Health Care Plan of a Patient - Case Study Example

Patient 2 (Heart Disease) Gordon Walker Age 45 Gender: Male Diagnosis Coronary Heart Disease. Social History Mr. Walker lives in a rural area with his wife and 3 teenage children. He is currently unemployed. Mr. Walker has "heavy alcohol intake" and is a smoker. Medical history Mr. Walker has a history of hypertension, and hypercholesterolaemia. Type 2 Diabetes diagnosed in 2005 Mr. Walker tells you that he takes Panadol for headaches a few times a week. He also tells you that he doesn't regularly take the medications that the doctor prescribed because he feels okay and doesn't need them. 1. Knowledge of illness (outline key points that a patient with this condition should understand in order to monitor and maintain their condition) Gordon has coronary heart disease. This means the blood vessels that supply his heart muscles have narrowed down, so any point in time, the amount of blood that is supplied to his heart muscles are less than the required amount. Gordon understands that this puts him into a situation of myocardial ischemia or relative deficiency of blood supply to the heart muscles or if accentuated leading to myocardial infarction of heart attack (Conti, 2004). This condition usually happens with age and lifestyle related risk factors. Smoking and alcohol both lead to hypertension and atherosclerotic cardiovascular disease. The headache for which he takes Panadol may well be associated with hypertension, and he has a history of hypertension (Grundy, et al. 2004). Gordon also has hypercholesterolemia, which independently and in association with smoking, alcohol, and probable hypertension would predispose to atherosclerotic cardiovascular disease, where deposition of fat in the arterial walls would cause narrowing of the coronary arteries (Davis, 2002). Unfortunately Gordon also has diabetes mellitus, which makes him more prone to atherosclerotic coronary heart disease, would lead to more hypercholesterolemia, would aggravate the effects of hypertension, and would lead to a predisposition of adverse coronary events associated with coronary artery disease. Last but not the least, Gordon is noncompliant to medications and treatment, and his health behaviour is precariously risky. Specific goals (these may include treatment goals and or management goals) The following goals are designed for Gordon 1. Measurement and control of blood pressure 2. Measurement and control of hypercholesterolemia. 3. Measurement and control of blood sugars. 4. Following a healthy diabetic diet. 5. Health promotion to abstain from smoking and alcohol 6. Promotion of physical exercise. 7. Promotion of treatment complaince (Urden, Stacy & Lough, 2002). Coronary heart disease (CHD) is usually associated with one or more characteristics known as risk factors. A risk factor is an aspect of personal behaviour or lifestyle, an environmental exposure or an inborn or inherited characteristic, which on the basis of epidemiologic evidence is known to be associated with" the occurrence of disease. The risk of MI is thus doubled in the smokers, or a 200% increase in risk compared with nonsmokers. Higher systolic blood pressure (Nichols, 2003), higher low-density lipoprotein (LDL) cholesterol, higher fasting glucose levels and 2-hour insulin values, higher body mass index (BMI), and lower high-density lipoprotein (HDL) cholesterol are all associated higher mortality in this group of patients (Roth & Laurent-Bopp, 2004). Given this scenario, there must be a measure to assess his blood pressures and blood sugars. Laboratory tests may be included to measure his serum lipid levels. His medication history is important in that over-the-counter medication must be stopped. These also may aggravate hypertension. For hypertension regular intake of antihypertensive medication may be necessary. For a steady control of blood sugars abstinence from alcohol is a must along with regular medication, diet, exercise, and regular monitoring of the blood sugars. As expected, in his case, there is a high chance of the lipid profile being abnormal, and for that reason, apart from a healthy low-fat diet and exercise, statin agents may be necessary (Snow et al. 2004). Moreover, all these chronic problems need complaince to therapy and advice and a healthy lifestyle which must be promoted to him for healthy behaviour (Woods, Froelicher & Motzer, 2000). Psychosocial support (give the support a person and/or their family members can access and what agencies offer this support) Theoretical concepts of