Cardiology Case Study and Care Plan Analysis
Effective management of any condition depends on several factors. For instance, knowledge about the illness is paramount to a successful adoption of an approach that will assist in its management. Fundamental to this knowledge are analyses of various conditions’ case studies. Such evaluation of case studies has the potential to afford the best information onto which one can construct a comprehensive care plan tailored to the need of the patient. Thus, central to this discussion is a case study evaluation and a care plan synthesis of a cardiovascular condition. Without a doubt, arming oneself with such information will forge new understanding about the cardiovascular condition and ultimately influence its management.
Case Study Evaluation
Firstly, the case study revolves around a 52-year-old Irish-American patient. The best possible diagnosis for this candidate is a heart attack (Myocardial infarction). Such is the case given the clinical manifestations at the time of hospitalization. For a better understanding of this scenario, its evaluation is of the essence. The analysis will take into account all the core tenets of the disorder, its management, and outcomes.
Analysis of the Disorder (Heart Attack)
To prove the validity of the myocardial infarction diagnosis, an analysis the key elements of the disorder is a priority. The basic components include but not limited to pathophysiology, signs, and symptoms, progression trajectory, diagnostic testing and treatment options.
Pathophysiology
Central to the development of a myocardial infarction is various etiological factors. They comprise coronary artery dysfunction, spasm of the coronary artery and coronary artery embolism. All these causes result to a similar fate of myocardial ischemia that deprives some cardiac cells oxygen. Ultimately, this results in necrosis, which in turn leads to cardiac cell death known as myocardial infarction (Porth, 2014).
Signs and Symptoms
Patients with episodes of heart attack will present in most cases with life-threatening signs and symptoms. Excruciating chest pains are the common sign that is manifest in patients with heart attack. The angina is due to ischemia to a particular part of the heart leading to the death of cardiac cells on that site. Characteristic to this pain is that it is severe and occurs in the substernal region. Additionally, it may radiate to the shoulders or neck, persist for more than 15minutes and not relieved by rest (El-Sherif & Ramana Reddy, 2013).
Other clinical manifestations that may be present in asymptomatic patients include but not limited to increased heart and respiratory rates, shortness of breath (dyspnea), paleness and diaphoresis. The increased heart and respiratory rates, as well as diaphoresis, are mainly due to the stimulation of the sympathetic nervous system. On the other hand, dyspnea is common because of a faulty pumping system due to heart muscle damage (Porth, 2014).
Diagnostic Testing
Diagnostic tests of significance to this condition comprise the radiological examinations and laboratory investigations. Radiological examinations include electrocardiogram (ECG), and echocardiogram. An ECG will assist in checking the well-being of the heart. For instance, the presence of an abnormal Q wave indicates the presence of permanent tissue necrosis. On the contrary, the indication for an echocardiogram is when an ECG is non-diagnostic, and there is a need for assessing the possibility of a myocardial infarction diagnosis (El-Sherif & Ramana Reddy, 2013).
Laboratory investigations that are crucial in diagnosing this cardiac condition include cardiac biomarkers such as Troponin level. A high level of troponin in a period of 24hours is indicative of myocardial infarction. Also, an increase in serum level of protein enzymes such as aspartate aminotransferase and myoglobin further confirms the diagnosis of myocardial infarction. Besides, an elevation of serum Creatine kinase may also point out to the diagnosis of myocardial infarction (Porth, 2014).
Progression Trajectory
Without proper management, the condition has the possibility of complicating most severe conditions namely, acute pulmonary edema, heart failure, cardiogenic shock, myocardial rupture dysrhythmias and pericardial effusion (Porth, 2014).
Treatment Options
A comprehensive treatment plan for this condition must include both non-pharmacologic and pharmacologic interventions. Medications that one must administer to achieve optimal outcomes include analgesics such as Morphine for chest pains. Furthermore, thrombolytic like streptokinase for dissolution of the thrombi is also common. One may also use ACE inhibitors like enalapril to reduce the oxygen demand of the heart by interrupting Renin-Angiotensin system. Nevertheless, a patient must receive oxygen if he/she is having episodes of dyspnea. On the other hand, a non-pharmacologic intervention like bed rest in a semi-fowlers position is also reliable in relieving the patient’s symptoms (El-Sherif & Ramana Reddy, 2013).
Difference between the Disorder and normal development
Typically, the heart muscles inclusive of myocardium receive blood rich in oxygen and nutrients from coronary arteries. Thus, the coronary arteries play an important function of heart muscles’ nourishment (Porth, 2014).
