A Nursing Care Plan - Case Study Example

Planning Care Introduction This is a nursing care plan for Mr. Gordon Walker, a 45-year-old male, who has been transferred to the metropolitan coronary care unit from a rural hospital with a diagnosis of myocardial infarction for a coronary angiography. He lives in a rural area with his wife and three teenage children, who are currently not with him. So he is unhappy regarding his transfer away from his home and rural hospital and wants him sent back there. He is unemployed, a smoker, and has a current history of heavy alcohol intake. Mr. Walker has been diagnosed with type 2 diabetes mellitus in 2005. Apart from this, he has a past history of hypertension, hypercholesterolemia, and chronic renal impairment. He has history of self-medication with Panadol few times a week and admits of medication noncompliance. His current admission is due to acute onset of chest pain and shortness of breath leading to emergency admission to the rural hospital where he was diagnosed with acute anterior myocardial infarction and was treated with thrombolytic therapy. There was abatement of symptoms, and he was sent to the metropolitan hospital for coronary angiography and further investigations. 1. Knowledge of illness Mr. Walker understands that his disease is a result of atherosclerotic cardiovascular disease, which is caused by life-style associated risk factors. His diabetes mellitus, hypercholesterolemia, hypertension, and type 2 diabetes mellitus are interrelated to his dietary habits, perhaps obesity, and it in turn is causing chronic renal dysfunction, which may be further aggravated by his hypertension. His type 2 diabetes is an independent risk factor for his hypercholesterolemia, and both combined together would aggravate his atherosclerotic cardiovascular disease and deteriorate the outcome in terms of adverse cardiac events. Moreover self-medication and non-compliance to medications would also worsen the clinical picture. He also understands that smoking and alcohol use are risk factors for atherosclerotic cardiovascular disease, and they both may accelerate atherosclerotic cardiovascular disease and worsen his prognosis (Tacoy et al., 2008, 402-407). Mr. Walker has been educated on the relationship between the kidneys and hypertension. His chronic renal disease will cause hypertension, and hypertension will contribute to the development of chronic renal disease. Given his baseline myocardial infarction, hypertension is major modifiable risk factors for atherosclerosis. Therefore, he was educated on the need for medication compliance and regularity of treatment (Zoccali, Mallamaci, and Tripepi, 2002, 381-386). Mr. Walker has been educated that non-pharmacologic or lifestyle measures are important not only to prevent hypertension, but his overall condition of atherosclerotic cardiovascular disease, hypercholesterolemia, and diabetes, all will respond to such measures. He has been educated on basic dietary measures such as low-fat diet, low-salt diet, diet high in fruits and vegetables, and abstinence from alcohol would reduce his high blood pressure, hypercholesterolemia, blood sugar, and weight, which all together would reduce his risks of coronary artery disease (Chyun et al., 2003, 302-318). Mr. Walker has been educated on physical activity and has been demonstrated what kinds of activity may be suitable for him. He has also been alerted about resumption of physical activity very slowly following his myocardial infarction. He has been told that regular exercise increases work capacity. Training increases exercise capacity by increasing both maximal cardiac output and the ability to extract oxygen from the blood. Although he appeared less motivated about doing a regular exercise program, it was stressed repeatedly to him that regularity and persistence in such a program will help him (Ignarro, Balestrieri, and Napoli, 2007, 326-340). Mr. Walker has been given information on cessation of smoking since cigarette smoking is perhaps the most preventable known cause of CHD today, leading to more deaths from CHD than from either lung cancer or chronic obstructive pulmonary disease. CHD risk increases with number of cigarettes smoked, longer duration of smoking, and younger age at initiation of smoking. It has been repeatedly told to him that males are more prone to have myocardial infarction, and he should quit smoking (Fonteyn, 2004, 46). 2. Specific goals Goals are to restore patient to optimal physiologic, psychological, social, and work level; aid in restoring confidence and self-esteem; develop patient's self-monitoring skills, and assist in managing cardiac problems; modify risk factors. Mr. Walker will be explained and informed what had happened to his heart in relation to basic cardiac anatomy, angina, and myocardial infarction. He would be talked about the process of healing of heart, and a discussion will be initiated as to what he can do to assist in the recovery process and reduce the chance of future heart attacks. Mr. Walker will be instructed on body's response to activity with importance of rest and relaxation alternating with activity with gradual increase in activity. He will be advised on right posture during activity and at least 8 hours of sleep (Johansson et al., 2007, 467-475). 