Management of Coronary Heart Disease - Essay Example

Management of Coronary Heart Disease Coronary Heart Disease (CHD) is one of the diseases that are needed to be given attention due to the effects on the population. The study undertaken is aimed to focus on the process of assessment, planning, implementation and evaluation of patients with the said disease specifically in the clinical nursing area. The application of the different concepts had been achieved through actual study of a patient with the related ailment. Introduction The CHD is a state wherein the heart is having malfunctions due to hindered supply of oxygen from clogged arteries. The said blockage is referred to as plaque which can be composed of different types of materials that can be carried by the blood including fat, cholesterol, calcium, etc. The blockage of the arteries then is one of the main causes of the CHD thus it is often referred to as atherosclerosis. Other terms that are applied to the said diseases are coronary artery disease, hardening of the arteries, heart disease, Ischemic heart disease and narrowing of the arteries. There are different causes of the disease such as smoking, high levels of fats and cholesterol in the blood, high blood pressure and high blood sugar. Unhealthy lifestyle and the effects of the modern human activities can lead to such effects in the heart. For that matter, vigilance and medical attention is one of the basic and most important methods to prevent and save patients (National Heart Lung and Blood Institute, 2008). In addition, there are different related conditions to the occurrence of plaques in the arteries such as angina or heart attack or chest pain, heart failure and arrhythmias. It can also be connected to other diseases such as diabetes. Due to the said relationship, increase in cases lead to the being the leading cause of Death in the US for both sexes (National Heart Lung and Blood Institute, 2008). Objectives The study undertaken is aimed to present a study in the care delivery and management of patients with CHD. Upon the achievement of the said goal, the analysis of the different concepts that are related to cardiology nursing can be achieved. This is with special focus on the empirical and evidence-based approach. Incorporated in the study are the results of clinical trials on the said field. In addition, the study of case of a patient with a particular aspect of care and provision of the different forms of interventions is one of the main issues included. Management of Coronary Heart Disease To achieve the objectives of the study, the presentation of a specific case of clinical study is important in the understanding and application of the concepts. Patient and Other Background Information The patient is a 55 year old woman who is discomfort for the past 6 months in relation to pain of the chest, back and neck. It started with minor discomfort and then became more unbearable with cases commonly occurring in the morning. Due to health concerns, the patient sought medical opinion. The patient is considered and classified as an emergency case. Without any history of heart ailments, standard diagnostic processes were undertaken. The said procedures include blood examinations to be able to determine the CBC, lipid profile, serum Na, K, RBS, Trop T and CKMB. Based on presented history of the patient, angina and possible coronary artery spasms were considered. The pain experienced by the patient is based on the lack of oxygen in the affected area of the heart. Due to the said indications, atheroschlerosis was considered. In addition, myocardial infarction has also been considered. The working diagnosis is acute coronary syndrome. Included in the basis of the said diagnosis is angina which is chest pain. It is considered as one of the most important indicator of an abnormality in the cardiovascular systems. Based on the study undertaken, there are different types of angina namely stable, unstable and variant. Stable angina often occurs in shorter duration compared to the other types and can be alleviated easily. On the other hand, the unstable angina is more unpredictable and there are medications and recommendations involved such as rest and nitro-glycerine. In addition it can be considered as more serious in terms of the duration and severity. The variant type has indications of ECG changes which can be attributed to coronary artery spasm (National Heart Lung and Blood Institute, 2008). In addition, the treatment for angina is important specifically in the case of the patient who is a female. Based on the study, there is a higher risk for woman in contradiction to the misconception that the male members of the population are more affected by the heart conditions. Due to stressful lifestyle, non-specific chest pains are more common. Basically, it is safer if the cause of the said pain is already known but NSCP diagnosis can be dangerous and leading to coronary artery disease. One cause is the increase in risk of postmenopausal women inclusive of the age 50-79 (Woodward, 2008). Based on the said study then, although the patient lacks history of heart disease, the increased risk is one of the reasons for the consideration of the condition of the patient. In addition, the results of the results of the diagnostic tests also showed indications of the angina. In addition, the working diagnosis is based on the consideration of the pathogenesis of the different types of heart diseases such as the ischemic heart disease, myocardial infarction and even death (Yasue, Nakagawa, Itoh, Harada and Mizuno, 2008). Treatments and Interventions There are different types of treatments and interventions that can be used to respond to cases of coronary heart disease on the basis of the level and severity of the ailment. Medical procedures include angioplasty and CABG. Angioplasty is the process that leads to the opening of the arteries that had been blocked by plaques of different types. The process is undertaken through the insertion of a narrow tube that can enter the blood vessel and restore the flow and functioning of the arteries. This is made possible through a balloon at the tip of the tube that can be inflated to expand the diameter of the artery affected. The CABG on the other hand makes use of other arteries to be able to bypass the arteries that cannot function in optimum. The effects of the said procedures can relieve angina, improve the functions of the arteries and prevent the detrimental effects of heart attacks (National Heart Lung and Blood Institute, 2008). In the case under study, the patient had been diagnosed to have coronary artery spasms and heart attack due to the blockage in the arteries. For that matter, the patient had been prepared for angioplasty. The different required procedures and precursors had been undertaken and the process resulted in the restoration of the functions of the infected