However, in a diseased state, the normal physiologic function of coronary arteries is non-existent. They become narrow following a formation of a thrombus along the lumen. Consequently, there is a reduction of blood flow to the heart muscles causing ischemia, necrosis and eventually infarction of the nutrient and oxygen deprived cardiac cells (El-Sherif & Ramana Reddy, 2013).
Physical and Psychological Demands of Myocardial Infarction on the Patient and Family
Physically and psychologically, this condition affects the patient and his/her family. Firstly, in the physical demands, the patient has to put up with the various signs and symptoms that are characteristic of this condition. For instance, one has to bear with severe chest pains that occur due to myocardial ischemia. Moreover, anxiety is also a universal physical phenomenon that both the patient and his/her family are no exception. The anxiety of the patient is inevitable because he/she has the fears of the impending danger of death secondary to the severity of the clinical manifestations. As for the family, anxiety is manifest since they are left to nurse their fear of the unknown of the fate of their beloved (Salminen-Tuomaala, Astedt-Kurki, Rekiaro, & Paavilainen, 2013).
Additionally, the patient and his/her family are under psychological torture. A case in point is the stress that the condition breeds to both the patient and family. Stress is unavoidable in such circumstances since it has a high financial implication that comes with myocardial infarction. Besides, the pressure is also evident due to the lifestyle changes that the patient and the family have to go through in their daily lives. Change poses a significant emotional and psychological demand that one cannot avoid given the rapid nature of the onset (Salminen-Tuomaala, Astedt-Kurki, Rekiaro, & Paavilainen, 2013).
Key Concepts to Share with Patient and Family
A comprehensive teaching plan is of the essence in the optimal management of this cardiac disorder. Vital components that one must incorporate in patient education sessions include management strategies for this condition, dietary changes, exercises, and drug adherence.
Firstly, a nurse must teach the patient and family on all issues surrounding this disease. For example, the lesson plan adopted by an individual should start from explaining the risk factors, causes, pathophysiology, and management strategies of myocardial infarction. Information of this kind will increase the understanding of the condition in the patient and his/her family and ultimately enhance the chances of attaining better prognosis ().
Moreover, dietary modification is a priority area that one must target to share with the patient and his/her family. The patient has no choice but to adapt a cardiac diet that is low in fats and sodium, which have the potential to worsen the disorder (Gibney, Margetts, Kearney, & Arab, 2013).
Nevertheless, one must also emphasize the need of including exercises in the daily routine. Exercises are essential to the well-being of such patients and family as they help reduce the risk of further complications and development of the same cardiac disorder respectively (Gibney, Margetts, Kearney, & Arab, 2013).
Finally, reinforcing the importance of drugs adherence is another subject that must have a place in a teaching plan. Compliance to drugs allows one to keep at bay the myocardial infarction from complicating to more severe conditions, whose implications is far much immense (Brown & Bussell, 2011).
Key Interdisciplinary Team Personnel
Central to the efficient management of a cardiac patient just as other patients is a multidisciplinary team that works for the common good of the patient. Healthcare professionals that are of the essence in the management of this disorder are the cardiologist, nutritionist, and a mental health provider.
A primary advantage that a cardiologist will add to the plan of care for such a patient is giving an expert opinion regarding the condition. Such information matters since it will allow one adopt the best evidence-based intervention. Moreover, the cardiologist will assist in prescribing, conducting and interpretation of diagnostic tests that are more definitive in diagnosing the cardiovascular condition of an individual (Arena et al., 2012).
On the other hand, a nutritionist is also a valuable member of the team that will determine the success of the interventions adopted. Such is the case given, the vitality of dietary modification in patients with cardiac problems like this one. The nutritionist will thus ensure that the patient and family members have received counsel on the right diet that will optimize the health care outcomes (Arena et al., 2012).
Lastly, the nurse must also consider working closely with a mental health provider. An indication of a move of this kind is the psychological distress that is common among patients and families with the burden of cardiac disorders. A mental health provider will ensure that both the patient’s and his/her family psychological needs receive the required attention (Arena et al., 2012).
Facilitators and Barriers to Optimal Disorder Management
Success or failure of myocardial infarction is dependent on various factors. The factors can be either facilitators or barriers to optimal management of the condition. First on the agenda are the facilitators. One primary facilitator is a cardiac rehabilitation program that helps the patient cope with the demands of the situation. For instance, it provides the patient with necessary information of which, how and when to undertake exercises. Moreover, such a program inspires one to move ahead despite the predicaments that the condition poses. Another facilitator is the psychological and social support that is available for such a patient. The myocardial infarction patient requires a strong support system that will ensure that he/she is free from the challenge of psychological distress that emanates from this state of health (Nice, 2013).
