Chest Pain In Patients With Cardiovascular Diseases: A Case Study
Nursing Implications For Chest Pain In Patients With Cardiovascular Diseases: A Case Study
This is synthesis report based on the case study of a patient named Renda Balley suffering from cardiovascular diseases. She suffered from myocardial infarction, which causes several symptoms and one of them being angina or cheat pain. Proper nursing implications involve providing relief to patients suffering from chest pain. These are carried out by providing smooth muscle relaxants like nitroglycerin, morphine, among others. If proper nursing implications are not carried out, it can give rise to serious consequences including cardiac shock and death of the patient.
Moreover, preventive measures are to be carried out to prevent the risk of developing critical health issues in the future like coronary artery diseases. One of the most effective preventive measure is exercising, which can open up new perspectives in preventing high risk medical conditions in the future.
Description
The case study of the patient Renda Balley involved diagnosis of cardiovascular disease with presence of hypertension, arrhythmia, dysarrthymia, myocardial infarction, among others. She was a heavy smoker and had a history of cardiac abnormalities and underwent surgeries. She underwent radiofrequency ablation in order to overcome cardiac arrhythmia. Chest Pain In Patients With Cardiovascular Diseases: A Case Study
The nursing implications or suggestions provided to her included: assessment of chest pain, respiration, blood pressure, electrocardiogram, among others (Bandstein et al., 2014). Moreover, the patient also suffered from dysrhythmias and as a result, hemodynamic regulations were provided in the nursing care plan to determine pulse rate, ventricular contractions, tachycardia, among others (Stouffer, 2017). These nursing interventions are highly relevant for care of patients with cardiovascular diseases.
The purpose of the paper is to introduce the two nursing care plans: Nitroglycerin SL administration and morphine administration that would have helped the patient to overcome the chest pain associated with ostial stenosis. Chest Pain In Patients With Cardiovascular Diseases: A Case Study
In the case study, the patient suffered from coronary artery disease. She had severe stenosis or blockage of the coronary arteries, MLAD, ostial right coronary artery (RCA), middle and distal RCA, proximal circumflex, left external iliac, left superficial femoral and the medial branch. She had undergone surgical interventions like percutaneous coronary intervention in order to open up the blocked coronary arteries. Stents were also used in order to improve the luminal diameter of the coronary arteries. However, a previous XIENCE failure was reported. However, she was not administered any nitroglycerin SL or morphine to reduce her chest pain as a result of blocked coronary arteries. Moreover, she was given a BIPAP, which can increase the rate of myocardial infarction.
Angina or chest pain occurs as a result of poor supply of oxygen to the heart muscles or myocardium. Angina feels like a squeezing or pressure on the heart (Chitra, Jegan & Ezhilarasu, 2017). This pain can move to the jaws, arms, back, among others. Angina is usually associated with coronary artery disease. Coronary heart disease occurs as a result of plaque buildup on the interior of the coronary arteries. Myocardial infarction is also associated with morbidity and increased rates of mortality among the elderly people. One study depicts the role of opiods in providing pain relief to patients suffering from myocardial infarction. Myocardial infarction causes pain, breathlessness and anxiety in patients. The empirical research article aimed at determining the clinical efficacy and outcomes associated with the morphine use in patients with acute myocardial infarction. According to the study, pre-hospital use of morphine causes a haemodynamic effect, which is beneficial in patients with acute myocardial infarction. It was also not associated with any complications or side-effects. It causes a decreased heart rate without affecting the systolic blood pressure. This makes it a favorable treatment method for patients experiencing severe chest pain as a result of myocardial infarction (Puymirat et al., 2015). Morphine provides relief from chest pain which cannot be treated by nitroglycerin.
Literature Review
Acute heart failure is a condition in which doctors, nurses and healthcare officials have to provide rapid relief to the patients. Nursing interventions in this field involves acute monitoring of patients to observe any symptoms that require immediate treatment and attention. Use of vasodialaters like nitroglycerin are required to control ventricular rate in patients with acute heart failure. Morphine on the other hand can reduce the afterload, preload, relieve dyspnea and heart rate (Mebazza et al., 2015).
ORDER A PLAGIARISM-FREE PAPER HERE
Nitroglycerin is the first line treatment in association with angina or chest pain and myocardial infarction. Nitroglycerin generates nitric oxide, which helps to cause vasodialation and increases the amount of blood flow to the heart muscles or myocardium. Nitroglycerin helps in creation of equilibrium between supply of nutrient and oxygen compared to the demand of the ischemic heart. However, over usage of nitroglycerin can cause tolerance and give rise to endothelial dysfunction, increased vasoconstrictor sensitivity and pro-oxidant effects (Ferreira & Mochly-Rosen, 2012).
These nursing interventions are non-surgical methods that could have benefitted the patient described in the case study prior to the surgical means like percutaneous coronary interventions. These interventions could have helped the patient in getting relief from chest pain.
