NURS7105 Mrs. Jones Case Study Sample

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• Subject Code : NURS7105
• University : University of Queensland School of Medicine My Assignment Services is not sponsored or endorsed by this college or university.
• Subject Name : Nursing

Cardiovascular and Respiratory Nursing

Contents

Introduction.

Epidemiology.

Risk factors and abnormal vital signs demonstrating pathophysiology.

Pathophysiology.

Assessment by registered nurse.

Nursing priorities.

Clinical intervention.

Psychosocial issues.

Ethical issue in nursing.

Conclusion.

Introduction to Mrs. Jones Case Study

The case study which is provided is of Mrs. Jones who is a 74 years old female. She was admitted to the hospital after experiencing abdominal pain and constipation. For that, she underwent a surgery which was open hemicolectomy. She also had a history of hypertension, ulcerative colitis, osteoarthritis, asthma, hypercholesterolemia and heart failure. She also has experienced an episode of depression and anxiety in the past. Currently, she is experiencing tightness in her chest and is having problem in breathing. With that, she is experiencing a high amount of pain in her jaw and chest. Her respiration rate (RR) is 26 per minute and pulse rate is 128 beat per minute. Also, blood pressure (BP) of her is 200/110 mmHg and saturation of oxygen (SpO₂) is 86%. She also explained that she is experiencing the pain of level 9 on a scale of 10. By looking at the vitals and symptoms it can be said that she might be having a myocardial infarction (MI).

Epidemiology

There are 32.4 million people who experience strokes and MI every year all over the world. These patients are at higher risk of developing severe cerebral or coronary events. Patients who survived MI have more chances that MI happened to them again and they have a death rate of 5% (World Health Organization, 2020). In Australia, in the year 2015, the prevalence of heart attack was 339 in 100,000 people among which men experience more of it than the woman by the ratio of two (Australian Government, 2020).

Risk Factors and Abnormal Vital Signs Demonstrating Pathophysiology

The risk factors that are underlying the patient condition are psychosocial stress, hypertension, hypercholesterolemia and increased BP (Dugani et al., 2019). These factors increase the risk in patients for MI. In the case study also, the patient previously had episodes of anxiety and depression that could cause stress on the mental wellbeing of the patient. With that, the patient also had a history of hypertension and hypercholesterolemia. These both are the clinical factors which could further increase in the danger of occurrence of MI in the patient (Kiani, Hesabi, & Arbabisarjou, 2015). Having systolic blood pressure more than 140 mmHg and diastolic blood pressure more than 90 mmHg could also cause acute MI in the patient (Park et al., 2017). In this case, also, the patient has 200/110 mmHg BP which is above the normal measurement. The normal heart rate of a person is 72 per minute but if the patient has heart rate greater than 80 or especially 90 than it can also be a risk factor of MI (Alapati et al., 2019). The respiration rate of a normal person is between 12 to 16 breaths per minute but in a patient who is experiencing MI will have difficulty in breathing and thus will have abnormal respiration rate (Barthel et al., 2013). SpO₂ in the patient should also be higher than 95%. If not, then this will indicate that the person has a low amount of oxygen in the body and oxygen is needed to be supplied from outside that is via oxygen therapy. Lacking oxygen in the body can cause pain in the muscles and therefore the patient will experience a high level of discomfort due to pain (Khoshnood, 2018).

Pathophysiology

MI occurs in the patients because there is an erosion or rupture of an atherosclerotic plaque in the combination of thrombotic occlusion of a coronary artery. Infarction can also happen because of reduced blood flow within the coronary artery. The size of the infraction is based on the size of the ischaemic region which is at risk, intermittency and duration of coronary occlusion and collateral blood flow magnitude (Heusch & Gersh, 2017). In patient, the blood supply is limited among the three layers of the heart and patient might experience a large amount of pain. With that, BP and heart rate of the patient also becomes abnormal which can cause problems for the patient (Reddy, Khaliq & Henning, 2015).

Assessment by Registered Nurse

For the additional assessment, a registered nurse should do diagnosis by electrocardiography (ECG). Inferior and anterior infarctions can be detected on ST-segment elevation or T- wave inversion. However, posterior and lateral infarctions are more difficult to detect even by experienced clinicians. Therefore, it is appropriate to use ECG as alterations can easily be assessed in the patient (Lüscher et al., 2015). Another technique which could be used by the nurse is chest X-ray. It can be performed in the patient who is complaining about chest pain to rule out vascular of pulmonary disorders. It can also be used for telling the definitive diagnosis (Zuin et al., 2017).