On the contrary, the optimal management of this condition faces numerous hurdles. A case in point is the practice of many cardiac patients to seek medical attention upon the onset of symptom. Such a habit has crippled the optimization of managing this condition at an early stage when it is easily manageable. That notwithstanding, ineffective triaging procedures also have a significant role to play regarding the poor prognosis of myocardial infarction management. The triage areas lack standard guidelines for identifying the condition and thus causing further havoc. Also, late referrals to the appropriate specialists such as cardiologists have also affected the management of this condition negatively (Chai, Putit, & Siop, 2016).
Strategies to Overcome Barriers Identified
According to Chai, Putit, and Siop, (2016) barriers to optimal management of myocardial infarction are evitable if there is devotion to institute education strategies. A key component that is worthy address is the issue of seeking the hospital services early before the onset of symptoms. An action of this kind will enable one to profit from the reversal of the condition before progression to severity.
Furthermore, training the health care professionals on the triaging and referral procedures will also influence the management of this condition positively. For instance, the triaging skills will enable the health care professionals to establish the disorder with ease. Likewise, early referrals will profit the patient with the best and timely intervention of cardiac specialist (Chai, Putit, & Siop, 2016). Clearly, with such measures, one is sure to bridge the gap that exists in the management of this health problem.
Care Plan Synthesis
Comprehensive and Holistic Recognition and Planning for the Disorder
Assessment Data
On the subjective data, the patient is a 52-year-old patient who presents with a chief complaint of chest crushing sub-sternal pain that is unrelieved by rest that has lasted for four hours. He has a history of hypertension and hypercholesterolemia as well as a positive family history of hypertension among his brothers and heart disease of his father. That notwithstanding, he has in the past failed to comply with prescribed drugs, poor dietary practices and lack of exercises. Of the essence is also the fact that he is a cigarette smoker for the past thirty years.
Objectively, the vital signs on the hospital admission were a blood pressure reading of 160/92mm/Hg, a heart rate of 60beats/ minute, a respiratory rate of 16breaths/minute, a temperature reading of 98F and a BMI of 22.6kg/m2. On the physical examination, the patient has a right carotid bruit with a high natural waist circumference of 44inches. Lab results also indicate an abnormal lipid profile of high cholesterol (210) and lower density lipid (200) with a little amount (25) of high-density lipid. Additionally, he has a high fasting blood sugar of 140 as well as a glycosylated hemoglobin level of 7.5. Lastly, the chest x-ray reveals hyperinflated lungs with no infiltration.
Nursing Diagnosis
One of the primary nursing diagnoses of this patient includes but not limited to acute pain related to oxygen supply and demand imbalance. Besides, a decreased cardiac output related to the minimized cardiac contractility of the patient is another viable patient problem. Anxiety associated with the fear of an impending heart attack and death is evident in this case scenario. Finally, the patient also exhibits a knowledge deficit in the self-care after a myocardial infarction episode.
Planning
The primary goals of the care plan are to control and relieve pain, reduce cardiac workload, decrease anxiety as well as equip the patient with necessary information that is necessary for self-care.
Effect Of Patient’s Sociocultural Background On Optimal Management And Outcomes
Socially, this patient has a limited social support that is not readily available to him since his children live in another city, and his wife has diabetes. A limited social interaction of this kind plays a prominent role in the sub-optimal management of the condition and outcomes obtained. Such is the case given the patient psychological distress that the patient admits is on the rise. Clearly, with a support system that in place, the patient would not have suffered this fate since emotional support would have been present for this patient.
From a cultural perspective, the patient has certain beliefs that have no scientific backing. Such beliefs are thus the achievement of optimal management of this condition and positive outcomes. For instance, he exhibits a backward stand that men are not to become sick whatsoever the case. Moreover, he believes that his gender should only visit the hospital when he is utterly defeated to carry on with daily operations. Consequently, these beliefs influence his well-being since prior hospitalization he exhibits reluctance to contact the hospital, which eventually results in severe symptoms of the condition.
Indeed, from these instances, it is apparent that the need for understanding the socio-cultural background of an individual is of the essence in the provision of optimal care.
Evidence-Based Approach to Address Key Issues Identified
Primary to the success of the management of this condition is the administration of appropriate medications both in the acute and post-discharge. For example, administering morphine for pain and anxiety relief, enalapril for reducing the cardiac workload, oxygen supplementation to ease dyspnea and streptokinase for thrombolysis are essential to managing this condition (El-Sherif & Ramana Reddy, 2013).
