Acute Coronary Syndrome Aetiology and Pathology of Illness, Risk Factors, Incidence and Prevalence Data, Pharmacological Management - Case Study Example

Acute Coronary Syndrome Name Institution Date Acute Coronary Syndrome Introduction An anterior wall myocardial infarction (anterior STEMI or AWMI) takes place when the anterior myocardial tissue normally supplied by the left anterior descending coronary artery (LAD) experiences injury because of lack of supply of blood. When there is an extension of AWMI to the septal as well as lateral areas, the culprit lesion is normally more proximal in the LAD or in the left major coronary artery as well. Some of the acute myocardial infarction’s symptoms include and not limited to chest pain that might radiate to the jaw or arm, nausea, vomiting, and chest tightness (Janda &Tan, 2009). The diagnosis lies on myocardial necrosis’ laboratory findings that cause myocardial enzymes’ leakage, like troponin, into the moving blood (Goodacre et al, 2009). The electrocardiographic (ECG) findings divide acute infarcts into non ST-elevation infarction (non-STEMI) and ST-elevation myocardial infarction (STEMI). STEMI is normally the result of coronary artery’s blockage with large cardiac enzymes’ elevations in the serum and finally lead to Q waves on the ECG (Goodacre et al, 2009). Contrary, non-STEMI that overlaps with the acute coronary syndrome (ACS) unstable angina, brings about modest cardiac enzymes’ elevations in the serum and pathologically indicates patchy or small regions of necrosis (O'Connor et al, 2010). This paper discusses various ACS’s issues in relation to the case study. SECTION 1 Aetiology of the illness Acute MI occurs from lack of supply of oxygen to the functioning myocardium. Regional infarcts are as a result of lack of flow of blood that happens when an epicardial artery is blocked by thrombus or atheroma, or other obstructions (Woo & Schneider, 2009). Global subendocardial infarcts take place when there is absence of oxygenation regardless of circulation, for instance, when there is respiratory arrest followed by extended hypoxemia (Moe & Wong, 2010). Pathology of the illness STEMI normally develops through an occlusive thrombus (blood clot) formation within a major coronary artery that has been affected previously by atherosclerosis (Woollard & Geissmann, 2010). Deposition of cholesterol finally creates a plaque within the artery wall referred to as atherosclerotic plaque. Formation of atherosclerotic plaque is a long term procedure, which needs several years to ascertain. Occasionally this plaque might erode or rupture and can trigger fibrin deposition and platelet aggregation, which result in occlusive thrombus’ formation within a coronary artery. This blood clot blocks a coronary artery completely and interferes with supply of blood to myocardium’s region, intense changes happen in the myocardium that result in irreversible changes as well as myocardial cells’ death, and finally STEMI develops. Risk factors Risk factors that have been well-established resulting in formation of plaque and atherosclerosis include hypertension, age, male gender, family history, diabetes, smoking, and dyslipidemia. Factors that are less well-established include chronic kidney disease, metabolic syndrome, and obesity. AMI’s potential triggers include psychosocial conditions, use of nonsteroidal anti-inflammatory (NSAID), and excessive consumption of alcohol. Incidence and prevalence data Even though a lot of the additional raises in coronary heart disease mortality and morbidity are approximated to take place outside developed regions like Europe and North America, few countrywide investigations have been published of acute MI epidemiology from other areas (Valensi et al, 2011). In Australia, cardiovascular disease is the foremost cause of death. Coronary heart disease affects nearly 1.4 million Australians and kills 59 Australians every day (Australian Institute of Health and Welfare, 2011). SECTION 2 Pharmacological management of illness for the chosen client Captopril is one of the angiotensin-converting enzyme (ACE) inhibitor that is used for hypertension management and a couple of congestive heart failure (Brilakis et al, 2013). An ACE inhibitor is started one or two days following attack. It acts by reducing ventricular remodeling, reducing recurrent infarction and preventing heart failure’s onset (Akif et al, 2010). Adverse effects related to long term use of captopril include cough as a result of increase in bradykinin’s plasma levels (Akif et al, 2010). Other side effects include tachycardia, headache, itching, chest pain, weakness, and palpitations. Another medication used for management of MI is clopidogrel (plavix). Platelet adhesion, aggregation, and activation are vital in the ACS’s pathophysiology. Clopidogrel which is an oral derivative of thienopyridine, is a platelet adenosine diphosphate (ADP)-receptor antagonist with the capacity of inhibiting activation