SCHOOL OF HEALTH SCIENCES

DEPARTMENT OF NURSING

NURS 201 PHYSIOPATHOLOGY

(2021- 2022 Fall )

Student number : 21909408

Student Name Surname:DEBORAH MUKENDENGE MUJINGA

"The preparation of this assignment consists of my own work and I did not get help
from another person"
1. a) Write in detail the physiopathology of chronic heart failure (Etiological factors,
predisposing conditions should also be written).
Heart failure is the pathophysiologic state in which the heart, via an abnormality of
cardiac function (detectable or not), fails to pump blood at a rate commensurate
with the requirements of the metabolizing tissues or is able to do so only with an
elevated diastolic filling pressure. In heart failure, the heart may not provide
tissues with adequate blood for metabolic needs, and cardiac-related elevation of
pulmonary or systemic venous pressures may result in organ congestion. This
condition can result from abnormalities of systolic or diastolic function or,
commonly, both. Although a primary abnormality can be a change in
cardiomyocyte function, there are also changes in collagen turnover of the
extracellular matrix. Cardiac structural defects (eg, congenital defects, valvular
disorders), rhythm abnormalities (including persistently high heart rate), and
high metabolic demands (eg, due to thyrotoxicosis) also can cause HF.
Predisposing etiological causes include structural alterations, congenital or
acquired, where there is a disorder of the peripheral vessels, coronary circulation,
pericardium, myocardium, endocardium or cardiac valves that produces alterations
in the normal physiology of the heart.Coronary artery disease, heart attack, and
high blood pressure are the main causes and risk factors of heart failure. Other
diseases that damage or weaken the heart muscle or heart valves can also cause
heart failure. Heart failure is most common in people over age 65, African-
Americans, and women.

b) Explain the causes of the signs and symptoms of chronic heart failure.
Heart failure signs and symptoms may include:
Causes of signs
 Coronary artery disease and heart attack. Coronary artery disease is
the most common form of heart disease and the most common cause of
heart failure. The disease results from the buildup of fatty deposits in
the arteries, which reduces blood flow and can lead to heart attack.
 High blood pressure. If your blood pressure is high, your heart has to
work harder than it should to circulate blood throughout your body.
Over time, this extra exertion can make your heart muscle too stiff or
too weak to properly pump blood.
  Damage to the heart muscle. Heart muscle damage can have many
causes, including certain diseases, infection, heavy alcohol use, and the
toxic effect of drugs, such as cocaine or some drugs used for
chemotherapy. Genetic factors also can play a role.
 Inflammation of the heart muscle (myocarditis). Myocarditis is most
commonly caused by a virus, including the COVID-19 virus, and can
lead to left-sided heart failure.
 Abnormal heart rhythms (arrhythmias). Abnormal heart rhythms
may cause your heart to beat too fast, creating extra work for your
heart. A slow heartbeat also may lead to heart failure.
Symptoms:
 Shortness of breath with activity or when lying down
 Fatigue and weakness
 Swelling in the legs, ankles and feet
 Reduced ability to exercise
 Swelling of the belly area (abdomen)
 Nausea and lack of appetite

c) Write down nursing interventions related to the three symptoms

nursing interventions related to:
 Swelling in the legs, ankles and feet: Elevate legs, avoiding pressure under
the knee or in a position comfortable to the patient.
 Swelling of the belly area (abdomen): reduce the salt in your diet and limit
the amount of fluids you are drinking, as recommended by your doctor
 Reduced ability to exercise: Encourage active and passive exercises. Increase
activity as tolerated

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

factors, predisposing conditions should also be written).
Chronic kidney disease, also called chronic kidney failure, involves a gradual loss
of kidney function. Your kidneys filter wastes and excess fluids from your blood,
which are then removed in your urine. Chronic kidney disease (CKD) is kidney
impairment that lasts for ≥ 3 months, implying that it is
irreversible. Hypertension and diabetes are the most common causes; Risk
factors for chronic kidney disease include older age, low birth weight, obesity,
smoking, high blood pressure, diabetes, a family history of kidney disease, and
being of African-American descent. Pathologic features include fibrosis, loss of
renal cells, and infiltration of renal tissue by monocytes and macrophages.

