Pathopharmacology

PATHOPHARMACOLOGY 15

Investigate the followingdisease processes: heart disease

Heart disease refers to different conditions, which affect the heart.Cardiovascular disease is a term also used in referring to heartdisease (Tennessee Department of Health, 2006). These areillnesses characterized by the narrowing or blocking of bloodvessels, which may result in angina, heart attack or stroke.Different conditions, which affect the heart rhythm, muscles andvalves, are as well types of heart disease. The illness developsfollowing a collection of fatty substances, calcium as well as scartissue in “arteries, which are responsible for supplying blood tothe heart” (Mayo Clinic, 2015). The arteries are known ascoronary arteries, which makes it possible for the heart to receivenutrients and oxygen needed in pumping blood.

Individuals are urged to consult a doctor as soon as they experiencefainting, breathe shortness and chest pain. Doctors carry outexaminations to validate the kind of heart disease one has. Theillness is simpler to treat following early detection. Treatmentinvolves changing lifestyle. When the disease is caused by collectionof fat, the patient is advised to consume low-fat food and exercise.When changing lifestyle is not enough, medication is given toregulate the illness. Also treatment can be in form of surgery.Depending on the damage caused to the heart, surgery is recommendedto rectify the problem.

Analyze the pathophysiology ofthe disease process you selected in part A (Heart Disease)

Heart disease occurs when the heart is unable to pump as well ascirculate ample blood as needed by the body. This results inineffective as well as damaged heart muscles, resulting in heartoverload. There are various conditions, which can result in heartfailure. An illustration is damage to the heart muscle following aheart attack. In a heart attack/myocardial infarction the heartmuscles lack oxygen due to an absence of blood supply resulting inmuscle tissue death. Some of the major pathologies of heart diseaseare: weakening of heart muscle contraction following ventricle bloodoverload during diastole (Jackson, Gibbs, Davies &amp Lip, 2000). Inhealthy persons, such overload results in increased musclecontraction, which increases cardiac output. Contrary, when anindividual has heart disease, weak cardiac muscles makes itimpossible for the heart to supply enough blood.

As compensation for reduced cardiac output, heart rate drops. Thisworsens the heart’s condition since heart muscles need additionalnutrients to function causing the myocardial muscles to pump harder.Due to the failure of diastole or systole contractions, volume ofstroke declines (Jackson, Gibbs, Davies &amp Lip, 2000). When thereis an increase in blood volume within the ventricle following asystole increase, it implies the ejection of less blood. When thevolume after diastole drops, it implies the entry of less blood inthe heart. Cardiac reserve might decline, yet the heart requiresenough capacity in dealing with regular or high metabolic demands. Inthe case of heart disease, the reserve reduces. As a result, theheart begins to become bigger, which is known as hypertrophy. Atfirst, fibres of the heart muscle become larger to enhancecontractility. However, they stiffen with time and become unyielding(Jackson, Gibbs, Davies &amp Lip, 2000).

Discuss the standard of practicefor the selected disease process Earlydetection of heart disease is crucial in ensuring the wellbeing of apatient. As soon as an individual presents with any symptomsassociated with heart disease conditions, for instance chest pain,the clinical practitioner should instantly conduct anelectrocardiogram (ECG). The ECG assists the doctor in recordingelectrical signals as well as assisting the doctor to noticeinconsistencies in the rhythm and heart structure. Once the ECG hasbeen conducted, the medical practitioner should conduct a clinicalmedical evaluation. It is also crucial to administer oral aspirinwhen the case is suspected to be acute. When sick individuals satisfythe conditions for reperfusion, they are given “percutaneouscoronary intervention” (Heart Online, 2015).

When an individual presents with a minor case of heart disease orrecords no changes on the ECG, it is crucial to conduct a clinicalhistory. This entails evaluation of heart illness risk factors andthe history of present symptoms (Heart Online, 2015).Additional assessments involve sensitivity troponin, physicalexamination and conducting blood tests. Sick persons are stratifiedas having low or high risk of heart disease depending on the levelsof troponin, profiling of risk factors as well as their clinicalpresentation.