of platelet (Roe et al, 2010). Together with aspirin, clopidogrel 300mg needs to be administered orally as early as possible. Slight mortality benefit is observed in combination of clopidogrel and aspirin. Plavix should not be used together with esomeprazole or omeprazole. Esomeprazole and omeprazole considerably decrease plavix antiplatelet activity (Roe et al, 2010). Side effects include gastrointestinal hemorrhage and pruritus. Anginine is used in relieving pain due to angina pectoris acute attack. Anginine is one of the vasodilators, implying that is brings about blood vessels’ dilatation (Lippincott, 2011). Some of the side effects include fainting, headache, and increased heart rate. SECTION 3 3 areas to educate client and their significance Reducing mortality and morbidity among post-MI patients calls for effective secondary measures’ implementation. This is why patient education plays a significant role in promoting the effective secondary measures (Dirksen, 2011). Some of the major areas that the patient will be educated on include: medical compliance, exercise, and pain management. Medical adherence or compliance normally refers to whether a patient takes his or her medications as prescribed (e.g., once, twice or thrice a day), as well as whether he or she continues to take the medication prescribed (London, 2009). Nonadherence to medication is a growing issue to clinicians, stakeholders, and healthcare systems due to mounting proof that it is common and linked to unwanted outcomes and higher expenses of care. Medications’ nonadherence is prevalent for patients that have cardiovascular diseases. A study indicated that following hospitalization of acute MI, nearly one fourth of patient did not fill their cardiac medications by the seventh day of discharge (Dirksen, 2011). The ultimate goal of any medical therapy prescribed is to attain particular desired outcomes in the concerned patient. These outcomes are an essential part of the objectives in the conditions or diseases management (Dirksen, 2011). On the other hand, regardless of all the best efforts and intention on the healthcare professionals’ part, those outcomes may not be attainable if the patients are not compliant. This shortfall might as well have serious and negative effects from the disease management’s perspective. Therefore, medical compliance has been a clinical concern’s topic from the 1970s because of the widespread characteristic of non-compliance with medications (London, 2009). Because of the direct association of non-compliance with poor outcomes in treatment, it is hence important for the nurse to explain to the patient the importance of taking his medications as prescribed. Some of the factors that influence medication compliance include and not limited to demographic factors. Factors classified in this group entail ethnicity, education, gender, marital status, and age. Naturally, it might be expected that patients that have higher level of education should have greater knowledge concerning disease and medication and hence be more compliant. On the contrary, it was established that even patients that are highly educated may not comprehend their medical conditions or believe in the advantage of being compliant to their regimen of medication. Some research indicated that patients who have lower level of education have better compliance (Carpenito, 2009). Marital status may positively influence compliance of the patient with medication. The support and help from a spouse may possibly be the grounds why patients that are married are more compliant to therapy unlike single patients (Dirksen, 2011). Physical exercise and activity is another area of interest in patient education. Regular exercise and standard physical activity are advised for most individuals who have suffered a MI. It is advisable that they try to be physically active (London, 2009). For instance, they should consider taking the stairs whenever possible, wash their car, and walk to the shop. Previously, people believed that exercise placed a strain on an individual’s heart and was not good. Conversely, the opposite is true for a lot of individuals that recover from MI. regular exercise and physical activity are basically good for the heart. Actually, regular exercise is among the major components of cardiac rehabilitation programmes, which are popular following a MI attack. Regular exercise is considered as a major method of reducing the risk of getting a further MI. There are some cases where strenuous exercise may not be recommended, hence the nurse or the clinician should advise the patient. However, exercise is much beneficial for most individuals who have experienced an MI (Carpenito, 2009). Following a MI attack, it is best to gradually increase the level of exercise and activity. The patient should be advised to simply go for a short walk daily during the initial week or so of discharge. It is imperative for the nurse to consider that everyone is