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Students will create an online education resource (website) for a chosen disease.
You will choose ONE of the four provided scenarios below and create an online educational resource package (a website)
Your target audience are registered nurses (graduates) or enrolled nurses who need an education resource to help plan the care for their patients.
The website must include the following sections:
1. Justification and epidemiology:
• Identify the chosen disease. What is your rationale for choosing this disease? Provide an overview of epidemiological data for the chosen disease within the Australian context.
2. Pathophysiology and pharmacology (video):
• You are required to create and upload to the website a short video (6-7 minutes maximum length) of yourself “teaching” your target audience about
the disease pathophysiology and related pharmacology.
• This video needs to include:
i. A comprehensive discussion of the pathophysiology of the chosen disease
ii. Identifications of one (1) drug commonly used to manage the chosen disease. You need to identify the drug class, describe the mechanism of action, indications and relevant considerations for the chosen drug, with reference to the patient. This needs to be linked back to the pathophysiological changes of the disease.
3. Impact of chronic disease:
• Identify and discuss the impact of the chosen chronic disease on the patient.
4. Long term management and health promotion strategies:
• Identify long term management strategies to promote health and independence for the patient with the chosen chronic disease. These should be linked to the identified factors impacting the patient in the previous section.
5. Nursing care plan for an acute exacerbation (infographic):
• You are required to develop a nursing care plan that identifies two (2) acute issues, goals and interventions to manage the issues.
• This is to be completed using the provided infographic template on LEO
6. Justification of nursing care:
• You will provide your discussion and justification for the identified issues and interventions outlined in your nursing care plan.
7. References Scenarios:
1. A 69-year-old male of Australian background with a history of hypertension and is a current smoker (30 years), diagnosed with aortic stenosis.
In the realm of cardiovascular disorders, aortic stenosis holds a position of considerable clinical importance, particularly among geriatric populations. Given its propensity to significantly compromise cardiac output, the disease warrants diligent attention from healthcare providers (Di Giola et al., 2021).
The selection of aortic stenosis as the subject matter for this educational resource is underscored by its prevalence and severity, especially in the context of an aging Australian populace.
Epidemiologically speaking, cardiovascular diseases have long been ensconced as leading contributors to morbidity and mortality within Australia (Strange et al., 2021). Aortic stenosis, a subset of these cardiovascular maladies, manifests in approximately 3% of individuals aged 65 and above (Ternacle et al., 2019).
Intriguingly, a gender-based disparity exists, with the disease showing a predilection for males. With age, the likelihood of developing this condition escalates, thereby amplifying its public health significance (Nitsche et al., 2020).
Pertinent to this discussion is the role of concomitant risk factors such as hypertension and smoking, which not only are pervasive health concerns in Australia but also serve to exacerbate the severity of aortic stenosis (Lowernstern et al., 2021).
In light of this, the patient under consideration—a 69-year-old male with a history of hypertension and a three-decade-long smoking habit—categorically falls into a high-risk demographic. This confluence of epidemiological factors and individual risk profile renders aortic stenosis an imperative subject for targeted education among nursing professionals.
Slide 1: Introduction to Aortic Stenosis
• Aortic stenosis is a prevalent valvular heart disease.
• Characterized by a narrowing of the aortic valve opening.
• Leads to obstructed blood flow from the left ventricle to the aorta.
• Significant impact on cardiovascular health.
• Higher prevalence in aging populations, posing public health concerns.
Aortic stenosis, a condition typified by the constriction of the aortic valve, serves as a formidable impediment to the efficient egress of blood from the left ventricle into the aorta.
This hemodynamic obstruction elicits a cascade of pathophysiological responses, including compensatory ventricular hypertrophy, increased myocardial oxygen demand, and, ultimately, potential heart failure.
As a preeminent valvular pathology, aortic stenosis occupies a crucial niche within the broader landscape of cardiovascular diseases. The condition's significance is further amplified by its higher prevalence among the aging demographic, thereby rendering it a pertinent public health issue.
Given these factors, aortic stenosis necessitates comprehensive clinical attention, encompassing accurate diagnosis, timely interventions, and vigilant long-term management, to mitigate its multifaceted impact on patient well-being.
Slide 2: Pathophysiological changes
• Narrowing of the aortic valve obstructs blood flow.
• Increased pressure in the left ventricle.
• Ventricular hypertrophy as a compensatory mechanism.
• Elevated myocardial oxygen demand.
• Reduced cardiac output, leading to heart failure if unmanaged.
In the context of aortic stenosis, the narrowing of the aortic valve serves as the focal point of pathophysiological alterations. This valvular constriction precipitates a hemodynamic bottleneck, compelling the left ventricle to exert additional force to propel blood through the compromised valve. Consequently, the ventricle undergoes hypertrophy, a compensatory but ultimately maladaptive response, aiming to sustain cardiac output.
