Patient Profile

This essay will introduce a patient Mrs Eleanor Hale, a 56-year-old female who was suffering from pneumonia. The patient had suffered from Ischemic heart disease (IHD), peripheral vascular diseases and hypertension and was a chain smoker for past 30 years, starting from the age of 19 to 49. The health analysis of the patient states that the patient was suffering from major heart problem of coronary heart disease (CAD), where the heart artery is incapable of delivering sufficient oxygen-rich or oxygenated body fluid to the heart (Nhlbi.nih.gov, 2019). This condition leads to the development of coronary or ischemia heart disease due to accumulation of waxy constituent known as plague inside coronary artery. This essay will focus on the treatment approach used for the patient including percutaneous trans-luminal coronary angioplasty (PTCA), which is an invasive surgical procedure for opening the blocked artery of the heart for unobstructed circulation of the blood (Aihw.gov.au, 2019). Hence, this essay will give a detail insight in the critical analysis of the patient health including pathophysiology of the disease, treatment and psychosocial approach of the patient. 

The patient weighed 88 kg and was 158cm tall. In this case study, the patient was observed with the clinical symptoms of little higher pulse rate from normal with normal blood pressure and body temperature. After administrating the patient medication, it was observed that she was diaphoretic, which states the condition of excess sweating or perspiration in-patient due to abnormal trigger in sweat glands (Health.gov.au, 2019). The patient was also suffering from pain in her chest with minor ache in inner side of upper left arm, which was making her feel nauseous. The clinical analysis of the patient was done and the vital sign were observed after 10 minutes of her symptoms, which stated that her pulse rate was not normal like before and she was facing problem in breathing (Heusch et al., 2014).

The sign and symptoms of coronary or ischemia heart disease are as follows (Healthywa.wa.gov.au, 2019):

• Chest pain (angina)
• Pain in arms, back, shoulders and upper abdomen
• Dizziness and nausea
• Fatigue and weakness
• Rapid heartbeat
• Sweating
• Shortness of breathe
• Palpitations

Coronary heart disease (CAD) is the heart condition developed due to damaged or diseased blood vessel, which fail to supply adequate amount of oxygenated blood to the heart. This condition takes place due to deposition of plaque (cholesterol deposit) in the heart artery leading to narrowing of the blood vessels (nhs.uk, 2019). This condition results in poor or decreased blood supply to the heart, which eventually leads to angina or chest pain and shortness of breath. The patient was showing some major symptoms of coronary heart disease due to deposition of plague such as chest pain, rapid heartbeat, difficulty in breathing and palpitations. The accumulation of plague occurs due to the damage in the artery known as endothelium. Once the endothelium is injured, it leads to accumulation of debris, fats and cholesterol in the damaged artery. Due to high concentration of LDL the damaged artery, atherosclerotic plague deposition takes place, which further causes constriction of the blood vessels (Ambrose & Singh, 2015). Angiogenesis takes place, which is the primary reason of coronary heart disease. Hence, this narrowing of blood vessel majorly result in chest pain or angina. Further deposition of plague in the damaged blood vessel causes shortness of breath and pain in inner side of her arm. The primary reason of hypertension and diaphoresis was the fluctuating heart rate, which was due to the uneven and inadequate blood flow. The patients was a chain smoker and because of her smoking habit the harmful chemicals such as carbon monoxide and nicotine had set a pressure strain on her heart, which in turn increased the palpitation rate of her rate (kyu at al., 2016). The sensation of vomiting or nausea was due to the amplified parasympathetic tone resulted from the discomfort of the narrowed blood vessel lacking oxygenated blood.  

Pathophysiology of the Disease

The major risk of coronary or ischemia artery disease is congestive heart failure (CHF), which is a functional state resulting due to the incapability of the heart to supply adequate amount of blood in order to meet up with the metabolic requirements of the human body (Urden, Stacy & Lough, 2017) . The systolic and diastolic activity of the ventricle (left) changes, which lead to congestive heart failure. Nursing care plan is developed to support patients with effective treatment approaches in order to improve the function of heart. Nursing care plan includes identification and prevention of the problem by providing the patient with an appropriate care plan to change their everyday activity or lifestyle for modification in their health issue (Fihn et al., 2014). The major priority of nursing care plan was given to the chest discomfort that the patient was suffering. Hence, the following evidences leads to the development of a nursing care plan, which include (Dalal, Doherty & Taylor, 2015):

• Reports of pain worsening condition
• Distraction activities (such as restlessness, crying, and moaning)
• Autonomic responses (such as diaphoresis, fluctuating respiratory rate, changes in pulse rate and change in blood pressure).

The nursing intervention with rationale for Coronary artery disease are as follows (Saffi, Polanczyk & Rabelo-Silva, 2014):

• Educate the patient to inform nurse instantly in case of chest pain.