Discuss the evidence-basedpharmacological treatments in your state (Tennessee) and how theyaffect management of the selected disease in yourcommunity According to West TennesseeHealthcare website heart disease has no cure. Instead therapy isintended at minimizing the possibility of prospect damage to theheart and enhancing life quality. When diagnosed with heart disease,the doctor selects a treatment approach, which is most suitable forthe specific individual. Treatment options range from procedures likeangioplasty, others are medical or surgical.

Open-heart surgery is used as a treatment option when there is needto repair or replace heart valves that have become narrow.Alternatively, in some patients, the risk might be high making itimpossible to carry out open heart surgery. Currently, an advent andless invasive process is available to treat such patients. It isknown as “transcatheter aortic valve replacement” that makes itpossible for healthcare providers to replaces a heart valve that hasbeen damaged by not having to perform open heart surgery (WestTennessee Healthcare website). Depending on the extreme of harmto the valve, the doctor might have to replace or repair it. This isdone through surgical valve replacement or commissurotomy, whichinvolves cutting the valve leaflets to make the valve slightly looseso that blood can flow with ease (West Tennessee Healthcarewebsite).

Treatment is also possible through medications, for instance, when aheart disease result in a heart attack, clotbusters must beadministered immediately in specific heart attacks (West TennesseeHealthcare website). Apart from recommendations to changelifestyles that enhance the risk for heart disease, doctors alsorecommend medications. Most of the drugs have demonstrated theability to extend individual’s lives. Hence, whereas some drugsmight assist in controlling symptoms, others reduce the possibilitythat an individual with heart disease will pass away. Heart diseaseaffects the heart, but since the conditions differ they are treateddifferently. For instance, some sick individuals may be dealing withextreme clotting of blood, whereas others are require a drop in bloodpressure.

The pharmacological treatments ensure that heart disease iseffectively managed in good time to avoid fatalities within thecommunity. Some treatment options are effective in avoiding repeatincidences of heart disease symptoms like heart attack. In addition,pharmacological treatments used make it possible to healthcareproviders to have ready treatment options for the disease, which aresignificance especially when handling a high risk patient.

Discuss clinical guidelines forassessment, diagnosis, and patient education for the selected diseaseprocess

When a patient presents with the possibility of heart disease, thereare a number of clinical guidelines that ought to be followed forassessment, diagnosis as well as education (Grady et al, 2000). Thedoctor begins by conducting a physical examination on the sickindividual. This involves asking about any possible family past ofheart disease and personal history prior to conducting any tests.After getting the history, the doctor then progresses to conducttests that include x-rays, blood test and specific tests aimed atdiagnosing heart disease (Mayo Clinic, 2015).

An electrocardiogram (ECG) refers to a test, which records signalsand assists in identifying any irregularities in the heart (MayoClinic, 2015). Holter assessment involves the patient wearing adevice that records a progressive ECG, normally for one to threedays. The device assists in detecting heart beat abnormalities (MayoClinic, 2015). Echocardiogram involves conducting an ultrasoundon a patient’s chest, which depicts detailed images on how theheart looks and is functioning (Mayo Clinic, 2015). Cardiaccatheterization is a test that includes inserting a sheath inside avein, which is then connected to another long tube. With theassistance of x-ray imaging, the doctor directs the longer tube tothe heart, making it possible to measure heart pressure. In addition,the test makes it possible to observe blood movement in the heart andcheck for anomalies (Mayo Clinic, 2015). Another heart diseasetest is MRI. The test involves the production of a magnetic field,that creates images to assist the doctor analyze the heart (MayoClinic, 2015).

Patient education begins by informing on heart diseasepathophysiology. Most patients are unaware of how the disease occursor its meaning and presume that it refers to a complete heart failure(Grady et al, 2000). The phrase ought to be careful explained. It isalso important to clarify amid anticipated symptoms and those ofworsening heart disease. Sick persons need to be aware of warningsigns and advised to inform the medical providers straight away. Theobjective of patient education is to ensure that sick persons seekmedical intervention as early as possible to guarantee propermanagement of the illness (Grady et al, 2000).