unique and the period of walk relies on how fit an individual is to start with. A realistic goal by around 6 weeks following a MI attack is to target to walk for around 20-30 minutes every day (Dirksen, 2011). Concerning strenuous effort’s bursts, as a rule, standard manual work is fine. On the other hand, the patient should not perform or do anything that makes him need to hold his breath. For instance lifting objects that are very heavy when one would require, gritting his teeth and holding his breath. In several situations, moderate exercises should make one a little short of breath. Nearly every person experiences pain following surgery. Pain can also be caused due to some conditions like heart diseases and cancer. Controlling pain is considered a team effort (Dirksen, 2011). This is why the nurse needs to teach the patient on pain management. A practical expectation is that pain will be greatly controlled. The patient can be given some pain killers to carry home so as to control any experienced pain. Patients with well controlled pain normally experience better outcome of their condition. Education techniques used and their impact on client A lot of health care presently entails assisting patients manage health conditions whose outcomes can be highly influenced through behavior and lifestyle change (London, 2009). Motivational interviewing has shown to considerably increase compliance of patients to treatment regime. Another education technique will be therapeutic nurse/patient communication. The quality of care provided by a nurse is in several ways, reliant on communication quality that exists between the nurse and his patient. Effective therapeutic communication will greatly impact on how the patient will respond through the session because he will be directly involved and communication is patient-centered, hence complying to the advise provided will be high (Carpenito, 2009). Impact of client education on illness management Client education is one of nursing role’s prior to discharge of patients (London, 2009). This is why the manner in which the nurse presents the content matters a lot of how it will impact on illness management. Some clients may have beliefs regarding their condition and medication. It is imperative for the nurse to have a discussion with the patient and hear them out so that she can deliver her services putting in mind the patient’s perspective. With the help that the nurse provides to the patient referred on the case study, it is likely that positive outcomes will be observed. The nurse should make sure that the patient understands the risks linked to coronary heart disease and the possible strategies used to decrease them (Dirksen, 2011). Information about any prescribed medicine should also be conveyed clearly. The patient together with his family needs to receive written advice on what to expect or do after discharge and there should also be provision of the cardiologist’s telephone numbers so as to reach them in case of an emergency. Family/community resources that may participate in illness management Family can play a significant role in helping the patient’s condition improve through reminding him of his therapeutic regime, hence moral support. Some of the resources that could be beneficial to the patient include community based organizations that offer help to patients who have suffered a heart attack. Other useful resources include internet links such as NSW health Internet, Heart Attack Every Second Counts, National Heart Foundation - Australia, National Heart Foundation - New Zealand, British Heart Foundation and Heart Beat Victoria (Dirksen, 2011). This could be beneficial to the patient considering that he is technologically literate hence getting help from these sites should be considered. Conclusion This paper has discussed several issues in relation to acute coronary syndrome in relation to the case study. It has been noted that coronary heart disease is one of the Australian’s leading cause of death. This is why proper management and prevention is imperative so that lives can be greatly saved. Even though there are improved methods of treatment for MI, including angioplasty and administration of thrombolytic drugs, prevention is still the best treatment. An individual is able to help prevent a heart attack through understanding the risk factors associated with coronary artery disease as well as heart attack and promptly taking action to reduce those risks. Even if an individual has suffered a heart attack, he can still reduce his risk, most possibly by making some lifestyle changes, which promote better health. With regards to the case study, medical compliance, pain management and physical exercise are some of the areas of concern that have been discussed to help improve the patient’s condition. Reference Akif, M., Georgiadis, D., Mahajan, A., Dive, V., Sturrock, E. D., Isaac, R. E. & Acharya, K. R. (2010). 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