The Acute Pain on the Chest during Angina - Essay Example

Assessment 2: Case study Essay Mrs. Brown is suffering from a condition known as Angina which occurs as a result of inadequate supply of oxygen to the parts of the heart. The patient experiences acute pain on the chest which lasts for about fifteen minutes a characteristic common with the patients of Angina. The patient also has a history of hypertension and she experiences stress from her current job as an executive (Warburton 2007). The two priority problems in Mrs. Brown’s case are; the acute pain on the patient’s chest which she rates it at 9 in a scale of 10 that relates to Angina and the patient’s lack of tolerance to activity which emanates from various factors like Mrs. Brown’s weight which indicates that she is obese, stress, lack of physical activity and the cardiac responses. This essay is therefore going to elaborate on the nursing problems in Mrs. Brown’s case as well as the nursing interventions for each problem illustrated (Anderson 2007). The patient’s first problem is the acute pain on the chest which she rates it at a scale of 9/10. This problem relates to the patient since the symptoms that the patient narrates are the characteristics of Angina. The patient points out that she is sweaty and that she feels an extreme pain on the chest which feels like someone was squeezing out on her chest. The patient’s history of hypertension implies that she has a problem with the circulation of blood in her body due to the narrowing of the airways. The two main priority interventions for this problem are the administering of nitroglycerin to the patient to relieve the acute pain and encouraging deep breathing and coughing exercises (Johnson 2008). Before embarking on any intervention, a nurse should be able to establish the history of the patient in order to match the patient’s condition with the symptoms that she depicts. This will help the nurse in making the right diagnosis for the patient. The baseline information that was obtained by the nurse in the case of Mrs. Brown will include the weight, blood pressure, pulse rate and respiration rate. This information helped the nurse to come to a conclusion that Mrs. Brown really suffered from Angina and Hypertension (Ang, et al., 2009). Intervention 1-administration of nitroglycerin to relieve the pain Cameron (2011) points out that when the patient is administered with a dose of nitroglycerin, the action of this medicine will help to dilate the coronary arteries and instantly increase the venous pooling consequently reducing the rate at which oxygen is used in the body as well as the myocardial preload. The pain that is experienced by Mrs. Rose is due to the lack of enough oxygen supply to the heart making her have a feeling of squeezing in the heart. This drug will help in the redistribution of blood to the area of the heart muscle (Blackwood 2009). The administering of the drug should be started in the ED sublingually or by using a spray after every five minutes for three doses. This intervention is relevant to the patient’s case because nitroglycerin has been proven to be effective in chest pain reduction. One of the positive considerations when using nitroglycerin is to reduce the dose gradually when the symptoms are alleviated. A negative consideration is that the drug should not be administered to patients who have used Sildenafil drug as this will cause hypotension and death. This intervention will help in relieving the patient of the acute pain she is feeling on her chest therefore this intervention is effective (Cantor, et al., 2009). Intervention 2- Encouraging Coughing Exercises and Deep Breathing Weir-Hughes (2007) points out that coughing is one way that helps in clearing the airways. Patients suffering from angina have their arteries being narrowed and therefore the flow of oxygen to the heart is limited. Effective coughing has been proved to clear the airways and with the adequate hydration, secretions are mobilized which helps in the humidification of the chest area (By 2010). Taking deep breaths will help Mrs. Brown to stabilize the breathing process due to pain in the chest which Mrs. Brown claims that it seems that someone is squeezing the chest. Various studies have been carried out which clearly shows that coughing and breathing exercises helps in the clearing of the airways and stabilizing of the breathing patterns (Bhatt et al 2010). The mechanism of breathing is that when the patient coughs, a considerable amount of air rushes in to the wind pipe which causes the closure of the glottis thus causing an increase in the pressure in the lungs thus the circulation of oxygen in the heart area is improved. The nurse should be able to educate Mrs. Brown on the importance of the coughing and breathing exercises as this will help in reducing the pain on the chest. After this intervention, the nurse should be able to see changes in the respiratory rate of Mrs. Brown as it is expected that at the end of the intervention, the rate will be at 12-20 respirations/min from 24 respirations/min recorded when the patient was feeling acute pain (Dandrea, 2010). One of the negative considerations of this intervention is that as much as coughing is important in the clearing of the airways, sometimes this technique can make the patient to run short of breath thus causing suffocation and death in some instances (Brito, Ciapponi & Kwong, 2011). The second problem experienced by the patient is the intolerance to activity which emanates from various factors like Mrs. Brown’s weight which indicates that she is obese, as well as experiencing some level of stress as a result of her job as the executive manager. Other factors include cardiac responses and the lack of physical activity which the patient feels some difficulty in breathing as a result of walking briefly in the hospital (Taggart 2009). Intervention 1- Identification of Safe Activity Level for the Patient The nurse should be able to identify the level of activity of Mrs. Brown in her daily living. The patient admits to not doing any physical exercises as she claims that she has no time since her job as the manager is too demanding. The nurse should educate the patient on the importance of doing exercises on a daily basis which will help the patient to reduce her weight to an acceptable level. The reduction in weight will help to reduce the fat that is lining the arteries that enabling the adequate supply of oxygen to the heart through the circulation of blood (Mulley, 2011). The patient experienced a short of breath when she took a walk around the ward which clearly indicates that the patient does not involve herself in much activity. She relies on take away food for