Left Sided Heart Failure Concept Map

The Map should be about Left-Sided Heart Failure

Assessment 1 – Concept map and guided questions.

Information 1 – Getting started.

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Your first assessment is generating a concept map for left heart failure and answering three questions related to a case study about a patient who has an acute exacerbation of heart failure. When preparing your assignment refer to the criteria and standards in the Learning Guide.

You can begin this assessment now by finding readings about heart failure and summarising the information under the headings of the pathophysiology template. This information can then be used for your concept map.

Some readings that you may find helpful to start your assignment are:

Your textbook:

Craft,J.A., Gordon,C.J., Huether,S.E., McCance, K.L., Brashers, V.L. & Rote,N.E.

(2015). Understanding pathophysiology – ANZ adaptation (2nd ed.).

Chatswood, NSW: Elsevier Australia. Chapter 23.

Also:

Aitken, L., Marshall,A. & Chaboyer, W. (2015). ACCCN’s critical care nursing

(3rd ed.). Chatswood, NSW: Elsevier Australia. Chapter 10.

Wagner, K.D. (2014). High acuity nursing (6th ed.). Upper Saddler River, New

Jersey: Pearson. Chapter13.

(These books are available online from the Western Sydney University library). Left Sided Heart Failure Concept Map.

This is just to begin. You will then find more readings to add to your information.

Remember that the information in your concept map and answers to the questions must correlate with the references that you cite so keep an accurate record when preparing your assignment. The marker of your assessment will check your citations.

An example of a pathophysiology template for a left-sided ischaemic stroke and a concept map using this information has been attached to start you thinking about how you will approach your assignment. The concept map has been generated using Word Left Sided Heart Failure Concept Map. However, if you wish, you may prefer to use a concept map template that you may find on the web.

Below are the Sub-heading that needs to be in the Concept Map.

Disease

Definition

AETIOLOGY

PATHOGENESIS

DIAGNOSIS

TREATMENT

COURSE OF DISEASE

PROGNOSIS

PREVENTION

The separate Reference page for Concept Map. You may have more than 2 reference
Visually Stimulating, add pictures in the background and visually Below is an sample example but this concept map needs to look unique and visually very appealing, please.
Add pictures of heart, lungs what ever connects to the Map and its information.
I have attached a sample of the concept map of another topic to guide you what information requires in the map. Left Sided Heart Failure Concept Map.
500 words and it is worth 25 Marks.

Please see attach other files for questions and Marking Criteria.

stroke_concept_map_map

Pathophysiology template

Disease: Ischaemic stroke affecting the dominant left cerebral hemisphere

Definition: An ischaemic stroke is death of brain tissue resulting from an occluded artery caused either by an atherosclerotic obstruction or embolus that interrupts blood supply to the area of the brain supplied by the occluded artery. The sudden loss of blood circulation results in a corresponding loss of neurologic function (Jauch, 2014). Left Sided Heart Failure Concept Map.

AETIOLOGY:

A depletion of blood flow in a cerebral artery resulting from a:

Thrombus –atherosclerotic plaque that has ruptured in a cerebral artery
Embolus
from heart e.g. left atrial thrombus, left ventricular thrombus, atrial fibrillation
from carotid artery (Craft &Gordon,2011)

PATHOGENESIS:

Interruption of blood flow to cerebral tissue initiates a biochemical ischaemic cascade.
Mitochondrial production of ATP ceases èdepolarisation è influx of sodium and calcium and efflux of potassium. Passive inflow of water into cells causes cytotoxic oedema and destruction of cells in infarct core.
Membrane depolarization also stimulates the release of neurotransmitters. Glutamate release èexcessive calcium influx into nearby neurons (exocitotoxicity) èdestruction of cells by lipolysis, proteolysis and free radicals.
Mitochondria break down releasing toxins and apoptotic factors.
Injured brain tissue triggers inflammatory response èrelease of inflammatory mediators ècell death and oedema

èdestruction of cells in infarct core ènecrosis

èischaemic penumbra around core has diminished blood flow but preserved cellular metabolism.

Areas of necrotic tissue are not able to conduct nerve impulses so functions such as initiating and conveying motor impulses, receiving and interpreting sensory information and speech control will be interrupted.

(Bautista, 2014; Craft & Gordon, 2011; Maas & Safdieh,2009).

CLINICAL MANIFESTATIONS:

Just superior to the medullary junction, 90% of axons in the left pyramid cross to the right ® right motor dysfunction.

The middle cerebral artery supplies the frontal, temporal and parietal lobes as well as the basal ganglia and internal capsule. (Tocco,2011). Left Sided Heart Failure Concept Map

Therefore specific clinical manifestations include:

Hemiplegia and weakness on right side of body
Sensory loss on right side
Inability to see the right visual field of each eye
Aphasia
Apraxia
Dysarthria
Impaired reasoning
Behavioural changes
Problems with memory

(Bautista, 2014; Craft & Gordon, 2011).