Compare the standard practicefor managing the disease within your community with state or nationalpractices

The standard practice in the management of heart disease is the samewithin the community, state and nationally as provided by the“American Heart Association”. AHA works together with the“Tennessee Department of Heart Disease and Stroke PreventionProgram” in enhancing the care system for individuals that sufferfrom heart disease in any of the states (Newsroom &amp MediaCenter, 2008). Standard practices are set to be followed by allstates and communities. In order to enhance management of heartdisease various policies and practices are recommended in the stateand nationwide. Physicians are supposed to use electronic healthrecords, which make it possible for healthcare providers to beproactive in monitoring and safeguarding the wellbeing of theirpatients through tracking the illness. State policies have beenimplemented that deal with “collaborative drug therapy management”in order to enhance adherence to medication and enhance healthoutcomes (CDC, 2014). Healthcare providers are expected totake measures towards the diagnosis of heart disease as soon as apatient presents with any signs. This involves conducting tests andasking about the patient’s health history. When detected early, itis highly likely that the disease is contained and does not result inadverse effects on the patient. In addition, it is possible to manageany heart disease condition as soon as it is detected. In order toensure consistency in administering care healthcare providers areexpected to employ the same standard practices, both locally andnationally.

Discuss characteristics of andresources for a patient who manages the selected disease well,including access to care, treatment options, life expectancy, andoutcomes

In order for a patient to manage heart disease well, they must beproperly educated about heart disease. That is, the patient is awareof what heart disease is, its symptoms and how to detect warningsigns. Hence, the individual is able to seek treatment early in caseof any abnormalities. Lifestyle has also been associated with heartdisease. An individual that managed the illness well demonstratesimproved changes in their lifestyle. This means that if the patientpreviously consumed foods that have high fat content, they nowconsume food with low fat. In addition, the patient exercisesregularly to avoid build up of fat that may for instance, eventuallyresult in secondary heart attack.

In order to manage heart disease, a patient must have financialresources to access healthcare. Treatment of the disease can becostly especially when it requires surgery. In addition, financialresources make it possible for a sick individual to select the besttreatment options. There are different treatment plans for heartdisease, and some are more effective than others. However, provided apatient has the required funds, then they easily access care. Whenheart disease is managed effectively, an individual is able to livelonger. Such a patient is one that accesses care as soon as theydetect any irregularities. The patient outcome is higher when heartdisease is properly managed. This means that the patient adheres towhat they are told by the healthcare provider, which includes leadinga healthy lifestyle, avoiding strenuous activities, taking medicationappropriately.

Analyze disparities betweenmanagement of the selected disease on a national and internationallevel

Heart disease is a major cause of mortality internationally. However,death rates appear to be higher in developing than developedcountries. The illness largely affects old people. In a researchconducted by Mentz et al (2014) on global disparities in themanagement of heart failure, it is apparent that there are regionaldisparities on how heart disease is managed depending on the country.There are observable disparities in the use of medication duringclinical practice. According to the study, patients from NorthAmerica have a higher likelihood of using beta blockers and lesslikely to use MRAs or ACEs. The findings is in line with ameta-analysis showing that using beta blockers is linked with reducedsurvival advantages in sick persons in America when compared to othernations (Mentz et al, 2014). Countries like Russia and Europe depicta greater employment of MRAs. Russia additionally depicts a higherrise in employing evidence-based heart disease therapy when comparedto United States.

Discuss three or four factors(e.g., financial resources, access to care, insured/uninsured,Medicare/Medicaid) that contribute to a patient being able to managethe selected disease

Financial resources – heart disease affects both wellbeing andfinances. There are direct expenses following a heart disease forinstance a heart attack. An individual has to pay for diagnosisexaminations, ambulance fee, charges when in the hospital and surgerycosts if need be. In addition, the patient has to spend onmaintenance of the disease. These expenses are incurred throughbuying drugs, tests and appointments. Hence, a patient must haveenough money to pay for all expenses linked to heart disease in orderto manage the illness (Tennessee Department of Health, 2006).

Access to care – when a sick individual is able to accesshealthcare services, they get professional assistance on how tomanage heart disease, which in turn makes it possible for theindividual to manage the illness. Access to care involves proximityto a healthcare facility and ability to access a healthcare providerat any time. This makes it possible to seek medical attention as soonas any symptoms of the disease are detected ensuring on timetreatment that reduces the risk.