Rationale- Declined cardiac output and pain may excite the nervous system (sympathetic) to discharge extreme quantities of norepinephrine a neurotransmitter to escalate the discharge of thromboxane A₂ and platelet accumulation. This compelling vasoconstrictor origins coronary artery contraction, which can complicate, precipitate and elongate cardiac attack. Intolerable pain can result in declining heart rate, vasovagal reaction and declining BP.

• Entree and document the patient reaction for the provided medication

Rationale- Delivers information regarding the progression rate of disease. Helps in estimating the efficiency of intrusions, and indicate any required change in healing treatment (Stergiopoulos et al., 2014).

• Identify the location, intensity, duration and frequency of pain

Rationale- Helps in differentiating the chest pain from other associated pain and assist in estimating the possible development to unbalanced angina.

• Observe the symptoms of the patient carefully: nausea, palpitation, dyspnea, vomiting and dizziness

Rationale- Reduced cardiac output due to the occurrence of ischemic myocardia might excite the nervous system (including parasympathetic and sympathetic nervous system).

• Assess reports of discomfort or pain in arm, hand, neck, shoulder, and jaw (usually on the left side)

Rationale- The cardiac pain might radiate effecting the left side of the patient body. Pain is devoted to the extreme shallow locations attended by the identical vertebral cord nerve condition (Lennon et al., 2014).

• In case of anginal condition help the patient to take complete rest

Rationale- Decreases the myocardial oxygen petition of the body to decrease the danger of tissue damage.

• Uplift the head of patient’s bed in case of shortness of breath

Rationale- Accelerates gas exchange in order to decrease hypoxia condition, which ultimately result in difficulty of breathing or shortness of inhalation.

• Monitor the heart rhythm and rate of the patient

Rationale- Patients suffering with uneven or unstable angina are often at an increased or higher risk of severe life-threatening condition of dysrhythmias (Suissa et al., 2017). This condition occurs due to the response in ischemic stress or changes.

• Complete monitoring of vital signs after initial cardiac attack

Treatment Approach

Rationale- The blood pressure of the patient might increase initially due to sympathetic stimulation and then might fall in case of compromised cardiac yield. Tachycardia can also progress in reaction to the sympathetic stimulation in the patient body. This can be continued as a compensation rejoinder in case of fall in the total cardiac output.

• Adequate care of the patient in case of anxiety and pain

Rationale- Anxiety in-patient discharges catecholamine’s, which in turn increases the myocardial capability hence escalating ischemic pain (Saffi, Polanczyk & Rabelo-Silva, 2014). The attendance of nurse in such condition might reduce the feeling of helplessness and fear in-patient.

• The comfortable and quite environment should be maintained

Rationale- The emotional or mental stress can increases the myocardial pressure or workload.

• Supplemental oxygen should be provided when required

Rationale- Higher oxygen content required for myocardial uptake in order to reverse the condition of ischemia (Dalal, Doherty & Taylor, 2015).

• Auscultate heart and breath sounds and careful attention to listen the murmurs

Rationale- S₃, S₄, or cracks can happen due to any medication (like beta-blockers) or due to cardiac decomposition (Maddox et al., 2014). Progression of murmurs might disclose a valvular reason for pain (such as mitral stenosis and aortic stenosis) or rupture of papillary muscle.

In this study, the patient Mrs Hale was suffering from a psychosocial issue, which directly or indirectly was effecting her health condition making it worse day-by-day as she was alone and nobody was there to support her emotionally and physically. She was living all alone in a rented house with no mental and monetary support to recover from her bad health condition as her only source of income was from the pension she got after retirement. The patient was depressed and mentally unstable due to the lack of support in her life (Whalley, Thompon & Taylor, 2014). Mrs Hale had one son who was also not bothered about her health and well-being and would visit rarely to meet her that was affecting her mental peace and stability. The patient states that her emotional burden to the nurse and highlighting her bad condition she was facing recently. As the patient was living, alone she had to do all her housework, which would increase the cardiac pain and make it difficult for her to breath properly. Mrs Hale states that she hates taking help from anyone for any work, which had made her condition even worse. She was a chain smoker and continued smoking for 30 years from the age of 19 to 49. Because of her smoking habit, she was early diagnosed with ischemia or coronary artery disease (Park et al., 2015). Hence, the above psychosocial condition clearly states that the patient was suffering from a major stress, which was ultimately effecting her health even more such as the increased frequency of chest pain, anxiety and weakness.

Nursing Care Plan

Conclusion

In this essay, a detail insight was provided on a case study of Mrs Hale, who was suffering from ischemia or coronary artery disease (CAD). The initial condition of the patient were observed including the sign and symptoms, which stated her health condition. The pathophysiology of the disease was explained relating to her health symptoms, as she was majorly suffering from cardiac or chest pain. This essay also includes the nursing care plan developed for the patient in order to treat her efficiently and effectively. The nursing care plan included the intervention, which should be followed with proper rationale justifying the patient condition. Hence, this essay concludes that in order to recover quickly the patient had to take proper medication and follow the nursing care plan, which will release the patient from all emotional and mental stress that she was going through.

References:

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