A Critical Discussion Paper

The Pathophysiology Of Chest Heaviness

Breathing challenges are an indicator that the patient is having chest heaviness due to blockage of arteries which lead to reduced blood circulation thus forcing the heart to struggle with the limited oxygen in the blood. Patients with such conditions need to learn how to manage the condition in case the attack appears since in most cases, the patient is required to deal with the situation immediately to increase the effectiveness of medication and reduce the effects of the condition.

Mr. Ferguson presents cheat heaviness which is a common symptom for coronary heart artery disease that blocks arteries thus reducing circulation. The chest heaviness problem is a result of shortness of breath making it impossible for the patient to breathe well. When cholesterol builds up in the arteries, it leads to thickening of the walls which make the arterial space narrow thus limiting blood flow (Tobin, 2010). The outcome is the reduced amount of blood that reaches the heart muscles which means that the amount of oxygen that the heart receives too is low thus damaging the endothelium. These effects lead to the accumulation of cholesterol, fats, and lipoproteins in the artery vessels. Fatty acids are then formed in the artery which produces the extracellular matrix that forms the atherosclerotic plaque that narrows the luminal space (Carlos, 2004). The outcome of all this is a narrow cap with an edge that leads to acute coronary disease. As the plaque deposits grow larger, the blood vessel are narrowed leading to myocardial infarction which is mostly known as heart attack. This occurs mostly when the heart fails to function due to insufficient oxygen. Nursing Management Of Chest Heaviness Discussion Paper

Baren, Brennan, & Brown (2008) suggests that Glyceryl trinate is a common medication for high blood pressure and heart failure patients by reducing chest heaviness through increasing blood circulation thus restoring the patient to normal conditions. As a nitrate family drug, it works by dilating the blood vessels thus increasing blood circulation in the body which restores breathing to normal thus making the heaviness to disappear.  The role of the drug is to reduce heart attacks that patients with the condition face by restoring the breathing thus reducing the risk of heart failure in most patients.  The drug works by producing nitric oxide which activates for guanlyl cyclace that leads to the formation of cyclic guanosine monophosphate a compound that is mostly used to produce nitrogen which makes the arteries and muscles relaxed thus increasing blood circulation. The mechanism that the drug uses reduce chest heaviness is the fact that Glyceryl is rapidly absorbed in buccal and sublingual mucosa when inhaled or taken through any other means thus the effects of the drug can be realized within five minutes of taking. Patients who do not react to the drug like Ferguson need to visit the nearest health facility or call a doctor immediately.

Pharmacokinetics Of The Prescribed Medications And Their Indications

For the drug to be effective Kaski, Arrebola-Moreno, & Dungu (2011) suggest that it has to be taken within a short time after the attack starts so that the reverse mechanism of the drug can be realized. In most cases, patients who have taken the drug immediately after they sense signs of an attack have reported positive results. According to Albrecht (2013), the medication becomes less effective as the patient uses it with time which may be one of the reasons why Ferguson has not noticed any changes in the disease even after taking several puffs of the spray. The immune system of the body develops tolerance making the effectiveness of the drug limited from three weeks of continuous use. Patients who have developed tolerance to the drug require a lot of doses of the same for their bodies to respond to the symptoms of the disease. Other reported side effects of the drug include vascular abnormalities that lead to the increased prognosis of the disease leading to endothelial dysfunction.  Some patients experience side effects like impaired transformation, counteraction of GTN, plasma volume expansion and some people may feel oxidative stress.

According to Thull-Freedman (2010) chest pain or heaviness patients need to be diagnosed according to specific guidelines established by the relevant body. This means that the practitioner has to follow a set of measures and steps for establishing the condition that the patient is facing. In the case of Ferguson, the first step that the practitioner needs to do is to determine the nature of the condition that the patient is facing and its magnitude. Chest heaviness is not always an indicator of a heart attack since it can sometimes arise from indigestion, innocuous problem or even muscle strain as a result of anything like heavy exercise. Therefore, the practitioner needs to carry out an assessment of the problem through the use of tools like the PQRST assessment which seeks to determine the provoking factor of the problem, the quality of the heaviness and the severity of the problem according to what the patient feels (Karnath, Holden, & Hussain,, 2008). The role of this is to allow the practitioner to assess the risks that the patient may be prone to like the possibility of an imminent heart attack. If the practitioner notes at least two risks that the patient presents according to the signs, then there is a possibility of a heart attack.