Nitroglycerin has a relaxant effect on the smooth vascular muscles. In coronary artery disease, the coronary arteries are blocked as a result of ostial stenosis (Strauss et al., 2015). As a result, the heart muscles do not supply enough of both oxygen and blood, which can result in severe chest pain or angina. Nitroglycerin helps to improve both the oxygen and blood supply to the heart muscles or myocardium. This helps to dialate the peripheral veins, and when given in higher doses can cause the peripheral arteries to dialate, thereby reducing both afterload and preload and subsequent oxygen consumption of the myocardium.
Myocardial infarction is associated with pressure, tightness and squeezing pain, in chest. The pain often migrates to the arms, back and jaws. Those who have chest pains, which are nitrate resistant can use morphine instead. It helps to decrease heart rate, venous return, blood pressure and can also stimulate locally mediated histamine regulated processes. This helps to reduce the oxygen demand of the myocardium. Morphine helps to reduce pain associated with ischemic tissue destruction. It also provides anxiolysis, which is helpful in case of patients with acute myocardial infarction (Parodi et al., 2015).
The consequences of myocardial infarction because of poor nursing treatment results in various complications. The complication types are ischemic, mechanical and arrhythmic (Kutty, Jones & Moorjani, 2013). Ischemic includes angina, reinfarction and extension. Mechanical involves heart failure, aneurysms, cardiac rupture and shock. Arrhythmias include atrioventricular node or sinus dysfunction. Thus, proper nursing interventions are necessary to be carried out in a timely manner in order to reduce mortality rate of patients and to provide pain relief in individuals suffering from coronary artery disease.
Nursing Implications
Conclusion
This synthesis report focuses on the clinical issues that can occur because of poor nursing care in association with the case study of Renda Balley. The patient Renda Balley was suffering from cardiovascular diseases with symptoms like chest pain. However, her case study revealed that the nursing implications did not involve the administration of any heart muscle relaxants that would help her to get relief from chest pain. Moreover, she was provided with a BIPAP, which can increase the severity of her myocardial infarction. Thus, proper nursing care plan was not carried out which could have serious consequences on her health. Coronary artery diseases are usually associated with high cholesterol, high blood pressure, among others. Lack of a proper diet and exercise usually causes such medical conditions. Therefore, new ideas are need that would enable the general population to engage in physical activities. It is necessary for health insurance companies and hospitals to provide rewards that would encourage individuals to carry out daily physical activities. Moreover, assessment of physical fitness is also essential in order to monitor the health of the general population as well as patients with cardiovascular diseases. Maintaining a healthy lifestyle can prevent the occurrence of broader issues in the future regarding health of individuals. Thus, it can be concluded that physical activity can prevent the occurrence of various risk factors and long-term health issues that is slowly gripping the present generation.
References
Bandstein, N., Ljung, R., Johansson, M., & Holzmann, M. J. (2014). Undetectable high-sensitivity cardiac troponin T level in the emergency department and risk of myocardial infarction. Journal of the American College of Cardiology, 63(23), 2569-2578.
Chitra, R., Jegan, C., & Ezhilarasu, R. (2017). Analysis of myocardial infarction risk factors in heart disease data set. Biology & Medicine Case Report, 1(1).
Ferreira, J. C., & Mochly-Rosen, D. (2012). Nitroglycerin use in myocardial infarction patients. Circulation Journal, 76(1), 15-21.
Kutty, R. S., Jones, N., & Moorjani, N. (2013). Mechanical complications of acute myocardial infarction. Cardiology clinics, 31(4), 519-531.
Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S.,& McDonagh, T. (2015). Recommendations on pre?hospital & early hospital management of acute heart failure: a consensus paper from the Heart Failure Association of the European Society of Cardiology, the European Society of Emergency Medicine and the Society of Academic Emergency Medicine. European journal of heart failure, 17(6), 544-558.
Parodi, G., Bellandi, B., Xanthopoulou, I., Capranzano, P., Capodanno, D., Valenti, R., … & Alexopoulos, D. (2015). Morphine is associated with a delayed activity of oral antiplatelet agents in patients with ST-elevation acute myocardial infarction undergoing primary percutaneous coronary intervention. Circulation: Cardiovascular Interventions, 8(1), e001593.
Puymirat, E., Lamhaut, L., Bonnet, N., Aissaoui, N., Henry, P., Cayla, G., & Goldstein, P. (2015). Correlates of pre-hospital morphine use in ST-elevation myocardial infarction patients and its association with in-hospital outcomes and long-term mortality: the FAST-MI (French Registry of Acute ST-elevation and non-ST-elevation Myocardial Infarction) programme. European heart journal, 37(13), 1063-1071.
Stouffer, G. (2017). Cardiovascular hemodynamics for the clinician. John Wiley & Sons.
Strauss, R. A., Johnson, A., Lampert, R. C., Aziz, S. R., & Wessel, J. (2015). BASIC LIFE SUPPORT, ADVANCED CARDIAC LIFE SUPPORT, AND ADVANCED TRAUMA LIFE SUPPORT. Oral and Maxillofacial Surgical Secrets-E-Book, 131. Chest Pain In Patients With Cardiovascular Diseases: A Case Study