stress suggest that a person's coping resources modulate biologic and cognitive responses to stressors. One coping mechanism, social support, has received considerable attention as a buffering agent against the effects of environmental stresses. Social support is assessed by evaluating the structure and function of social relationships. Structural support reflects social interactions, social ties, and networks. Functional support focuses on the specific function of the support. Nursing must consider the differences in function of support that provides resources or tangible aid and support that provides emotional comfort and care. Social isolation has negative health consequences. Personality factors, including personality predispositions and psychological states and traits, have been linked to development and recovery from CHD. Personality predispositions are considered more stable traits, whereas psychological states may be more transient and acute. More recent investigations suggest that these emotions influence both the development and recovery from CHD (Steingart, 2003). Several population studies have demonstrated a relationship between high levels of the negative emotion of anxiety and an increased incidence of heart disease (Simmons Holcomb, 2002). Gordon's smoking and alcohol both indicate this, and stress relief can be very important strategy. The advice should begin with family and friends who may support him during his stress. Action Plans (outline what the patient has been told to do in the event of a sudden worsening of their condition and /or emergency) In the event of an acute myocardial event, Gordon must take one sublingual nitroglycerin and immediately report to the nearest emergency (Jones & Slovis, 2001). In the event of a hypertensive crisis, Gordon must contact his physician and acute treatment should be initiated as soon as possible (Granger & Miller, 2001). If the diabetes worsens or blood sugars drop down, it would constitute an emergency, and he may need admission. Withdrawal of alcohol may also lead to emergency symptoms that would need admission. Gordon was also advised how complaince to therapy and maintenance of healthy life style could prevent such occurrences. Healthy lifestyle (outline the lifestyle changes that would assist this person to improve or maintain their chronic condition) Coronary artery disease is a disease of the lifestyle. Lifestyle modification in the form of regular physical exercise, low-fat low-carbohydrate diet, increased fibre in the diet all reduce cholesterol and hence would reduce chances of deposition of fat and would reduce the risk of adverse cardiac events. These diets will also help control blood sugars. The combined effects of diet and exercise lead to control of blood pressure, but he will have to abstain from smoking and alcohol. He must be compliant with medication, exercise, and diet regimens (Hughes, 2003). Reference List Conti, C. (2004). Silent myocardial ischemia: Diagnosis, treatment, and prognosis. Consultant, 44(9), 1201-1208. Davis, L.L. (2002). Chest pain. In M.J. Goolsby (Ed), Nurse Practitioner Secrets. Philadelphia: Hanley & Belfus, Inc. Jones, I.D., & Slovis, C.M. (2001). Emergency department evaluation of the chest pain patient. Emergency Medicine Clinics of North America, 19(2), 269-282. Granger, B., & Miller, C.(2001). Acute Coronary Syndromes. Nursing 2001, 31(11), 36-44. Grundy, S., et al. (2004). Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III Guidelines. Circulation, 110(2), 227-239. Hughes, S. (2003). Novel cardiovascular risk factors. The Journal of Cardiovascular Nursing, 18(2), 131-138. Nichols, J. (2003). The new standard for diagnosing MI. Clinical Advisor, 6(3), 76-82. Roth, E., & Laurent-Bopp, D. (2004). Challenges of treating dyslipidemia in patients with the metabolic syndrome. American Journal for Nurse Practitioners, 8(4), 58-66. Simmons Holcomb, S. (2002). Helping your patient conquer cardiogenic shock. Nursing 2002, 32(9), cc32-33. Snow, V., et al. (2004). Lipid control in the management of type 2 diabetes mellitus: A clinical practice guideline from the American College of Physicians. Annals of Internal Medicine, 104(8), 644-649. Steingart, R. (2003). Uncovering MI and sudden death risk in asymptomatic individuals. Clinical Advisor, 6(8), 16-24. Urden, L., Stacy, K., & Lough, M. (2002). Thelan's critical care nursing diagnosis and management, 4th ed. St. Louis: Mosby. Woods, S., Froelicher, E., & Motzer, S. (2000). Cardiac nursing, 4th ed. Philadelphia: Lippincott Williams & Wilkins. Read More