However, this hypertrophic adaptation exacerbates myocardial oxygen consumption, thereby elevating the risk of ischemia. Furthermore, the persistent hemodynamic strain can culminate in a decrement in cardiac output, a scenario that, if left unaddressed, may segue into heart failure. Thus, the pathophysiological ramifications of aortic stenosis are not merely localized to the valve itself but reverberate through the cardiac system, necessitating prompt and targeted therapeutic interventions.
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Slide 3: Clinical Manifestations
• Chest pain or angina due to reduced coronary blood flow.
• Fatigue resulting from decreased cardiac output.
• Shortness of breath, often indicative of congestive heart failure.
• Exercise intolerance as a common clinical presentation.
• Syncope or fainting episodes due to impaired perfusion.
In aortic stenosis, the clinical manifestations are often insidious but progressively debilitating. Angina, or chest pain, arises from the myocardial ischemia engendered by obstructed coronary circulation. This is compounded by fatigue, a direct consequence of diminished cardiac output which restricts the body's ability to meet metabolic demands, especially during physical exertion.
Additionally, shortness of breath emerges as a critical symptom, often signaling the onset of congestive heart failure or exacerbated by activities that increase oxygen demand. Such breathlessness is typically the result of fluid retention and pulmonary congestion, secondary to compromised left ventricular function.
Exercise intolerance and even episodes of syncope may manifest due to the insufficient perfusion and heightened metabolic demands. Collectively, these clinical manifestations serve as harbingers of worsening cardiac function and necessitate immediate medical intervention.
Slide 4: Drug Class Identification: Beta-Blockers
• Drug Class: Beta-Blockers
• Commonly used in cardiovascular diseases.
• Effective in reducing heart rate and myocardial oxygen demand.
• Suitable for management of aortic stenosis symptoms.
• Often used in conjunction with other antihypertensive agents.
Beta-Blockers emerge as a pivotal pharmacological class in the therapeutic armamentarium for aortic stenosis, particularly for symptom management. These agents function by antagonizing the beta-adrenergic receptors, thereby attenuating sympathetic nervous system activity on the heart.
The resultant effects include a reduction in heart rate and a decrease in myocardial oxygen demand, both of which are paramount in the context of aortic stenosis. Specifically, by slowing the heart rate, Beta-Blockers facilitate improved ventricular filling, ameliorating the compromised cardiac output engendered by the stenotic aortic valve.
Moreover, the reduction in myocardial oxygen demand serves to mitigate the risk of ischemic events, particularly angina, which is a common symptom in these patients. Used judiciously, often in combination with other antihypertensive medications, Beta-Blockers can effectively modulate the symptomatic presentation of aortic stenosis, thereby enhancing both clinical outcomes and patient quality of life.
Slide 5: Mechanism of Action
• Beta-Blockers inhibit beta-adrenergic receptors.
• Result in decreased heart rate and contractility.
• Lower myocardial oxygen demand.
• Improve ventricular filling during diastole.
• Contribute to reduced workload on the heart.
The mechanism of action of Beta-Blockers in the context of aortic stenosis is multifaceted and primarily centers on reducing the cardiac workload.
By competitively inhibiting beta-adrenergic receptors, these agents diminish the effects of catecholamines like adrenaline and noradrenaline on the heart. Consequently, there is a notable decrease in both heart rate and myocardial contractility.
This reduction in contractile force and rate is particularly salient in the setting of aortic stenosis, as it serves to attenuate the myocardial oxygen demand, thereby mitigating the risk of ischemic events.
Furthermore, the slowed heart rate engendered by Beta-Blockers affords a longer diastolic filling time, which in turn can ameliorate the hemodynamic compromise wrought by the stenotic aortic valve.
Thus, Beta-Blockers serve as a cornerstone pharmacotherapeutic agent in the management of aortic stenosis, effectively alleviating both symptoms and physiological stressors.
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Slide 6: Indications and considerations
• Indicated for symptom management in aortic stenosis.
• Useful in controlling coexisting hypertension.
• Must be used cautiously in smokers due to cardiovascular risks.
• Monitoring for side effects like bradycardia or hypotension.
• Requires dose adjustment and close monitoring for efficacy.
For a patient with aortic stenosis coexisting with hypertension and a history of smoking, Beta-Blockers present both opportunities and challenges. These agents are not only efficacious in ameliorating the symptoms of aortic stenosis but also serve a dual purpose in controlling hypertension.
However, the use of Beta-Blockers in smokers necessitates heightened vigilance owing to the enhanced cardiovascular risks associated with tobacco use. The presence of nicotine can exacerbate tachycardia and elevate blood pressure, potentially counteracting the effects of Beta-Blockers.