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Nursing Management Of The Adverse Effects Of The Medication

Manageable conditions like chest heaviness require practitioners to educate patients on how to manage such conditions when the symptoms appear. Arnold, Goodacre, Bath, & Price (2009) argue that chest heaviness can be fatal if the patient does not know how to manage the problem. The role of nursing education is to empower patients with the ability to manage conditions when attacks occur mostly at home. Since the easiest way to manage chest heaviness is the use of the spray, then it means that nursing education should be used to ensure that the patient learns ways of managing the condition when it occurs. Thus patients are required to have the ability to detect early signs and symptoms of the condition so that measures can be taken to address the problem. The first thing that the practitioner needs to assist the patient to understand is the fact that diets with heavy fats are some of the major causes of blocked arteries. Therefore patient needs to be taught how to maintain diets heavy with fresh vegetable and fruits and the same time limit intake of processed foods, fried foods, greasy foods, and alcohol. Maintaining a diet low in fats reduces the accumulation of cholesterol in the arteries which makes the condition more challenging to manage.

One challenge that most patients who have conditions that require them to take medication every day are managing their medications. The role of medications is to put the body in a way that reduces the ability of episodes to occur. This means that the patient has to find a way of tracking the medication and following the prescribed order to realize the efficiency of the drugs. In the case of Ferguson, the practitioner can work with him to determine his routine and develop a way of ensuring that the routine is intertwined with the medication (Berra, Fletcher, & Miller, 2007). The patient needs to understand the triggers of the attack in his routine so that medications can be taken in real time. The practitioner should work with the patient to develop a management plan that Ferguson can follow. For example, the patient needs to understand the importance of walking with glyceryl everywhere so that attacks can be managed early when they occur. This also includes ensuring that the patient understands the signs and symptoms of an attack so that they can use the inhaler immediately. Since glyceryl works well if taken in the early moments of the attack, then the patient needs to be assisted to personally manage the condition.

Information That The Practitioner Will Share With The Patient On Managing The Condition

Exercise is another element that the practitioner needs to focus on by keeping the patient physically fit and increasing blood circulation thus reducing the accumulation of fats. Simple exercises like rising of a bicycle, brisk walking, jogging, and playing exercise that does not require a lot of physical activity are good for such patients (Brown, Clark, Dalal, Welch, & Taylor, 2011). Exercise leads to easy management of the condition since once the body is physically fit, then it is difficult for one to encounter episodes of chest heaviness. In the case of Ferguson, the type of exercise adopted should relate to his personal life routine so that it becomes easy for him to exercise.

Conclusion

Patients with chest heaviness problem can lead a normal life if they understand the nature of their problem and put proper mechanisms in place to manage the condition. This is a condition that cannot be treated but drugs can be used to reduce the magnitude of the attack. Through management education, practitioners ensure that patients adequately and properly use glyceryl as a remedy for the attack episode. This means that the drug has to be taken immediately when the episode occurs to increase the efficiency of the drug. Therefore, Ferguson needs to adequately manage the condition by taking medication adequately, exercising, maintain a proper diet and knowing the signs and symptoms of the conditions when episodes start so that glyceryl can be taken immediately.

References

Albrecht, S. (2013). The Pathophysiology and Treatment of Stable Angina Pectoris. Cardiovascular, 38(2), 43-60.

Arnold, J., Goodacre, S., Bath, P., & Price, J. (2009). Information sheets for patients with acute chest pain: randomised controlled trial. BMJ, 338.

Baren, J., S.G., R., B. J., & Brown, L. (2008). Pediatric Emergency Medicine. Philadelphia: Elsevier.

Berra, K., Fletcher, B., & Miller, N. H. (2007). Chronic stable angina: Addressing the needs of patients through risk reduction, education and support. 5th Québec International Symposium on Cardiopulmonary Prevention/Rehabilitation, (pp. 13-15). Québec .

Brown, J., Clark, A., Dalal, H., Welch, K., & Taylor, R. (2011). Patient education in the management of coronary heart disease. London: Wiley.

Carlos, J. (2004). Pathophysiology and Management of Patients With Chest Pain and Normal Coronary Arteriograms (Cardiac Syndrome X). Circulation, 109, 568-572.

Karnath, B., Holden, M., & H. N. (2008). Chest pain and its importance in patients with panic disorder: an updated literature review. Primary Care Companion to the Journal of Clinical Psychiatry, 105, 376-383.

Kaski, J., Arrebola-Moreno, A., & Dungu, J. (2011). Treatment strategies for chronic stable angina. Expert Opin Pharmacother, 12, 2833-2844.

Thull-Freedman, J. (2010). Evaluation of chest pain in the pediatric patient. The Medical Clinics of North America, 94(2), 327-347. Nursing Management Of Chest Heaviness Discussion Paper