Nursing Care of a Person with Angina: The Situation of Mrs. Brown - Case Study Example

Running Header: NURSING CARE OF A PERSON WITH ANGINA Nursing Care of a Person with Angina: The case of Mrs Brown Name Institution Introduction Angina is a clinical condition characterized by acute chest ache experienced as a squeezing sensation in the upper chest for 3-5 minutes and lasting for over 15-30 minutes. The condition is precipitated by physical activity, emotional stress, exposure to extreme temperatures and eating heavy meals. Mrs. Brown has a history of recurring angina and high pretension which point to two problems: the central chest pain, and shortness of breath. To relieve the pain as an urgent intervention, GTN spray followed by application of oxygen therapy is recommended. For the second condition, the intervention includes application oxygen therapy followed by monitoring the vital signals of patient in a position to relieve shortness of breath (British National Formulary, 2008). The priority problem 1: Central chest pain An effective intervention strategy for Mrs. Brown begins from the accurate diagnosis of her condition. The diagnostic process involves two main activities. The first is the plan which involves the description of the pain. In particular the quality of the pain which can be described as heaviness, lightness, whether occurring as a squeezing sensation or as a feeling of indigestion. The second is to correctly identify the location of the pain and the radiation if any is exhibited. Most times the pain occurs as a size of fist in a particular spot and can easily radiate to the periphery including the neck arm or upper abdomen. The predisposing factors also give an idea of the type of angina that is being experienced in terms of whether it is stable, unstable, Variant (Prinzmetal's) or Micro-vascular angina (Chaitman, & Laddu, 2011). The observation of the duration of the pain indicates the kind of angina one is suffering from. It lasts for 3-5minutes and may extend for as long as for 15-30minutes. This is followed by the nature of the alleviating factors for the symptoms being experienced at the point of occurrence. Lastly, the associated symptoms on attack are very critical in helping arrive at the correct diagnosis (Kasouridis et al., 2010). Assessment: The subjective assessments of the patient revealed very important symptoms. Mrs. Brown weighs 120kg, and is currently in an executive management job. The various observations on admission revealing a temperature 37.2oC, pulse 110b/min, respirations 24 respirations/min, and BP 146/89mmHg, point to an elevated chance of hypertension. The pain that was experienced immediately after she walked around the hospital block is indicative of a condition that is brought about by the slightest physical exertion. The pain she describes is heavy and in her own terms ‘It feels like someone is squeezing or pressing down on my chest’. The pain however does not seem to radiate toward the periphery or to other remote organs. The other symptoms from the observation include elevated blood pressure and jugular or main vein to the neck’s distension. The observation of the skin revealed cool and clammy skin with teary eyes. The objective assessment involves the reading of the electrocardiogram (ECG) or tachycardia to indicate the functionality of the heart (O’Rourke, 2008). Diagnosis The experience of acute pain can be attributable to the low supply of blood due to low myocardial blood flow. These results in very short oxygen supply to vital organs and particularly the lungs hence the acute pain. The decrease in myocardial blood supply is characterized by a state in which the patient experiences a severe discomfort or a very uncomfortable sensation and is accompanied by shortness of breath as the body works to compensate the reduced supply of vital nutrients (Wu, Chen, & Deng, 2009). Inferences: Mrs. Brown’s Angina could have resulted from any manifestations in which there results a decrease in oxygen supply by the coronary arteries which may be as a result of a partial blockage by plaque deposition leading to constriction of the veins. More appropriately there was an association of her condition with, an increase in the physical activity of the heart as demonstrated by the pain she experienced only after few minutes walking around the hospital block. The increased physical activities imply an increase in the requirements of oxygen to be supplied to the myocardial region. This increased demand has to be met and if the coronary arteries are constricted, then this is a likely cause of angina. The most common cause is arthrosclerosis but aortic stenosis, hypotension, hyperthyroidism, anemia, ventricular arrhythmias, or hypertension could be other minor causes (Nghiem, Coelli, & Barber, 2011). Intervention strategy: The first step in the intervention strategy is to keep Mrs. Brown out of pain by administering the sublingual nitroglycerin (NTG) spray. The pain is a manifestation of lack of oxygen reaching the heart muscle. Nitrates like (NTG), gives relief to patients in two ways: They broaden the arterial vessels taking blood to the heart muscle and they loosen up the veins that return blood from the heart to the rest of the body (British National Formulary, (2008). Because she experiences severe pains, it is of foremost important for Mrs. Brown to have a rest as vital resting signals that act as indicators of normalcy are taken. Following this intervention then prescribe a complete bed rest to quicken recovery of all vital rest signals. The patient was then placed in a semi-Fowler or high-Fowler position. According to the (Free Medical Online Dictionary, 2009), it refers to ‘placement of the patient in an inclined position, with the upper half of the body raised by elevating the head of the bed approximately 30 degrees’ (p.1). According to Becker and Hass, Placing the patient in a semi-Fowler or high-Fowler position helps in reducing the ventricular filling initial loading (Becker & Haas, 2007). The patients’ EGC on a ten point lead is taken immediately during the very acute pain episodes under close monitoring by the nurse. The phone must always be available for the patient to report immediately any severe pains experienced. Lastly, the intervention involves administering oxygen through oxygen therapy as may be required (Wang et al., 2006). The rationale: The collected baseline data for Mrs. Brown is critical in understanding the current health status of the patient including her history of the angina attacks. It also helps to consider the effectiveness of the various interventions already administered by nursing team interventions. The NGT intervention is to help relieve pain and reduce any emotional and physical stress while safeguarding the patient from persistent decreased myocardial oxygen supply which may lead to further tissue injury (Bueno, Mamtani & Frishman, 2011). The Evaluation The patient should be under surveillance for a continuous period under bed rest for 