MI Peer Response due 1-11-23
Instructions:
400 words for each2 peer response total of 800 words.
Look at your course colleagues’ responses.
· From your advanced practice mindset reflect on a discussion you would like to have with two of your course colleagues about their responses.
· Post a response individually to each of them that expresses your advanced practice nursing role perspective of the data represented in their response.
· In each response add statistical data regarding MI to include population group impacted, preventative measures to include primary secondary and tertiary prevention for MI. Include at least 4 new references.
Use scholarly resources relevant to your advanced practice nursing role to support the key elements of the peer discussions you construct. [For example – if you are a nurse educator (clinical or academic) what are your thoughts about their ability to follow task instructions for constructing the assignment, etc.?; if you a nurse leader what are your thoughts about the success of their application of a process improvement model, etc.?; if you are a nurse practitioner what are your observations about the non-conventional modality presented in the schemata, can you locate any evidence or the foundational basic sciences that support the modality, etc?
Please be sure to validate your opinions and ideas with citations and references in APA format.
1. Peers posting
Unit 1 Discussion – Initial post
Case Study: Mr. T is at higher risk for cardiac disease. He presents with a BMI of 38.4, elevated blood pressure, high cholesterol, a family history of early age heart attack and stroke, hypertension, and is African American. African Americans suffer from cardiac diseases greater than any other ethnicity (American Heart Association, 2023). Also of note is his position as a corporate manager, which may be associated with higher stress levels which have been shown to impact heart health negatively (American Heart Association, 2020). Mr. T also drinks alcohol but does not indicate quantity.
Explain the progressive pathophysiologic relationship between an MI and the development of left ventricular (LV) failure.
A myocardial infarction (MI) occurs when the oxygen supply to the heart tissue is insufficient due to compromised circulation related to sclerotic vessels, clots, or significant blood loss (McCance & Huether, 2019). When heart tissue is damaged following an MI, the structure of the heart can be altered with scar tissue or necrosis, affecting the contractility of the heart and its ability to pump blood to the body. The left ventricle receives oxygenated blood from the pulmonary veins and pumps that blood out to the arteries. When the left ventricle cannot pump efficiently, blood begins to back up in the pulmonary vessels leading to fluid build-up in the lungs that manifests as shortness of breath and crackles in the lung bases on auscultation.
What factors affect the severity of LV failure?
Several factors can contribute to the severity of left heart failure. Initially, severity is determined by the extent of damage to the heart. The more extensive the damage to the cardiac tissue, the less productive the heart will be. The presence of coronary artery disease and hypertension can increase severity as well as comorbidities like diabetes and lung and kidney disease (McCance & Huether, 2019). When perfusion pressure decreases, the kidneys respond through the renin-angiotensin-aldosterone system, which causes increases in blood volume and vasoconstriction, ultimately increasing the workload on the heart and exacerbating heart failure (McCance & Huether, 2019). Other important considerations are age, obesity, and lifestyle choices such as smoking, poor diet, and alcohol consumption (McCance & Huether, 2019). Chronic alcohol consumption has been shown to hasten atherosclerosis and increase blood pressure, increasing workload and adding resistance that the heart must pump against (Fernández-Solà, 2020).
Document the manifestations and management of clients with deep vein thrombosis.
Deep vein thrombosis (DVT) is a serious condition that can happen to anyone (Centers for Disease Control and Prevention [CDC], 2022). The most common symptoms of DVT are pain, swelling, tenderness, redness, and warmth, most often in the lower leg and pelvis; however, it should be noted that half of all cases are symptomatic (CDC, 2022). Acute treatment of DVT involves the use of anticoagulants such as Heparin or Warfarin and the use of a compression stocking during the day for at least two years (NHS Inform, 2022). Prevention is key, though, and patients should be educated on the importance of physical activity, maintaining a healthy weight, avoiding sitting for long periods, and wearing loose-fitting clothing (CDC, 2022).
Submit a summary of some of the things you learned from this video.
The video reviewed the common pathologies of the cardiovascular system and areas to focus on, such as understanding hypertension, primary and secondary, and how it affects functioning and causes and exacerbates conditions like congestive heart failure.
References
American Heart Association. (2023). African Americans and heart disease, stroke.
American Heart Association. (2020, February 4). Chronic stress can cause heart trouble.
Centers for Disease Control and Prevention. (2022, June 14). What is venous thromboembolism?