Insured – insured means that the patients is registered under arecognized medical insurance cover, which consents to meeting all theindividuals medical needs. As a result, the individual is able toaccess care without worrying on how to pay, is able to pay forappointments and buy drugs that ensure heart disease is properlymanaged.

Explain how a lack of thefactors discussed in part A4 leads to an unmanaged disease process

When a patient lacks financial resources, access to care and isuninsured, it means that they are not in a position to manage heartdisease process. Financial resources are very important because theillness is costly (Tennessee Department of Health, 2006). Anindividual is required to pay for drugs, tests and doctor’sappointments. However, without the money paying for these servicesbecomes impossible. Bearing in mind the need to take drugs andfrequently conduct tests to ensure the proper functioning of theheart, then lack of financial resources resonates to unmanaged heartdisease. Access to care is very crucial especially duringemergencies. In addition, a patients need to have contacts ofhealthcare providers whom they can consult. Inability to access caremeans that the patient’s heart conditions are ineffectivelymanaged. Insurance makes it possible to access and pay for healthcarethrough an insurance company. Lack of insurance may mean that thepatient does not access care often, skips appointments and does nottake precautionary tests, enhancing the chances of secondary heartillness.

Describe characteristics of apatient with the selected disease that is unmanaged

A patient with unmanaged heart disease demonstrates signs ofdiscomfort, has an abnormally high blood pressure. Because bloodpressure is a sign of heart disease, when the illness is not properlymanaged hypertension is a major indicator. A patient has persistentchest pain. Any chest pain is an indicator of heart failure hence,when a patient insistently complains of chest pain it implies thatthe condition is not well managed. Other signs can range fromabnormal sweating, feeling dizzy and nausea.

Analyze how the selected diseaseprocess affects patients, families, and populations in your community

Heart disease is a major cause of death in Tennessee (TNDepartment of Health). The illness is a major challenge inTennessee as heart diseases ranks as the major cause of mortality(Tennessee Department of Health, 2007). Heart disease affectsnot just the sick persons, but their families as well as populationswithin the community. The patients’ wellbeing is adversely affectedas they are unable to engage in activities that they couldpreviously. In addition, the patients spend a lot of money in orderto manage the illness. It also implies having to change one’slifestyle, which can be extremely hard and result in stress. Familiesare affected in that they have to take care of the sick persons. Forinstance, supposing that a child is diagnosed with heart disease, itis the parents who are responsible for managing the condition. It isnot only emotionally draining, but financially and physically aburden to take care of a sick child. At times parents or relativesalso develop illnesses like stress associated with having to caterfor a patient. The effect to populations in the community is thatthey reduce. Heart disease is associated with high fatality. The morepeople pass away the more the people within a society reduce. Anothereffect could be an increase in the number of sick people in acommunity. Heart disease has a high incidence, which means that manypeople have the illness.

Discuss the financial costsassociated with the selected disease process for patients, families,and populations from diagnosis to treatment

Patients have to pay for diagnosis tests in order to ascertain thatthey have a heart disease. The tests can be many, meaning that moremoney is spent. Following diagnosis, a patient is introduced todifferent drugs to manage the disease. The drugs are expensiveespecially when they have to be used on a regular basis. In addition,are the frequent medical appointments and follow up tests that needto be paid for. Families’ financial costs are the same as those ofpatients. However, they may spend more especially when they have topay for home nursing for their sick relative. At times family alsoassists in medical expenses needed in conducting tests to determinethe type of heart illness. After which, they assist in paying formedication. Populations incur financial costs by acting as donors.There are many heart disease foundations that depend on money fromdonors. The money is used in paying for tests and drugs, as well asfollow up to ensure the condition is managed.

Discuss how you will promotebest practices for managing the selected disease in your currenthealthcare organization

Promotion of best practices in managing heart disease is achievedthrough building capacity. Healthcare providers are an importantresource in the management of diseases. However, they at times lackthe needed information and tools to effectively manage a disease.Hence, it is important to build capacity within the healthcareorganization. Building capacity will target frequent assessment ofheart disease. Bearing in mind that the disease has been widespread,it is necessary for healthcare providers to conduct frequentassessment to individuals that present signs of heart disease. Theobjective is to ensure early diagnosis, and as a result immediatetreatment, which saves the patient’s life. This can be achievedthrough developing a technique that makes it possible to record thefrequency of heart disease symptoms regularly.