DIAGNOSIS

Complete history
Physical and neurological examination
Brain MRI or CT scan – Essential in differentiating cerebral haemorrhage from ischaemic stroke. MRI is superior as cerebral ischaemia can be identified within minutes and can identify small areas of stroke.
Other tests for vascular imaging can be used e.g. CT angiography, magnetic resonance angiography

(Silverman & Rymer, 2009).

TREATMENT

The emphasis of ischaemic stroke treatment is placed on salvaging potentially reversible ischemic penumbra brain tissue, preventing secondary stroke and minimising longterm disability. (Jaunch, 2014).

Reperfusion
thrombolytic agent (e.g.tPA)
intra-arterial technique

Neuroprotection

-antithrombotic therapy (e.g. aspirin)

Nursing management

Acute phase

frequent evaluation of neurological status
frequent evaluation of vital signs
Monitor oxygen saturation – administer oxygen if required
Screen for swallowing deficits and manage appropriate hydration and nutrition strategies
Manage activities of daily living
Screen for communication deficits and address appropriate communication strategies
Prevent complications e,g pressure areas, contractures, DVT
Assess urinary and faecal continence and address appropriately
Left Sided Heart Failure Concept Map

Rehabilitation

begin as early as possible by preventing complications, passive and active movement and mobilizing as early as possible.
Support and encourage activities provided by physiotherapists, occupational therapists and speech therapists
Education – e.g. lifestyle modification, adherence to medications

(National Stroke Foundation, 2010).

COURSE OF DISEASE

With reperfusion – blood is restored to the area and signs and symptoms gradually resolve

Without treatment – Course is determined by severity of stroke. Ischaemia will extend to penumbra as stroke evolves, signs and symptoms worsen. As cerebral oedema resolves, and with structural and functional reorganisation recovery may continue for 6 months to a year. (peak recovery in about 3 months). Requires rehabilitation to optimise function. Left Sided Heart Failure Concept Map.

(Teasell & Hussein, 2014).

Complications

Contractures

Fatigue

Incontinence

Mood disturbances

Falls

Dysarthria and aphasia

PROGNOSIS

Stroke prognosis is influenced by factors such as age and stroke severity.
One in five likely to die within one month of suffering ischaemic stroke.
Of those who recover about 90% will experience some impairment
Left Sided Heart Failure Concept Map

(Dashe,2014)

PREVENTION

Eliminating modifiable risk factors will prevent an ischaemic stroke.

Don’t smoke
Diet high in fruit and vegetables, low in fats and salt
30 minutes of moderate-intensity physical activity on most days of the week
Maintain healthy BMI
Limit alcohol to no more than two standard drinks per day

(National Stroke Foundation, 2010)

If a history of atrial fibrillation – ensure adherence to anticoagulation therapy.

References

Bautista, C. (2014). Disorders of Brain Function. In S. Grossman & C. Porth (Eds),

Porth’s pathophysiology: Concepts of altered health states (9^th ed.). (pp489-

524). Philadelphia: Lippincott Williams & Wilkins.

Craft, J. & Gordon, C. (2011), Alterations of Neurological Function across the

Lifespan. In J.Craft, C.Gordon & A. Tiziani (Eds). Understanding

Pathophysiology (pp 188-226). Sydney, Australia:Elsevier Australia.

Dashe, J. F. (2014). Stroke prognosis in adults. UpToDate. Retrieved from:

http://www.uptodate.com/contents/stroke-prognosis-in-adults

Jaunch, E.C. (2014). Ischemic stroke treatment and management, Retrieved from:

http://emedicine.medscape.com/article/1916852-overview

Maas, E.B. & Rymer, M.M. (2009). Ischaemic stroke: Pathophysiology and Principles

of Localization. Neurology 13 .Retrieved from:

http://www.turner-white.com/pdf/brm_Neur_V13P1.pdf

National Stroke Foundation (2010). Clinical guidelines for stroke management

Melbourne Australia.

Silverman, I.E. & Rymer, M.M. (2009). An atlas of investigation and treatment.

Ischaemic stroke. Clinical publishing:Oxford,U.K. Left Sided Heart Failure Concept Map

Teasell, R.& Hussein, N. (2014)Brain reorganization, recovery and organizecare.

In Stroke rehabilitation clinician handbook 2014. Retrieved from:

http://www.ebrsr.com/sites/default/files/Chapter%202_Brain%20Reorganization,%20Recovery%20and%20Organized%20Care_June%2018%202014.pdf

Tocco, S. (2011). Identify the vessel recognize the stroke. American Nurse Today

9 (6). Left Sided Heart Failure Concept Map