Furthermore, close monitoring for adverse effects such as bradycardia or hypotension is indispensable. Periodic evaluations, including blood pressure measurements and perhaps even echocardiographic assessments, are crucial for dose titration and ensuring therapeutic efficacy.
In summary, while Beta-Blockers are broadly indicated for this patient profile, their administration must be judicious, tailored, and accompanied by rigorous clinical oversight.
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Slide 7: Linking Pharmacology to Pathophysiology
• Beta-Blockers reduce heart rate and myocardial oxygen demand.
• Improve ventricular filling by prolonging diastole.
• Mitigate risk of ischemic events like angina.
• Complement existing antihypertensive therapy.
• Serve as a bridge to more invasive interventions like valve replacement.
The nexus between the pharmacological action of Beta-Blockers and the pathophysiological underpinnings of aortic stenosis is both direct and clinically significant. By inhibiting beta-adrenergic receptors, these agents attenuate the sympathetic drive on the myocardium, thereby lowering heart rate and myocardial contractility.
This is particularly salient in the backdrop of aortic stenosis, where the narrowed valve amplifies the workload on the left ventricle. By reducing this workload, Beta-Blockers mitigate the myocardial oxygen demand, thus diminishing the risk of ischemic events such as angina.
Additionally, the slowing of the heart rate allows for more effective ventricular filling during diastole, partially compensating for the reduced cardiac output occasioned by the stenotic valve.
Consequently, Beta-Blockers serve not merely as a symptomatic treatment but as a modulator of the disease process itself, making them an integral component of the therapeutic strategy for aortic stenosis.
In the realm of cardiovascular disorders, aortic stenosis holds a position of considerable clinical importance, particularly among geriatric populations. Given its propensity to significantly compromise cardiac output, the disease warrants diligent attention from healthcare providers (Bohbot et al., 2020).
The selection of aortic stenosis as the subject matter for this educational resource is underscored by its prevalence and severity, especially in the context of an aging Australian populace.
In the long-term management of aortic stenosis, a multi-pronged approach that encompasses lifestyle modifications, pharmacological interventions, and regular medical surveillance is instrumental for mitigating disease progression and enhancing quality of life (Strange et al., 2019).
Foremost among lifestyle changes is the imperative of smoking cessation. Given the well-documented deleterious effects of tobacco on cardiovascular health, the cessation of smoking is not merely advisable but imperative (Dudzinski & O’Gara, 2019). Concurrently, the implementation of stress management techniques, such as mindfulness and cognitive behavioural therapy, can ameliorate the psychological toll exerted by the chronic nature of the disease (Shroff et al., 2021).
Pharmacologically, a meticulous management regimen for Beta-Blockers and antihypertensive medications is essential. These pharmacological agents, particularly Beta-Blockers, act to alleviate the myocardial workload and hence are indispensable in the management of aortic stenosis (El Hussein et al., 2021). Regular monitoring of medication efficacy and side effects is crucial, requiring frequent adjustments to optimize therapeutic outcomes.
Scheduled medical evaluations, inclusive of periodic echocardiograms, serve as cornerstone elements in a comprehensive management plan. These echocardiographic assessments provide invaluable insights into the current state of the aortic valve, thereby facilitating timely medical interventions (Pawade et al., 2019).
Consultations with healthcare providers at regular intervals ensure that the management plan remains dynamically responsive to the evolving nature of the disease. In summary, the long-term management of aortic stenosis necessitates a synergistic interplay of lifestyle alterations, tailored pharmacotherapy, and rigorous medical oversight, aimed collectively at decelerating disease progression, alleviating symptoms, and ultimately, optimizing the patient's overall well-being.
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Causative Mechanism:
The genesis of acute chest pain in the context of aortic stenosis predominantly lies in the diminished blood flow occasioned by a narrowed aortic valve.
Clinical Evidence:
The patient's subjective complaints of angina serve as compelling evidence to substantiate the presence of acute chest pain.
Goal (SMART format):
The aim is to ameliorate the intensity of chest pain to a negligible level within a 30-minute window, as assessed by the patient's self-report.
Interventional Strategy:
The initial step involves the prompt administration of nitroglycerin, as per medical orders, followed by scrupulous monitoring of vital signs to gauge therapeutic efficacy and identify any adverse reactions.
Causative Mechanism:
Acute breathlessness is engendered by a reduced cardiac output, which in turn instigates a fluid back-up into the pulmonary system.
Clinical Evidence:
The corroboration for this acute issue is derived from both audible wheezing upon auscultation and the patient's explicit reportage of respiratory distress.
Goal (SMART format):
The objective is to escalate the oxygen saturation levels to a minimum of 95% within a one-hour timeframe, as monitored through pulse oximetry.
Interventional Strategy:
Immediate administration of supplemental oxygen is warranted, in conjunction with elevating the head of the bed to facilitate easier respiration. Concomitant monitoring of oxygen saturation levels is imperative to ensure the efficacy of the intervention and to make necessary adjustments.