3. Psychosocial support When Mr. Walker will recover, there will be many opportunities to facilitate and provide psychosocial interventions. During the course of caring for the cardiac patient, it is important to evaluate the patient's sources of social support, as well as the presence of high levels of negative emotional states, including anxiety, depression, and anger. He will be supported functionally in terms of education and knowledge. An anticipatory guidance will be provided on the disease and recovery process, so it can alleviate both patient and family stress (Karner, Dahlgren, and Bergdahl, 2004, 204-211). He has a very close family tie, and therefore transfer to a remote hospital has made him emotionally unstable, and nursing care will accommodate emotional support. Cardiac hospitalizations invoke apprehension and fear in most patients. Allowing the patient an opportunity to express these concerns can be beneficial for both the patient and their family. Because it is impossible totally to avoid mental stress in daily life, control of other coronary risk factors is especially important. Mental stress results in elevations in blood pressure and low-density lipoprotein and very-low-density lipoprotein cholesterol levels, highlighting the importance of controlling these risk factors. In response to mental stress, blood pressure surges that can occur at relatively low heart rates can be avoided through interventions on mental stress. Social support organizations may play important roles (Aalto et al., 2007, 316-329). 4. Action Plans Mr. Walker will be advised about sexual relations which should resume following consultation with the medical provider following assessment of his exercise tolerance. He will be advised about his medication regimen, need to remain regular on it, and on adverse effects. He will be advised to notify the healthcare provider with chest pressure or pain not relieved in 15 minutes by nitroglycerin or rest, shortness of breath, unusual fatigue, swelling of feet and ankles, fainting, dizziness, and very slow or rapid heartbeat. Mr. Walker has also be educated on the symptoms which needs immediate attention, such as, severe chest pain, respiratory distress, reduced urine output, and swelling of face or limbs. He has been advised on regularity of medication, compliance, regular medical checkup and advice. He should also stop self-medication (Deaton and Namasivayam, 2004, 308-315). 5. Healthy lifestyle The lifestyle change is the mainstay for his management regimen. He will have to alter his dietary pattern will low-fat, low-salt, low-carbohydrate and high vegetable diet to reduce weight, blood lipids, and blood sugar. This associated with increased physical activity will reduce his body weight. Taken together, these will control his hypercholesterolemia, blood sugars, and hypertension (Reimer et al., 2002, 87-94). He will have to abstain from smoking and alcohol. These changes will control his weight, improve metabolism and diabetes, reduce cholesterol, and reduce the risk of adverse cardiac events. He will have to comply with his medication regimen and stop self medications since regular treatment regimens are important in type 2 diabetes, atherosclerotic heart disease, hypertension, and chronic renal failure. Reference List Aalto, A., Weinman, J., French, DP., Aro, AR., Manderbacka, K., and Keskimki, I., (2007). Sociodemographic Differences in Myocardial Infarction Risk Perceptions among People with Coronary Heart Disease. Journal of Health Psychology; 12: 316 - 329. Chyun, DA., Amend, AM., Newlin, K., Langerman, S., and Melkus, GD., (2003). Coronary heart disease prevention and lifestyle interventions: cultural influences. Journal of Cardiovascular Nursing; 18(4): 302-18. Deaton, C. and Namasivayam, S., (2004). Nursing outcomes in coronary heart disease. Journal of Cardiovascular Nursing; 19(5): 308-15. Fonteyn, ME., (2004). A nurse led smoking cessation intervention increased cessation rates after hospital admission for coronary heart disease. Evidence Based Nursing; 7: 46. Ignarro, LJ., Balestrieri, ML., and Napoli, C., (2007). Nutrition, physical activity, and cardiovascular disease: An update. Cardiovascular Research; 73: 326 - 340. Johansson, A., Windahl, M., Svanborg, E., Fredrichsen, M., Swahn, E., Uhlin, PY., and Edell-Gustafsson, U., (2007). Perceptions of how sleep is influenced by rest, activity and health in patients with coronary heart disease: a phenomenographical study. Scandinavian Journal of Caring Science; 21(4): 467-75. Karner, AM., Dahlgren, MA., and Bergdahl, B., (2004). Rehabilitation after coronary heart disease: spouses' views of support. Journal of Advanced Nursing; 46(2): 204-11. Reimer, WJS., Jansen, CH., de Swart, EA., Boersma, E., Simoons, ML., and Deckers, JW., (2002). Contribution of nursing to risk factor management as perceived by patients with established coronary heart disease. European Journal of Cardiovascular Nursing; 1(2): 87-94. Tacoy, G., Balcioglu, AS., Akinci, S., Erdem, G., Kocaman, SA., Timurkaynak, T., and engel, A., (2008). Traditional Risk Factors Are Predictive on Segmental Localization of Coronary Artery Disease. Angiology; 59: 402 - 407. Zoccali, C., Mallamaci, F., and Tripepi, G., (2002). Hypertension as a cardiovascular risk factor in end-stage renal failure. Current Hypertension Report; 4(5): 381-6. Read More