Discuss three strategies youcould use to implement best practices for managing the selecteddisease in your current healthcare organization

Education – it is very important that both patients and thoseproviding healthcare have goof knowledge of the illness. Educationenhances understanding on heart disease, how to manage the illnessand makes it possible to detect warning signs in time. By enhancingeducation, healthcare providers are in a better position toadminister the appropriate care to patients and in a timely way.Patients visiting the healthcare organization also learn on how tocontrol the disease.

Improving primary healthcare – primary healthcare is very importantin the management of diseases. It refers to the preventing, managingas well as treating of persistent diseases. The same applies to heartdisease. When the illness is detected early it becomes possible tomanage. By improving primary healthcare, it means that healthcareproviders perform timely diagnosis tests, and begin treatment as soonas probable.

Underpinning values – values direct how individuals within anorganization perform their tasks. Values are linked to theorganizational objectives of an organization. By underpinning values,promotion of effective healthcare services becomes paramount forevery healthcare provider. As a result, providers improve theirpractice and provide effective treatment and care to their patients,hence managing the illness.

Discuss an appropriate method toevaluate the implementation of each of the strategies from part C1

Performance measurement makes it possible to evaluate theimplementation of these strategies. Through performance measurement,it becomes possible to detect whether the effectiveness of healthcareproviders has improved. For instance, supposing that there is anincrease in early detection of heart illnesses within theorganization, it means that the improvement to primary healthcare hasbeen effective. It also implies that more healthcare providers adhereto organizational values. Assessment surveys on heart illness can beconducted to test whether the healthcare providers have a betterunderstanding of the disease.

References

CDC, Centers for Disease Control and Prevention. (2014). Preventionstatus reports 2013: Heart disease and stroke – Tennessee.Atlanta, GA: US Department of Health and Human Services.

Grady, K. L., Dracup, K., Kennedy, G., Moser, D. K., Piano, M.,Stevenson, L. W &amp Young, J. B. (2000). AHA Scientific statement.Circulation, 102, 2443-2456.

Heart Online. (2015). Principles of medical management.Retrieved from: http://www.heartonline.org.au/articles/pathophysiology/principles-of-medical- management#heart-failure

Hirsch, K. R. (2014). Drugs to treat heart disease. Healthline.Retrieved from: http://www.healthline.com/health/heart-disease/drugs#DiseaseOverview1

Jackson, G., Gibbs, C. R., Davies, M. K &amp Lip, G. Y. H. (2000).Pathophysiology. British Medical Journal, 15(320), 167-170.

Mayo Clinic. (2015). Heart disease: Tests and diagnosis.Retrieved from: http://www.mayoclinic.org/diseases-conditions/heart-disease/basics/tests-diagnosis/con- 20034056

Mentz, R. J., Cotter, G., Cleland, J. G. F., Stevens, S. R… (2014).International differences in clinical characteristics, managementand outcomes in acute heart failure patients: better short-termoutcomes in patients enrolled in Eastern Europe and Russia in thePROTECT trial. European Journal of Heart Failure, 16(6),614-624.

Newsroom &amp Media Center, (2008). Tennessee heart diseaseand stroke prevention and care plan offers roadmap for saving lives.Retrieved from: https://news.tn.gov/node/162

Tennessee Department of Health, (2007). Tennessee heart diseaseand stroke prevention and care plan 2008-2012. Nashville, TNTennessee Department of Health.

Tennessee Department of Health, 2006. The burden of heart diseaseand stroke in Tennessee. Nashville, TN: Tennessee Department ofHealth.

TN Department of Health. Statistics and reports. Retrievedfrom: http://tn.gov/health/article/statistics-and-reports

West Tennessee Healthcare. Heart Care. Retrieved from:http://www.wthvc.org/heart-vascular- center/areas-of-expertise/heart-care#

West Tennessee Healthcare. What is heart disease? Retrievedfrom:http://www.wthvc.org/heart- vascular-center/for-patients/educational-information/what-is-heart-disease