The student is required analyse the following case study. A 64 year old female, presents to the Emergency Department with severe breathlessness on minimal exertion, at the same time there is a major...

The student is required analyse the following case study.


A 64 year old female, presents to the Emergency Department with severe breathlessness on minimal exertion, at the same time there is a major increase in her pulse rate. Her vital signs are:
•    Blood pressure: 156/96 mm Hg
•    Pulse: 128 bpm after exertion but reduces to 86 at rest
•    Respirations: 32 and shallow
•    Temperature: 36.9 C
She is given Ventolin 5 mg via the nebuliser was administered with no effect on respiratory rate, but did lead to severe anxiety and tremors. IV therapy of normal saline was commenced at 100 ml/hour.

An ECG is done and shows a slow atrial fibrillation, a chest x-ray demonstrates some fluid in the lung fields.
An arterial blood gas (ABG) is done and her results are pH 7.50, pO2 89 mmHg, pCO2 50 mmHg, HCO3- 22mEq. Her pulse oximetry reading is 85% on 3 litres of oxygen via nasal prongs. Troponin levels are done and these are normal.
The patient is transferred to a medical ward with the following medications prescribed:
Continue oxygen at 3 litres per/minute nasal prongs
Methyldopa 250 mgs. tds
physiotens 1 mane
Plendil 1 mane
Karvia 1 mane
Karviazide 1 mane
Overnight the patient's condition improves slightly with the oxygen, however when the oxygen is ceased the patient desaturates very quickly and becomes very breathless. The cardiologist assesses the patient and orders Lasix 40 mgs. As a stat dose and then to continue mane. The cardiologist states that the patient has some heart failure most likely due to hypertension which she has had for many years.
The next morning that patient states she is feeling much better and her lungs 'feel free they are not tight anymore'. She is again seen by the cardiologist who has now diagnosed atrial fibrillation and mild heart failure and she is commenced on Pradaxa and is to continue the Lasix.
You are required to analyse this case study. In your analysis you are expected to address the following:
•    Describe why hypertension leads to heart failure.

•    Describe the pathophysiology of heart failure and the given case's reported signs and symptoms and pathology results.

•    Describe the rationale behind the current medications in this specific case (it is expected that you will include the recommended strategies for the management of hypertension)

•    Describe three (3) priority nursing interventions you would implement for the patient, and provide the rationale for these based on good evidence.
•    Provide details of the instructions you would give to the patient on discharge to enable her to self-mange her heart failure by managing her fluid status and provide the rationale for these instructions.