Pathophysiological Mechanisms that can lead to Heart Failure

Purpose
The purpose of this discussion is to apply pathophysiological concepts to an individual presenting with cardiovascular dysfunction (heart failure). Related concepts will also be applied that includes potential alterations in fluid and electrolytes and acid/base balance.
Activity Learning Outcomes
Through this discussion, the student will demonstrate the ability to:
Explore age-specific and developmental alterations in the cardiovascular system. (CO 3, 1)
Relate pathophysiological alterations in cardiovascular processes to the development, diagnosis and treatment of heart failure. (CO 4, 2)
Examine current evidence to support the management of patients who present with alterations in the cardiovascular system. (CO 5, 3)

Due Date:
The student must provide an answer to the graded discussion topic posted by the course instructor, by Wednesday, 11:59 p.m. MT, of each week.
Students must post a minimum of two times (response to peers) in the graded discussion. The two posts in the discussion must be on separate days. Posting twice on two different days meets the minimum requirement. For full credit, the student must post at least three substantive posts on three different days. In addition, students must respond to all faculty questions.
A 10% late penalty will be imposed for discussions posted after the deadline on Wednesday, 11:59 p.m. MT regardless of the number of days late. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0). Week 8 discussion closes on Saturday at 11:59pm MT.
A 10% penalty will be imposed for not entering the minimum number/type of interactive dialogue posts OR not posting on the minimum required number of days. NOTHING will be accepted after 11:59pm MT on Sunday (i.e. student will receive an automatic 0).
Total Points Possible: 100
Requirements:
A 64-year-old woman presents to the primary care office with shortness of breath, leg swelling, and fatigue. She has a history of type 2 diabetes and hypertension. She reports that recently she had been able to go for daily walks with her friends, but in the past month, the walks have become more difficult due to shortness of breath and fatigue. She also sometimes awakens in the middle of the night due to shortness of breath and has to prop herself up on three pillows. On physical examination, she is tachycardic (110 beats per minute) and has a blood pressure of 106/74 mm Hg. Fine crackles are noted on inspiration in bilateral bases. The cardiac exam reveals the presence of a third and fourth heart sound and jugular venous distension. 2+ pitting edema is noted in the knees bilaterally. An ECG shows sinus rhythm at 110 bpm with Q waves in the anterior leads. An echocardiogram shows decreased wall motion of the anterior wall of the heart and an estimated ejection fraction of 25%. She is diagnosed with systolic heart failure, secondary to a silent MI.
Discuss the pathophysiological mechanisms that can lead to heart failure.
Differentiate between systolic and diastolic heart dysfunction
Discuss the causes of the patient’s shortness of breath, awakening in the middle of the night and the need to prop herself up on three pillows. Include pathophysiological mechanisms that causes each of these signs and symptoms.
Include two points of teaching for this patient
Support your response with at least one current evidence based resource.
Students must post a minimum of three times in each graded discussion (see participation guidelines below).

DISCUSSION CONTENT
Category
Points
%
Description
Application of Course Knowledge
30
30%
Posts make direct reference to concepts discussed in the lesson or drawn from relevant, evidence based outside sources, AND
Posts are on topic and answer all presented questions which demonstrates a solid understanding of the topic.
Applies concepts to personal experience in the professional setting and or relevant application to real life, AND
Decisions are well supported with evidence-based arguments that are in-line with the scenario; AND
Proper rationale and reasoning skills are demonstrated; AND
Information is taken from source(s) with appropriate interpretation/evaluation to develop a comprehensive analysis or synthesis of the topic
Support From Evidence Based Practice
30
30%

Discussion post is supported with appropriate, scholarly sources; AND
Sources are published within the last 5 years (unless it is the most current clinical practice guideline (CPG); AND
Reference list is provided and in-text citations match; AND
Provides relevant evidence of scholarly inquiry clearly stating how the evidence informed or changed professional or academic decisions




Interactive Dialogue
30
30%
Student provides a substantive* response to at least two topic-related posts of a peer; AND
Evidence from appropriate scholarly sources are included; AND
Reference list is provided and in-text citations match; AND
Student responds to all direct faculty questions OR if student was not asked a direct question, student responds to either a 3rd peer post or a faculty question directed towards another student
(*) A substantive post adds new content or insights to the discussion thread and information from student’s original post is not reused in peer or faculty response

90
90%
Total CONTENT Points= 90 pts
DISCUSSION FORMAT
Category
Points
%
Description
Grammar, Syntax, Spelling, & Punctuation

10
10%
Grammar, spelling, and/or punctuation are accurate, or with zero to one error.
Direct quotes in discussions are limited to one short quotation (not to exceed 15 words). The quote adds substantively to the discussion. 
(*) APA style references and in text citations are required; however, there are no deductions for errors in indentation or spacing of references. All elements of the reference otherwise must be included.

10
10%
Total FORMAT Points= 10 pts

100
100%
DISCUSSION TOTAL=100 points