Secondly, adopting appropriate non-pharmacologic intervention is also a priority i that one can utilize to manage this condition. A befitting example of such an intervention is resting the patient in a semi-fowler position to relieve the shortness of breath through enhancing lung expansion (El-Sherif & Ramana Reddy, 2013).
Besides, the vitality of health education is indispensable since the patient needs to understand all issues regarding his condition. Central to the teaching plan is lifestyle modification and drug adherence. Lifestyle change incorporates adoption of dietary alteration to a cardiac diet and an increase in exercise. On the other hand, the patient must understand the need for drug adherence through an emphasis on this subject (Brown & Bussell, 2011). With such teaching components, optimal care is a surety to this patient.
Identification and maintenance of support system is another area that a nurse must work towards achieving. Support systems will assist the patient psychologically as well as emotionally and thereby prevent the development of depression (Nice, 2013). For this case, the nurse can contact the children of the patient and encourage them to participate in the plan of care of their parent.
A Comprehensive but Tailored Approach to Disorder Management
A health promotion approach befits the management of this health problem. Such an approach will take into account the primary, secondary and tertiary prevention of the cardiac disorder.
Firstly, the main prevention of myocardial infarction is the most fundamental step of escaping this challenge. It begins before the occurrence of this condition. Strategies that are characteristic of this phase include lifestyle modification, optimal dietary practices, incorporation of exercises in routine daily activities among other interventions (Labarthe, 2011). With such actions, the challenge has no space in various societies.
Secondary prevention, on the other hand, involves all interventions that will lead to early diagnosis and treatment of cardiac conditions. Characteristic to such interventions are regular screening sessions for cardiovascular disorders and early treatment of conditions such as coronary artery disease that predisposes one to myocardial infarction (Labarthe, 2011).
Lastly, tertiary prevention takes into account the rehabilitation of an individual to prevent progression to the severity of this condition. Actions such as drug adherence and utilization of support groups are befitting in this phase of myocardial infarction management (Labarthe, 2011).
Conclusion
In closure, managing a patient with myocardial infarction is a hectic process that requires a lot of effort. Key components to its success, however, are early detection and treatment, lifestyle modification, use of interdisciplinary collaboration among others. With such interventions, medical personnel are on course to providing optimal management of the condition.
References
Arena, R., Williams, M., Forman, D., Cahalin, L., Coke, L., & Myers, J. et al. (2012). Increasing Referral and Participation Rates to Outpatient Cardiac Rehabilitation: The Valuable Role of Healthcare Professionals in the Inpatient and Home Health Settings: A Science Advisory From the American Heart Association. Circulation, 125(10), 1321-1329. http://dx.doi.org/10.1161/cir.0b013e318246b1e5
Brown, M. & Bussell, J. (2011). Medication Adherence: WHO Cares?. Mayo Clinic Proceedings, 86(4), 304-314. http://dx.doi.org/10.4065/mcp.2010.0575
Chai, L., Putit, Z., & Siop, S. (2016). Barriers to timely treatment-seeking in patients with acute myocardial infarction in Malaysia: a qualitative study. BMC Nurs, 15(1). http://dx.doi.org/10.1186/s12912-016-0155-5
El-Sherif, N. & Ramana Reddy, C. (2013). The Pathophysiology and Pharmacotherapy of Myocardial Infarction. Burlington: Elsevier Science.
Gibney, M., Margetts, B., Kearney, J., & Arab, L. (2013). Public Health Nutrition. Somerset: Wiley.
Labarthe, D. (2011). Epidemiology and prevention of cardiovascular diseases (2nd ed.). Sudbury, Mass.: Jones and Bartlett Publishers.
Nice., (2013). Myocardial infarction: cardiac rehabilitation and prevention of further cardiovascular disease | 1-Recommendations | Guidance and Guidelines | NICE. Nice.org.uk. Retrieved 10 November 2016, from https://www.nice.org.uk/guidance/cg172/chapter/1-recommendations
Porth, C. (2014). Essentials of Pathophysiology:4th International edition. Philadelphia: LIPPINCOTT WILLIAMS AND WILKINS.
Salminen-Tuomaala, M., Astedt-Kurki, P., Rekiaro, M., & Paavilainen, E. (2013). Coping With the Effects of Myocardial Infarction From the Viewpoint of Patients’ Spouses. Journal Of Family Nursing, 19(2), 198-229. http://dx.doi.org/10.1177/1074840713483922