arteries. Although this is the case, the diet and practices of the patients are monitored and recommended procedures to decrease the risk of recurrence is presented. In terms of medical interventions, there are different types of medications with different pathways that are targeted to be able to achieve the projected result and effect. Included in the said medications are CA-channel blockers or CCB that can help in the reduction of the coronary spasm commonly indicated through the result of the ECG which includes ST segment elevation/depression and negative U in the AV block. With the said medication, the NO pathway can be lessened reducing the effects associated with the detrimental effects of the CHD and the coronary spasms (Yasue, Nakagawa, Itoh, Harada and Mizuno, 2008). In addition to the advice given to the patient, another form of intervention is the cardiac rehabilitation which can be referred to as the post operative methods to cure the effects of the heart attack and to be able to recover from the effects of the disease. Aside from the fact that the cardiac rehabilitation can cure angina, it is a requirement after the procedures such as CABG and angioplasty. The said intervention can assist the medical procedures that had been undertaken to be able to hasten the recuperation of the body of the patient (National Heart Lung and Blood Institute, 2008). The team that undertake and perform the cardiac rehabilitation includes medical experts and physical therapy experts. The process is undertaken through two levels the exercise training and the education and counselling. Exercise activities can help train the body and improve resistance to recurrence of an attack. On the other hand, education and counselling is aimed to provide awareness on the changes that are needed to be undertaken to prevent heart related problems to escalate. Care Plan There are different stages of the care plan that is associated with the patient under study. It is presented along with the recommendations and interventions that are undertaken, A. Diagnostic Examinations Although the case is not ambulatory, the consultation is an emergency case that led to the admission on the working diagnosis ACS. This can be attributed to the indicators including the results of the blood and lipid tests. ECG had also indicated an abnormality in two pertinent areas of the graph. For that matter, although the patient is not showing severe signs of the effects related to the heart attack the results of the diagnostic observations became the bases of the admission of the patient. B. In-Patient Care Upon admission, the patient had been observed. Based on the recommendation of the cardiologist due to routine check of condition, the patient had been prepared to undertake angioplasty. Through the course of the admission of the patient, continuous checking and monitoring of the different parameters specifically in relation to blood chemistry and the ECG. The said monitoring is important on the basis of pathology on ischemic heart disease and cardiac related life threatening event. C. Medical Procedure In addition to medications to maintain the body integrity of the patient, the heart medications specifically targeted to block processes that can lead to heart attack are maintained. The patient is fully conscious thus the medications were both oral and intravenous. Intensified monitoring had been undertaken specifically prior the medically procedure undertaken which is angioplasty. Post operative effects are also taken cared of to be able to concentrate on the determination of the sole effects of the procedure undertaken. After the procedure the patient had been allowed a few days to recover and within the week was released with the advice to continue a regular consultation with the surgeon and the cardiologist as an outpatient. D. Post Operative Treatments When the patient had been released, the cardiac rehabilitation is at hand to be able to help the patient recover in the different aspects of her life. It can help physical recovery through the therapies undertaken. In addition, the knowledge of the practices to improve diet and habits are also included to prevent recurrence. In the case of the patient under study, the higher risk of heart attack in relation to age and gender became the basis for intensified attention to her own health. The Analysis of the Care Plan In the study undertaken, the patient was given emergency treatment and in patient care due to the sever angina on the event of consultation. On the basis of the measurement of the medically required parameters, the medical procedure referred to as angioplasty has been undertaken along with the required medication to relieve angina prior to the procedure and post operative pain after the procedure had been undertaken. Furthermore, the awareness in relation to the diet and activities that are suggested to improve health and prevent recurrence of the heart ailment had been included in the post operative treatment and cardiac rehabilitation. The actions undertaken related to condition of the patient can be considered as case specific. For that matter, the different factors that are needed to be given attention such as the vital body information, medication and medical procedures and the observed efficacy of the processes undertaken. This is to be able to ensure the integrity of the health of the patient. In cases wherein there are new methods that can be applied, in depth studies are needed to be undertaken before it can be applied in the clinical practice. In addition, the responsibility of the medical experts and workers is needed to be always considered for the utmost care that can be given to the patient. In the particular patient, angioplasty had been the medical procedure given. In other cases though, the parameters and actions prior to the operation and the processes undertaken on post operative can also be applied. Conclusion The focus of the study undertaken is the care given to a specific case of coronary heart disease. The different levels of treatments and the medical care and procedure given is a representation of the needed process to lessen the mortality and morbidity in relation to CHD, a considered top killer disease in the US. The objectives of the study to present the nursing care concepts studied and applied had been achieved through the procedures given and analysed in relation to the patient under study. Bibliography National Heart Lung and Blood Institute (2008) Coronary Artery Disease [online]. US Department of Health and Human Services and National Institutes of Health. Available from: Woodward, M. (2008). Cardiovascular risk in women with non-specific chest pain. Womens Health (Lond Engl) 2008 Nov 4: 561-4. Yasue, H., Nakagawa, H.., Itoh, T., Harada, E. and Mizuno, Y. (2008). Coronary artery spasm-clinical features, diagnosis, pathogenesis, and treatment. J Cardiol 51: 2-17. Read More