Mrs Brown, a 78 year-old female, was admitted to the Emergency Department at 6am after waking up
with severe breathlessness. Her family informed you that the patient has a history of heart failure that had
been diagnosed two years ago. On admission to the Emergency Department the clinical manifestations
were:
• Severe dyspnoea
• Respiratory rate of 24 breaths/minute
• SpO2 85%, on room air
• BP 170/95mmHg
• Pulse rate of 120 beats/minute
• Auscultation of lungs identifies bilateral basal crackles
Mrs Brown was connected to an ECG monitor that showed atrial fibrillation. A diagnosis of acute
exacerbation of chronic left-sided heart failure was made.
Question 1. (500 words) (Learning outcome 1 and 5)
Explain the pathogenesis causing the clinical manifestations with which Mrs Brown presented.
Question 2. (200 words) (Learning outcomes 2, 4 and 5)
….
Question 3. (300 words) (Learning outcome 3 and 5)
Two of the drugs that were given to Mrs Brown were IV furosemide and sublingual glyceryl trinitrate.
a. Discuss the mechanism of action of these two drugs, and relate to the underlying pathogenesis of
an acute exacerbation of chronic left-sided heart failure. And,
b. Describe the nursing implications (monitoring for and responding to adverse effects, and
evaluating therapeutic effect) when administering these two drugs to a patient with an acute
exacerbation of chronic left-sided heart failure.