Nursing Care of a Person with Angina - Case Study Example

Running Head: Nursing Care of a Person with Angina Title Nursing Care of a Person with Angina Your name Instructor’s name Date of Submission Emotional stress that the patient is undergoing due to her not liking her husband and as a result of the burden that she faces in her new job puts at a risk of developing angina. Stress often leads to the hormonal changes which is characterized by increased adrenaline levels in the blood stream that normally leads to inflammation of the blood vessels further predisposing one to atherosclerosis that is characterized by the formation of atherosclerotic plaques which in the long run will lead to the ischemia of the obstruction of hearts blood vessels and thus cutting of blood supply to the heart muscles (Kasper, 2005). The patient also has the risk factors that predispose one to angina, this includes the high blood pressures that the patient has which makes a high volume of blood to flow within the blood vessels and this tends to bring about the thickening f the blood vessels and also leads to the arteries becoming hardened due to the development of arthrosclerosis that will now lead to development of angina. The other risk factor that predisposes one to the development of the atherosclerotic plaque will be the diet of the patient which she says she only eats take away and this has greatly contributed to her weight gain but has made her more predisposed to atherosclerosis and this will lead to stenosis of the hearts arteries resulting in angina (South-Paul, 2007). Management of stress will include the patient being able to take enough more regular and effective rest as this will enable the pressure that has been build up at her new working place to be relieved .this will enable the patient to be able to relax and at least take her mind of the busy work that she has. She should also be able to take enough sleep in order to prevent her from over working of her mind. The patient can also attend the cognitive therapy where she will be made to be aware of her cause of stress for example the cause could be a personality disorder that she might be having that is leading to the problem. The personality disorder is likely to cause effects on the coronary artery to stenos and this could lead to the development of angina. She could also be made to learn on how she can be able to avoid the stressor elements and also deal with the stressor elements which she claims to be the husband and the workload that she gets at her new job and also what she can do to avoid the stress. This will involve the mediation of the husband and the wife since the cause is said to be the husband and this might be as a result of a conflict which the patient and the husband might be having. This will employ the use of mediation and diplomatic skills to defuse the tension between the husband and the wife over various issues they might be having. The patient should also be encouraged to think positively and should interact and socialize with other people as this will enable her to keep her mind from things that would cause her to have stress (South-Paul, 2007). The use of medication will entail the use of various anti depressants in the management of the stress. This will involve the use of drugs that will help in keeping in check of neurotransmitters which will normally be deranged when one is having severe stress like the one the patient has. The drugs used mainly target different receptors in order to avoid the secretion of neurotransmitters .The drugs would range from selective serotonin reuptake inhibitors which act by inhibiting the serotonin transporter and include drugs such as fluoxetine, citalopram.Other stress management drugs would include selective norepinephrine reuptake inhibitors which include venlafaxine, milnacipran. Also the tricyclic antidepressants could also be used an include drugs such as desipramine and imipramine. Monoamine Inhibitors such as phenelzine in the management of stress. Most of these drugs will inhibit the release of neurotransmitters ant this will reduce the effects of neurotransmitters. The neurotransmitters normally lead changes in the blood vessels and hence this will predispose one to develop atherosclerosis which will eventually lead to development of angina. Use of lithium has also been seen to cause improvement among the patients who have stress (Kasper, 2005). Measures to reduce risk factors will involve the management of hypertension will be through encouraging the patient to take up exercises as this will lead to the lowering of the blood pressure levels. The drug therapy will involve the use of the antihypertensives .this will be mainly having a goal of being able to reduce the blood pressure from 146/89 to a level of around 130/80.The drugs of choice will include the thiazide diuretics whose action will involve the lowering of blood pressure as a result of the dilatation of blood vessels. The diuretics also lower the fluid volume within the body and this will also end up in the lowering of blood pressures. Diuretics can also leads to the sparing of potassium and increased loss of the sodium ions and water this will facilitate the lowering of blood pressure. Angiotensin converting enzyme inhibitors will tend to lower blood pressure by dilating the arterioles, this effect results from the inhibition of the Angiotensin converting enzyme from kidneys that causes the conversion of Angiotensin 1 to Angiotensin 2.Aspirin could also be used in hypertension to prevent the formation of clots within the blood vessels as this will make them to get adherence of platelets to a patch of artheroma within the artery leading to the formation of a thrombus( Habermann, 2008).Glyceryl trinitrate brings about the dilatation and relaxation of arteries and veins and hence the reduction of resistance to flow of blood is achieved. In the long run this makes the heart to easily pump blood to the rest of the body. The widening of the veins and arteries will also lead to an increase in the amount of blood and oxygen that is being supplied to the heart muscles (Conway, 2007). The patient should also be advised to take a diet that has less fats .she is also to avoid the take away foods since they would mostly contain fats .the patient should also be encouraged to have regular exercises in order to reduce the excess weight that she is having the loss of weight will also bring about the reduction of the work load to the heart and also lower the blood pressures. Medication could also be used to bring about the suppression of the cholesterol. This will involve the use of statins.Statins enable this by hindering the formation of cholesterol in the liver. This will reduce the risk of the formation of an artheroma (Newson, 2010). The assessment for the management of risk factors will involve assessment of the management of hypertension Will be done by the regular taking of the blood pressures and the management will be mainly targeting a blood pressure of below 130/80 hence anything above that will still pose a threat to the patient. The measuring of the blood pressures will give an idea of how the blood pressures in the patient have been controlled or managed by the use of the anti hypertensives.Diet and exercise will be assessed by the measurement of the weight of the patient as this will be indicative of the changes in weight such as loss of the weight or further gain of weight by the patient. The history about the feeding habits will also will go to an extend to tell whether the patient is still adhering to the old diet of take away foods or has changed to conform to a diet that contains les fat. The patient will also be able to give information about the exercises that he does, how frequent the exercises are done .the levels of cholesterol will also be assessed by the use of the lipid profile which will shows the concentration of cholesterol in the blood. This will give an idea of how effective the exercises that the patient carries out will be effective in the prevention of the occurrences of elevated blood pressures (Habermann, 2008). Stress management evaluation will involve evaluation of the effectiveness of cognitive therapy in the management of stress will be done by assessing the patient for the presence of stressor elements and also how the patient has tried to tackle the stress condition she was in previously. An improvement will be noted when the patient actually confirms that she is strong and can face the challenges and is very optimistic and confident of this. Evaluation of the use of medication will be done through the measurement of the levels of the neurotransmitters that are being released. This is because most medication used in stress tends to inhibit the release of neurotransmitters in the brain. The low levels of the neurotransmitters will be indicative of an improvement in the patient and that the medication is effective. Stress could also be assessed by identifying a person’s attitude since the negative attitude patient would characterize the presence of stress. The poor physical well being of the patient will tell more about the level of stress since it will affect ones feeding habits (Kasper, 2005). References Kasper D, (2005). Harrison’s manual for medicine. McGraw-Hill Companies, Inc. South-Paul J, (2007). Current Diagnosis & Treatment in Family Medicine, 2nd Edition Habermann T & Ghosh A, (2008). Mayo Clinic Internal Medicine Concise Textbook, Mayo Foundation for Medical Education and Research Newson, L. R., (2010). Practice Nurse, A practical approach to angina, CINAHL. Conway, B., & Fuat A. (2007).Recent advances in angina management: Implications for nurses, Nursing Standard, CINAHL. Read More