herself and her husband. The nurse should plan the activity progression with the patient by starting with those activities which are less demanding and increasing the level of activity with the toleration from the patient (Newson, 2010). The positive consideration is that the patient should reduce her weight and be able to tolerate to various activities that she was unable to initially. The negative consideration to this intervention is that after the discharge from the hospital, the patient might not be able to adhere to the practice of indulging in various activities (Hodges, 2012). The level of activity has been identified as one of the most effective ways of improving the level of fitness of an individual. Exercises help to reduce the level of stress and the circulation of blood in the body thus improving the circulation of oxygen in the body. At the end of the intervention, the nurse should be able to identify the positive correlation between the level of activities undertaken and the tolerance of the activity by the patient (McCaffery, 2009). Intervention 2- Education on Healthy Living The nurse should embark on educating Mrs. Brown on the importance of a healthy living as this will help in solving some of Mrs. Brown’s problems. The selection of the right food that does not have a lot of fat will help in reducing the amount of fats that are consumed by the patient. The patient is also diagnosed with obesity, a condition that is caused by the consumption of excess carbohydrates in the diet. The patient can learn to balance her diet by having all the required supplements in her diet. The patient should also learn on balancing her work and finding time to do exercises as well as finding time to rest. The patient admits to eating take away food as she has no time to cook (Burgess 2007). This food obtained from the takeaway joints might not be healthy food which will only contribute to the patient’s accumulation of fat in the body. The patient also admits to having not taken her medicine since she thought that she had recovered from Angina. The nurse should elaborate to the patient the essence of completing a dose as directed by the physician. Healthy living has been proven to reduce the level of stress as well as helping an individual to reduce the fat levels in the body thus enhancing the circulation of blood in the body (Jenkins 2009). This intervention will help in reducing the patient’s weight and improve on the supply of blood to the heart. In conclusion, the patient is suffering from two major problems which include the acute pain on her chest which feels like someone is squeezing her chest and the second problem is the intolerance to activity which emanates from various factors like Mrs. Brown’s weight which indicates that she is obese, as well as experiencing some level of stress as a result of her job as the executive manage. The patient should start doing some exercises as this will help in burning of the fats in the body thus helping in the circulation of blood in the body which translates to the adequate supply of oxygen. Healthy living will also help the patient to determine the type of food that she is going to consume as well as reducing or eliminating stress altogether. References Anderson, J.L, et al. (2007). guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American college of cardiology/American heart association task force on practice guidelines (writing committee to revise the 2002 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction). J Am Coll Cardiol: pp 50 -157. Ang, D.C,e al (2009). Serial bedside B-type natriuretic peptide strongly predicts Prognosis in Acute Coronary Syndrome Independent of Echocardiographic abnormalities. Am Heart J: 158:133-40. Cantor, W.J, et al (2009). Routine early angioplasty after fibrinolysis for acute myocardial infarction. N Engl J Med; 360:2705-17. Bhatt, D.L, et al(2010). Clopidogrel with or without omeprazole in coronary artery disease.N Eng J Med; 363:1909-17. Brito V, Ciapponi A, Kwong J.(2011). Factor Xa inhibitors for acute coronary syndromes. Cochrane Database Syst Rev, (1):CD007038. Newson, R. (2010). A practical approach to angina. Practice Nurse, 39(8), 23-26. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/347492284?accountid=45049 McCaffery, D. (2009). The management of stable angina in the outpatient setting. Irish Medical Times, 43(48), 34-34,36. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/227307535?accountid=45049 Jenkins, R. (2009). Aggressive treatment imperative for angina in men. Australian Doctor, Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/195126111?accountid=45049 Burgess, J. H. (2007). How to treat an angina patient while waiting for a cardiology referral. Patient Care, pp. 23-23. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/231035156?accountid=45049 Warburton, L. (2007). How to diagnose and treat angina. GP, pp 26-26. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/225163199?accountid=45049 Johnson, S. (2008). Reducing heart pain: PALO ALTO COMPANYS ANGINA TREATMENT GETS FDA APPROVAL. McClatchy - Tribune Business News, pp. 1-1. http://search.proquest.com/docview/460113557?accountid=45049 Cameron, S. (2011). Do you really know angina? commonly used, there are so many definitions for this type of pain that were really not sure who feels what anymore. Medical Post, 37(27), 47-47. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/228830769?accountid=45049 By, R. W. (2010). New drug bolsters exercise capacity of angina patients. Wall Street Journal, pp. B.5-B.5. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/398799960?accountid=45049 Taggart, K. (2009). MIRACL drug eases angina, chest pain after coronary. Medical Post, 36(41), 21-21. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/228714152?accountid=45049 Mulley, S. (2011). Rethink emphasis on weight loss in obese patients. Medical Post, 47(4), 57-57, 59. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/861735481?accountid=45049 Hodges, D. (2012). Weight loss leads to lasting benefits in heart function. Medical Post, 48(2), 50-50. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/923561878?accountid=45049 Dandrea, K. (2010). Weight-loss competitions gaining in popularity. Long Island Business News, Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/275918702?accountid=45049 Blackwood, H. S. (2009). Obesity: A rapidly expanding challenge. Nursing Management, 35(5), 27-35; quiz 35-6. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/231379775?accountid=45049 Weir-Hughes, D. (2007). Reviewing nursing diagnoses. Nursing Management, 14(5), 32-5. Viewed on 11th May 11, 2012 from http://search.proquest.com/docview/236944775?accountid=45049 Read More