8 hours. Resting reduces body’s’ cardinal demand for oxygen and the pain eventually fades away (Everingham, 2010). If the intervention strategies are effective, the patient should be free of pain and in as stable condition. The confirmation would be through verbal affirmations by patient as well as through the indication of stable signs and no anxiety (Budzynshi et al., 2011). Priority problem two - Shortness of breath (SOB) The second problem demonstrated by angina patients is often the shortness of breath. The three different variant forms of angina all potray this symptom very closely. In the first instance, shortness of breath will accompany the acute or severe pains during stable or unstable episodes of angina. For stable angina which is characterized by regular episodes of pain and often initiated by strenuous physical and emotional stress, the shortness of breaths are often rare (Budzynshi et al., 2011). However, for the unstable angina, the shortness of breathes are usually common and begin even in the absence of any physical exertion. It is this type of angina that is not easy to cure by medical intervention and mere rest. The main reason for shortness of breaths is dependent on the nature of the precipitating factors of the angina condition. Normally shortness of breath is a result of the body mechanisms compensating for reduced myocardial oxygen supply to vital organs. The most common cause is arthrosclerosis which refers to reduction of volume or constriction of the coronary artery due to plaque deposits rendering the coronary arteries as narrow and stiffer thus reducing their capacity to deliver oxygen (Wu, Chen, & Deng, 2009). Otherwise angina can result from aortic stenosis or the constriction of the aorta, mitral stenosis or inadequacy, hypotension, hyperthyroidism, Lack of blood (anemia), ventricular arrhythmias, or hypertension (Wu, Chen, & Deng, 2009). Assessment: Since the cause of shortness of breath may be hidden, the initial vital signs of the patient including history are very important. For the case of Mrs. Brown, her medical history clearly shows her past experience with angina for which she was even under medication. The unstable angina is normally the better indicator of a developing coronary heart disease condition in patients and requires a holistic collaboration of patient and even family. The determination of patients’ (electrocardiogram) ECG and continuous monitoring of the patient during hospitalization are key observations that must be done throughout the hospitalization period. The electrocardiogram is the best indicator of the functionality of the heart under normal conditions and any problems could easily be detected (Eid & Boden, 2008). Diagnosis: The vital readings from Mrs. Brown’s previous medical data indicate a case of stable angina but which has a clear risk of quickly changing towards unstable if the intervention strategies suggested are not fully implemented or effective (Eid & Boden, 2008). Inferences The main symptoms accompanying Mrs. Brown’s condition are the recurrent angina and the emotional stress related to her job and the requirements of the executive position she holds. The emotional stress has weighed on her to the extent she has no more time for exercises and this is a primary indicator of reduced blood supply particularly to the myocardial region. Mrs. Brown’s Angina could have resulted from any manifestations in which there’s a decrease in oxygen supply by the coronary arteries which may be as a result of a partial blockage by fat deposition leading to constriction of the veins (Bueno, Mamtani & Frishman, 2011). More appropriately, there was an association of her condition with an increase in the physical activity of the heart as demonstrated by the pain she experienced only after few minutes walking around the hospital block. The increased physical activities imply an increase in the requirements of oxygen to be supplied to the myocardial region (Ignarro, Balestrieri, & Napoli, 2007). This increased demand has to be supplied and if the coronary arteries are constricted, then this is a likely cause of Angina (Bueno, Mamtani & Frishman, 2011). The intervention strategy The first strategy should be the application of oxygen therapy to ensure additional supply of oxygen to vital organs and prevent tissues damage. This can be achieved through nasal cannula or tight fitting masks. The flow rate is often measure in liters per minute (lpm) and could range from 0-15 lpm according to Joint Royal Colleges Ambulance Liaison Committee, (2009). It is clear that the short breaths suggest an inability of the coronary arteries to meet the oxygen demands of the body including the lung. The second intervention is to change patient’s position and ensure a posture that allows for maximum inhalation of vital oxygen to replenish the demand. Let the patient be in a semi-Fowler posture. All this must be accompanied by constant cardiac monitoring to notify the physician of any indicators of deterioration. This is followed by monitoring of vital signals as well as response to therapy (Everingham, 2010). Collaborative intervention: For a successful recovery from this condition, Mrs. Brown will require the support of her family, the nutritionist or dietician and the clinical nurse. Most important is the focus of all her support to ensure that she has manageable stress both at work and at home. The condition may require lifestyle changes that will only be sustainable through a frame work of the right support (Fihn et al., 2011). Rationale: With proper diet of low fat and low cholesterol foods, a healthy lifestyle of reduced stress and a proper exercise regime, the normal operations of the vital indicators will be achieved leading to reduction in the episodes of shortness of breath (Fihn et al., 2011). Evaluation: The evaluation will be based on assessing the progress of the patient from the intervention. To decrease the oxygen demand, bed rest on soft material to improve on the comfort of the patient must be prescribed. Post intervention period should be characterized with stable vital signs, the correct posture and no incidences of restlessness (Kones, 2010). Conclusion: Mrs. Brown has recorded incidences of angina with increasing frequency over the last few weeks. It is evident that her angina episodes are more often initiated through physical exertions and emotional stress at work. Since it points to a stable angina, intervention strategies were aimed at ensuring that these effects are curbed to avoid any further development of this condition into a coronary heart disease (Henderson & Timmis, 2011). The fist clinical problem of her condition is the acute chest pain coupled with shortness of breath. In both cases, relieving the pain and then applying oxygen therapy are the best interventions. These interventions are offered with the view to arrest the pain, improve comfort of the patient and relieve her and family of great anxiety. 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