pulmonary embolism. In Seminars in Interventional Radiology (Vol. 35, No. 02, pp. 92-98). Thieme Medical Publishers. https://doi.org/10.1055%2Fs-0038-1642036

Weze, K. O., Obisesan, O. H., Dardari, Z. A., Cainzos-Achirica, M., Dzaye, O., Graham, G., … & Osei, A. D. (2022). The Interplay of Race/Ethnicity and Obesity on the Incidence of Venous Thromboembolism. American Journal of Preventive Medicine. https://doi.org/10.1016/j.amepre.2021.12.023