Fernández-Solà, J. (2020). The effects of ethanol on the heart: Alcoholic cardiomyopathy. Nutrients, 12(2), 572.
McCance, K., & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
Zhan, C., Shi, M., Wu, R., He, H., Liu, X., & Shen, B. (2019). Mirkb: A myocardial infarction risk knowledge base. Database, 2019.
2. Peers posting
Case study 1 Discussion – Myocardial Infarction
Explain the progressive pathophysiologic relationship between an MI and the development of left ventricular (LV) failure.
To better understand and explain the progressive pathophysiologic relationship between an MI and the development of left ventricular failure, we must first speak about the pathophysiology of a myocardial infarction which is also more commonly known to the public as a heart attack.
A myocardial infarction occurs when “a pathophysiologic continuum impairs the pumping ability of the heart by depriving the heart muscle of blood-borne oxygen and nutrients.” (McCance & Huether, 2019) therefore a portion of the heart muscle dies because the blocked artery stops oxygen-rich blood from reaching the heart muscle, leading to cell death. Depending on the severity and the duration of those muscles being deprived of blood, the consequences of a MI can be devastating as it can weaken the heart muscle, and this is how it can lead to the development of left ventricular (LV) failure. It is important to remind that the left ventricle is the main pumping chamber of the heart, if the muscle has been weakened due to a MI, the left ventricle will then be unable to pump enough blood to meet the body’s needs. If left untreated, the left ventricle will start to hypertrophy because it will “serve as a compensatory mechanism and can help maintain cardiac output, but long-term can inhibit relaxation of the myocardium leading to impaired cardiac filling and decrease left ventricular output.” (Chaine & Alvey, 2022).
What factors affect the severity of LV failure?
Several factors can affect the severity of left ventricular (LV) failure, first as expressed previously the severity of the MI is a major factor as a larger MI is more likely to cause more damage to the heart muscle, leading to more severe LV failure. Factors may also vary depending on individuals, for example, hypertension management is one of the most important factors in the severity of the development of LV failure, as “it contributes to endothelial injury, a key step in atherogenesis and causes myocardial hypertrophy, which increases myocardial demand for coronary flow.” (McCance & Huether, 2019). Individuals that might be non-compliant with their blood pressure medications may also be at higher risk of developing severe LV failure. Like most heart conditions, there are modifiable factors that can be changed to minimize risks such as dieting, exercising, etc. However, old age and genetics can play a role in the development of severe failure LV failure as well.
Document the manifestations and management of clients with deep vein thrombosis.
Deep vein thrombosis (DVT) is a blood clot that forms in a deep vein, most commonly in the leg area, however, it can also develop in the arms (CDC, 2022). As nurses, we strive to recognize DVT with the following symptoms: the affected leg becomes swollen due to the accumulation of fluid caused by the clot-blocking flow. Patients experience pain in the leg, especially upon movement of the leg. Redness and warmth are also important signs of a DVT as the skin on the affected leg may become red or discolored and may feel warm to the touch due to increased blood flow to the area (CDC, 2022). It is important to also mention that about half of patients with DVT do not show any signs or symptoms (CDC, 2022).
Management of patients with DVT is very important because “chronic venous insufficiency, post-thrombotic syndrome (PTS) and pulmonary embolism (PE) are the main complications of DVT” (El-Menyar et.al, 2017). Anticoagulation medications and compression stockings are the first lines of treatment for DVT.
Submit a summary of some of the things you learned from this video.
The video highlighted different cardiac functions and conditions and their management, such as hypertension and its role in how it affects cardiac function in general. It also explained the main difference between primary and secondary hypertension. The video was very informative and a great alternative to learning about different cardiac conditions rather than trying to read a book.
Reference
Chahine, J., & Alvey, H. (2022, January). Left ventricular failure – StatPearls – NCBI Bookshelf. National Library of Medicine. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK537098/
Centers for Disease Control and Prevention. (2022, June 9). What is venous thromboembolism? Centers for Disease Control and Prevention.
El-Menyar, A., Asim, M., Jabbour, G., & Al-Thani, H. (2017). Clinical implications of the anatomical variation of deep venous thrombosis. Phlebology: The Journal of Venous Disease, 33(2), 97–106.
McCance, K., & Huether, S. (2019). Pathophysiology: The biologic basis for disease in adults and children (8th ed.). Elsevier.
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