Nursing Priorities

The priority of the nurse, in this case, is to manage the pain which is experienced by the patient. The patient stated that she is having the pain of level 9 on a scale of 10. This is a nursing priority because the pain in the chest induces a high amount of stress in the patient and could initiate a systemic circulatory effect that could further worsen the infarction which is ongoing. For that, nurses could provide the patient with morphine with the advice of doctors. Morphine was first introduced in the year 1923 and since then it is used as first-line therapy against the pain which is experienced because of infarction. Morphine has various effects such as it reduces BP and slows down the heart rate. It also helps in relaxing by relieving the anxiety which the patient has. Therefore, morphine could be used to ease out the chest pain (Abdikarim & Basgut, 2016). Morphine is an opioid which mimics the brain peptides actions by combining with multiple cellular receptors each having different action. This activates endogenous system which helps in modulation of the pain (Parodi et al., 2016). The second nursing priority is controlling the blood pressure. The patient blood pressure was 200/110 mmHg which is very much from the normal BP. This is necessary because lowering the blood pressure could reduce the cardiac workload and will enhance the functioning of the heart (Park et al., 2017). For this problem, the nurse can provide the patient with β-Blockers after consulting with the doctor. β-Blockers affect the metabolism of glucose adversely but in return led to the prominent improvement in the BP of the hypertensive diseased individual. This is done via decreasing the activity of the rennin and the cardiac output which is found to be always high in the case of patients. β-Blockers are antihypertensive drugs which impact differently on resistance vessels and contractibility and cardiac conduction. Some β-Blockers that are used are metoprolol, bisoprolol and carvedilol (Rosendorff et al., 2015). The third nursing priority is to manage the heart rate of the patient. In the case scenario, the heart rate has gone up to 128 per minute. This is a priority because increased heart rate has been associated with increased cases of mortality and morbidity. Increment in the heart rate later cause more implications which with the condition infarction. Here also, β-Blockers can work efficiently and could reduce the heart rate which could facilitate in the prevention of infraction (Alapati et al., 2019). Therefore, by reducing the pain and managing it, nurses could help the patient with MI. It is also important for nurses to reduce heart rate and blood pressure. This will normalize the other vitals too and would provide relief to the patient.

Clinical Intervention

The traditional treatment of myocardial infarction is with the help of drug therapy. Drug therapy involves inhibitors of angiotensin-converting enzyme, aldosterone receptor antagonists, angiotensin receptor blockers and β-receptor blockers (Peng, Zhou & Wu, 2017). By doing this remodelling of the left ventricle can be done. Another method which can be used is thrombolytic therapy which is one of the main approaches for the treatment of MI. It consists of recanalization of the coronary artery and perfusion restoration as early as possible. Coronary artery bypass grafting is a surgical method which is performed on the patient to reduce the symptoms. It is a very efficient method of restenosis treatment. This surgery moreover decreases myocardial damage and hospital mortality (Peng et al., 2017).

Psychosocial Issues

The psychosocial issue that can happen to the patient at the current stage of the disease is that the patient might experience general stress as she does not have any supporting family member with her (Vujcic et al., 2016). She has to take care of her husband and also her children live abroad so they can also not come to take care of her. With that, she has underlying multiple conditions like hypertension, asthma, osteoarthritis and so on and for her, the management of the diseases alone could be quite difficult especially at the age of 74.

Ethical Issue in Nursing

One ethical issue that the patient-nurse should consider while treating the patient is that she should work with beneficence. This ethical principle state that healthcare provider is under the obligation that he will provide care in every dimension so that patient outcome could be beneficial. The nurse who will work in accordance to this ethical principle has to provide utmost care to the patient and have to improve the techniques and strategies by which the patient could receive better results (Raus, Mortier & Eeckloo, 2018).

Conclusion on Mrs. Jones Case Study

In conclusion, it can be said that the patient was having myocardial infarction as she was experiencing chronic pain in her chest and her vitals were also showing abnormal measurement. There are multiple risk factors such as high BP, hypercholesterolemia, increased heart rate and so on. In the case of the patient, the heart rate was 128 per minute and BP was 200/110 mmHg. It is caused due to erosion or rupture of an atherosclerotic plaque in the combination of thrombotic occlusion of a coronary artery. The assessment could be done by doing an ECG or chest X-ray. The nursing priorities should be pain management and reducing the heart rate and BP. Drug therapy and coronary artery bypass grafting can be used for its treatment. With that, the patient might also experience stress due to this disease.

References for Mrs. Jones Case Study

Abdikarim, A. B. D. I., & Basgut, B. (2016). An evidence-based review of pain management in acute myocardial infarction. Journal of Cardiology & Clinical Research, 4(4), 1067.

