Question

1. a) Write in detail the physiopathology of chronic heart failure (Etiological factors, predisposing conditions should also be written).

b) Explain the causes of the signs and symptoms of chronic heart failure.

c) Write down nursing interventions related to the three Symptoms.

2. a) Write in detail the physiopathology of chronic kidney failure.

b) Explain the causes of the signs and symptoms of chronic kidney failure.

c) Write down nursing interventions related to the three Symptoms.

Provide references, all the answers (including the internet) should be added at the end of the text.

Answer 1

PATHOPHYSIOLOGY OF CHRONIC HEART FAILURE

The clinical and morphologic effects of left-sided CHF are a consequence of passive congestion (blood backing up in the pulmonary circulation), stasis of blood in the left-sided chambers, and inadequate perfusion of down-stream tissues leading to organ dysfunction

Right-sided heart failure is most commonly caused by left-sided heart failure, as any increase in pressure in the pulmonary circulation from left-sided failure inevitably burdens the right side of the heart.

Heart failure is most often caused by:

•Ischemic heart disease

•Hypertension

•Aortic and mitral valvular diseases

•Primary myocardial diseases

b)Symptoms:-

-breathlessness

-cough

-orthopnoea

-PND

signs:-

-increased respiratory rate

- pedal edema

- pink frothy

-crackles

A reduced ejection fraction leads to diminished renal perfusion, causing activation of the renin-angiotensin-aldosterone system to correct the “perceived” hypotension. This leads to salt and water retention, with expansion of the interstitial and intra-vascular fluid volumes, that then exacerbate the ongoing pulmonary edema.

If the hypoperfusion of the kidney becomes sufficiently severe, impaired excretion of nitrogenous products may cause azotemia (called prerenal azotemia because of its vascular origin).

In far-advanced CHF, cerebral hypoperfusion can give rise to hypoxic encephalopathy, with irritability, loss of attention span, and restlessness that can progress to stupor and coma with ischemic cerebral injury.

c)

symptoms	intervention
Dyspnoea	- oxygen inhalation -head end elevation
pedal edema	- elevate leg
cough	- give frusemide

2) PATHOPHYSIOLOGY OF CHRONIC RENAL FAILURE

- REDUCTION OF GFR, leading to increase in the creatinine level

due to renal injury leading to destruction of nephrons, leading to hypertrophy of normal nephrons leading to renal dysfunction The increased glomerular capillary pressure may damage the capillaries, leading initially to secondary focal and segmental glomerulosclerosis (FSGS) and eventually to global glomerulosclerosis.

factors:

HYPERTENSION

NEPHROTOXIN

DECREASED PERFUSION

PROTEINURIA

HYPERLIPIDEMIA

SMOKING

UNCONTROLLED DIABETES

urinary tract dysfunction

tubulointerstitial disease

cystic disease

b) symptoms:

- haematuria

-pedal edema

- breathlessness

-fatigue

-bradycardia

- anemia

The disease affects people of any age, most commonly older children and young adults. Many patients present with gross hematuria after an infection of the respiratory or, less commonly, gastrointestinal or urinary tract; some have have only microscopic hematuria, with or without proteinuria; and some develop acute nephritic syndrome, including some with rapidly progressive glomerulonephritis. The hematuria typically lasts for several days and then subsides, only to return every few months. The subsequent course is highly variable. Many patients maintain normal renal function for decades. Slow progression to chronic renal failure occurs in 15% to 40% of cases over a period of 20 years. Onset in old age, heavy proteinuria, hypertension, and the extent of glomerulosclerosis on biopsy are clues to an increased risk of progression.

c)

symptoms	intervention
-fatigue -anemia	-check for pulse, bp and haemoglobin - give erythropoietin
-edema	- symptomatic treatment
-palpitation	- check ecg and serum pottasium and sodium