The nursing care plan, meticulously constructed for managing acute episodes commonly manifesting in aortic stenosis, is anchored in evidence-based practices and is intrinsically aligned with the underlying pathophysiological mechanisms of the disease (Diğin & Özkan, 2020).
In addressing the issue of acute chest pain, the administration of nitroglycerin is not arbitrary but rather predicated on its proven efficacy in dilating coronary arteries and thereby ameliorating myocardial ischemia.
Given that the genesis of chest pain in aortic stenosis arises from reduced blood flow through a narrowed aortic valve, the timely introduction of nitroglycerin becomes indispensable (Hiroi et al., 2021). The monitoring of vital signs post-administration serves as a prudent measure to ascertain both the therapeutic benefit and the potential onset of adverse effects such as hypotension (Banovic et al., 2022).
Concomitantly, the issue of acute breathlessness, a direct sequel of reduced cardiac output and resultant pulmonary congestion, necessitates immediate intervention (Playford et al., 2023). The elevation of the head of the bed and the administration of supplemental oxygen are interventions substantiated by their physiological rationale (Postolache et al., 2020).
Elevation facilitates diaphragmatic excursion and optimizes lung volume, while supplemental oxygen ameliorates hypoxia (Bouhamida et al., 2023). In summation, each facet of the nursing care plan is meticulously tailored to mitigate the acute symptoms manifested in aortic stenosis. This tailored approach ensures that the interventions are not only symptomatically effective but also pathophysiologically congruent, thereby maximizing therapeutic outcomes.
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Bohbot, Y., Candellier, A., Diouf, M., Rusinaru, D., Altes, A., Pasquet, A., ... & Tribouilloy, C. (2020). Severe aortic stenosis and chronic kidney disease: outcomes and impact of aortic valve replacement. Journal of the American Heart Association, 9(19), e017190. https://www.ahajournals.org/doi/abs/10.1161/JAHA.120.017190
Bouhamida, E., Morciano, G., Pedriali, G., Ramaccini, D., Tremoli, E., Giorgi, C., ... & Patergnani, S. (2023). The Complex Relationship between Hypoxia Signaling, Mitochondrial Dysfunction and Inflammation in Calcific Aortic Valve Disease: Insights from the Molecular Mechanisms to Therapeutic Approaches. International Journal of Molecular Sciences, 24(13), 11105. https://www.mdpi.com/1422-0067/24/13/11105
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DIĞIN, F., & ÖZKAN, Z. K. (2020). Nursing Care After Heart Surgery. Advances in Health Sciences Research, 121. https://www.researchgate.net/profile/Eda-Cangoel-2/publication/344831659_Gender_Culture_MidwiferyNursing/links/5f9296dda6fdccfd7b77709b/Gender-Culture-Midwifery-Nursing.pdf#page=122
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El Hussein, M. T., Harvey, G., & Bueckert, A. (2021). Antihypertensive therapy in patients with moderate to severe aortic stenosis. The Nurse Practitioner, 46(9), 14-22. https://journals.lww.com/tnpj/Fulltext/2021/09000/Antihypertensive_therapy_in_patients_with_moderate.4.aspx?context=LatestArticles
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Nitsche, C., Koschutnik, M., Kammerlander, A., Hengstenberg, C., & Mascherbauer, J. (2020). Gender-specific differences in valvular heart disease. Wiener klinische Wochenschrift, 132, 61-68.
Pawade, T., Sheth, T., Guzzetti, E., Dweck, M. R., & Clavel, M. A. (2019). Why and how to measure aortic valve calcification in patients with aortic stenosis. JACC: Cardiovascular Imaging, 12(9), 1835-1848. https://www.jacc.org/doi/abs/10.1016/j.jcmg.2019.01.045
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Strange, G., Scalia, G. M., Playford, D., & Simon, S. (2021). Uncovering the treatable burden of severe aortic stenosis in Australia: current and future projections within an ageing population. BMC Health Services Research, 21, 1-9. https://link.springer.com/article/10.1186/s12913-021-06843-0
Strange, G., Stewart, S., Celermajer, D., Prior, D., Scalia, G. M., Marwick, T., ... & National Echocardiography Database of Australia Contributing Sites. (2019). Poor long-term survival in patients with moderate aortic stenosis. Journal of the American College of Cardiology, 74(15), 1851-1863. https://www.jacc.org/doi/abs/10.1016/j.jacc.2019.08.004
Ternacle, J., Krapf, L., Mohty, D., Magne, J., Nguyen, A., Galat, A., ... & Damy, T. (2019). Aortic stenosis and cardiac amyloidosis: JACC review topic of the week. Journal of the American College of Cardiology, 74(21), 2638-2651. https://www.jacc.org/doi/full/10.1016/j.jacc.2019.09.056
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