Alapati, V., Tang, F., Charlap, E., Chan, P. S., Heidenreich, P. A., Jones, P. G., ... & Kizer, J. R. (2019). Discharge heart rate after hospitalization for myocardial infarction and long‐term mortality in 2 US registries. Journal of the American Heart Association, 8(3), e010855. https://doi.org/10.1161/JAHA.118.010855

Australian Government. (2020). Incidence of heart attacks. Available at https://www.aihw.gov.au/reports/australias-health/australias-health-2018/contents/indicators-of-australias-health/incidence-of-heart-attacks

Barthel, P., Wensel, R., Bauer, A., Müller, A., Wolf, P., Ulm, K., ... & Schmidt, G. (2013). Respiratory rate predicts outcome after acute myocardial infarction: A prospective cohort study. European Heart Journal, 34(22), 1644-1650. https://doi.org/10.1093/eurheartj/ehs420

Dugani, S. B., Ayala Melendez, A. P., Reka, R., Hydoub, Y. M., McCafferty, S. N., Murad, M. H., Alsheikh-Ali, A. A., & Mora, S. (2019). Risk factors associated with premature myocardial infarction: A systematic review protocol. BMJ Open, 9(2), e023647. https://doi.org/10.1136/bmjopen-2018-023647

Heusch, G., & Gersh, B. J. (2017). The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: A continual challenge. European Heart Journal, 38(11), 774-784. https://doi.org/10.1093/eurheartj/ehw224

Khoshnood A. (2018). High time to omit oxygen therapy in ST elevation myocardial infarction. BMC Emergency Medicine, 18(1), 35. https://doi.org/10.1186/s12873-018-0187-0

Kiani, F., Hesabi, N., & Arbabisarjou, A. (2015). Assessment of risk factors in patients with myocardial infarction. Global Journal of Health Science, 8(1), 255–262. https://doi.org/10.5539/gjhs.v8n1p255

Lüscher, T. F. (2015). Myocardial infarction: Mechanisms, diagnosis, and complications. European Heart Journal, 36(16), 947-949. https://doi.org/10.1093/eurheartj/ehv071

Park, H., Hong, Y. J., Cho, J. Y., Sim, D. S., Yoon, H. J., Kim, K. H., Kim, J. H., Ahn, Y., Jeong, M. H., Cho, J. G., Park, J. C., & Korean Acute Myocardial Infarction Registry Investigators (2017). Blood pressure targets and clinical outcomes in patients with acute myocardial infarction. Korean Circulation Journal, 47(4), 446–454. https://doi.org/10.4070/kcj.2017.0008

Parodi, G. (2016). Editor’s choice-chest pain relief in patients with acute myocardial infarction. European Heart Journal: Acute Cardiovascular Care, 5(3), 277-281. https://doi.org/10.1177/2048872615584078

Peng, X., Zhou, J., & Wu, X. S. (2017). New strategies for myocardial infarction treatment. Journal of Cardiology and Therapy, 4(3), 664-670.

Raus, K., Mortier, E., & Eeckloo, K. (2018). The patient perspective in health care networks. BMC Medical Ethics, 19(1), 1-8. https://doi.org/10.1186/s12910-018-0298-x

Reddy, K., Khaliq, A., & Henning, R. J. (2015). Recent advances in the diagnosis and treatment of acute myocardial infarction. World Journal of Cardiology, 7(5), 243–276. https://doi.org/10.4330/wjc.v7.i5.243

Rosendorff, C., Lackland, D. T., Allison, M., Aronow, W. S., Black, H. R., Blumenthal, R. S., ... & Gersh, B. J. (2015). Treatment of hypertension in patients with coronary artery disease: A scientific statement from the American Heart Association, American College of Cardiology, and American Society of Hypertension. Circulation, 131(19), e435-e470. https://doi.org/10.1161/CIR.0000000000000207

Vujcic, I., Vlajinac, H., Dubljanin, E., Vasiljevic, Z., Matanovic, D., Maksimovic, J., & Sipetic, S. (2016). Psychosocial stress and risk of myocardial infarction: A case-control study in Belgrade (Serbia). Acta Cardiologica Sinica, 32(3), 281–289. https://doi.org/10.6515/acs20150424k

World Health Organization. (2020). Prevention of Recurrences of Myocardial Infarction and Stroke Study. Available at https://www.who.int/cardiovascular_diseases/priorities/secondary_prevention/country/en/index1.html

Zuin, G., Parato, V. M., Groff, P., Gulizia, M. M., Di Lenarda, A., Cassin, M., ... & Rossini, R. (2017). ANMCO-SIMEU Consensus document: In-hospital management of patients presenting with chest pain. European Heart Journal Supplements, 19(suppl_D), D212-D228. https://doi.org/10.1093/eurheartj/sux025

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