Proteinuria, hypoxia, and extensive angiotensin II production all contribute to

the pathophysiology. In an attempt to maintain GFR, the glomerular
hyperfiltration; this results in endothelial injury.
Proteinuria results from increased glomerular permeability and increased
capillary pressure.Hypoxia also contributes to disease progression. Angiotensin
II increases glomerular hypertension, which further damages the kidney.
Diabetes, which is the most common risk factor for chronic kidney failure in
the United States
 Age 60 or older
 Kidney disease present at birth (congenital)
 Family history of kidney disease
 Autoimmune Disorder (Lupus erythematosus)
 Bladder outlet obstruction (BPH and Prostatitis)
 Race (Sickle cell disease)

b) Explain the causes of the signs and symptoms of chronic kidney failure.
Signs and symptoms of kidney disease are often nonspecific. This means they can
also be caused by other illnesses. Because your kidneys are able to make up for
lost function, you might not develop signs and symptoms until irreversible damage
has occurred.
Causes of signs:
 Diabetes is the most common cause of kidney disease. Both type 1 and
type 2 diabetes. But also heart disease and obesity can contribute to the
damage that causes kidneys to fail.
 Glomerulonephritis an inflammation of the kidney's filtering units
(glomeruli)
 Interstitial nephritis an inflammation of the kidney's tubules and
surrounding structures
  High blood pressure can constrict and narrow the blood vessels in your
kidneys, which reduces blood flow and stops the kidneys from working
well When this happens, the kidneys are not able to remove all wastes and
extra fluid from your body.
Symptoms
 Nausea and vomiting
 Loss of appetite
 Fatigue and weakness
 Sleep problems
 Urinating more or less
 High blood pressure (hypertension) that's difficult to control
 Smoking and obesity
c) Write down nursing interventions related to the three symptoms.
nursing interventions related to:
 Fatigue and weakness: Rest, Encourage alternating activity with rest.
 High blood pressure (hypertension) that's difficult to control: Control
your blood sugar if you have diabetes.
 Smoking and obesity: don’t smoke, don’t use Tabaco and keep healthy
weight.

References

 https://emedicine.medscape.com/article/163062-overview - :~:text=Heart%20failure
%20is%20the%20pathophysiologic,an%20elevated%20diastolic%20filling
%20pressure.
 https://www.msdmanuals.com/professional/cardiovascular-disorders/heart-failure/
heart-failure-hf - :~:text=Pathophysiology%20of%20Heart%20Failure,may%20result
%20in%20organ%20congestion.
 https://www.universityhealth.org/heart-failure/risk-factors/ - :~:text=Coronary
%20artery%20disease%2C%20heart%20attack,African%2DAmericans%2C%20and
%20women.
 https://www.mayoclinic.org/diseases-conditions/heart-failure/symptoms-causes/syc-
20373142
 https://www.heartfailurematters.org/warning-signs/swelling-or-pain-in-the-abdomen/
 https://nurseslabs.com/heart-failure-nursing-care-plans/
 https://www.lecturio.com/magazine/chronic-renal-failure/
 https://www.verywellhealth.com/common-causes-of-chronic-kidney-disease-2085786
- :~:text=Risk%20factors%20for%20chronic%20kidney,being%20of%20African
%2DAmerican%20descent.
 https://www.kidney.org/atoz/content/about-chronic-kidney-disease - :~:text=The
%20two%20main%20causes%20of,blood%20vessels%2C%20nerves%20and
%20eyes.
 https://www.mayoclinic.org/diseases-conditions/chronic-kidney-disease/symptoms-
causes/syc-20354521 - :~:text=Diabetes%20is%20the%20most%20common,to
%20long%2Dterm%20functional%20decline.
 https://www.kidney.org/news/newsroom/factsheets/High-Blood-Pressure-and-CKD
- :~:text=High%20blood%20pressure%20causes%20kidney,extra%20fluid%20from
%20your%20body.
 https://nurseslabs.com/6-chronic-renal-failure-nursing-care-plans/