Care Plan for a Cardiology Patient
Abstract
Currently, the incidence of cardiovascular conditions is on the rise in the USA and accounts for 2200 lives lost each day (Mozaffarian et al., 2015). A worrying statistic of this kind, therefore, necessitates a rethink of the approach utilized to manage the heart conditions. A nursing care plan has the potential to bring to desirable change. In this strategy, the nurses are in pole positions to intervene appropriately and halt the severity and the existence of such conditions. Such an outcome is possible through patient assessment, formulating nursing diagnoses and institutionalizing of effective nursing strategies, which all make up the nursing care plan. Moreover, a comprehensive nursing care plan takes into account the follow-up care for the patient. Follow-up care is fundamental to the effective management of cardiac conditions given the drug adherence challenges that most individuals face in the pursuit of remaining healthy. Thus, with a nursing care plan in place, success in reducing the existence of heart conditions is inevitable.
Keywords: Cardiovascular conditions, Nursing care plan, Follow-up care
Care Plan for a Cardiology Patient
According to Mozaffarian and colleagues, (2015)cardiovascular disorders account for more than 2200 lives lost in a day, which translates to one life lost in 40 seconds in the USA. Clearly, this brings to question the approaches utilized by the health care institutions at large. Thus, there is a need to come up with timely solutions that will correct these statistics. In essence, this discussion seeks to present an evidence-based practice (nursing care plan) that can be effective in the management of a patient with a heart condition.
Care Plan Template
Patient Initials: I.M Age: 52 years Sex: Male
Subjective Data
Client Complaints: Chest pains (4/7)
HPI (History of Present Illness)
The patient manifested with a severe chest pain as the chief complaint, shortness of breath and diaphoresis at the time of admission.The onset of the chest pain was four days ago though it has been a common symptom for the patient in the last six months. The sub-sternum is the location of the chest pain and it radiates to the neck and jaw.
PMH (Past Medical History)
He is a known hypertensive patient with hypercholesterolemia. However, he is not compliant with the drugs for these conditions.Currently, the patient is compliant to discharge medications (Tenormin XL 50 mg OD, Lipitor 10 mg OD Glucophage – 500mg twice a day as well as Junior ASA OD).
Lastly, he has a past surgical history of a cholecystectomy operation (done ten years ago) with no complications to report to date.
Significant Family History
The patient’s two older brothers are currently under medications since they have hypertension and Diabetes type 2. Additionally, the patient’s father died of heart disease while the mother succumbed due to breast cancer.
Social/Personal History
He is married to one wife that is currently suffering from Diabetes type 2. He is a licensed carpenter with a high school qualification status. His annual income of $50,000 is not sufficient to sustain the patient with his wife.
Moreover, the patient has a low self-efficacy given his illness, and uncertainty of how he is going to take care of his disabled wife. Besides, his medical insurance is insufficient to cover both their health care needs.
Furthermore, he has a suboptimal dietary practice characterized by eating a heavy meal before sleep and taking junk foods for lunch. Additionally, he does not engage in exercises.
Lastly, he is a chronic cigarette smoker that has been taking one packet of cigarette in a day for the past thirty years.
Description of Client’s Support System
A limited support system characterized by three fully-grown children that are living far away from his area of residence. Hehas no other readily available support system in the local area where he resides.
Behavioral or Nonverbal Messages
He exhibits anxiety as evident by fears of coming to hospital before his eventual hospitalization and having more angina episodes despite having a recently inserted stent.
Client Awareness of Abilities, Disease Process, Health Care Needs
Firstly, he has a low self-efficacy because of the uncertainty surrounding his ability to accomplish his breadwinner role in the family.
Objective Data
Vital Signs
He has a high blood pressure reading of 160/92 on the left arm while sitting, a normal heart rate of 60beats/minute, and a normal respiratory rate of 16breaths per minute, the temperature of 98 F and a normal BMI of 22.6 kg /m2.
Physical Assessment Findings
The patient demonstrated reduced breath sounds across all the lung landmarks. The rate, rhythm, and regularity of heart sounds are within the normal ranges. Moreover, the patient has a right carotid bruit, which is common in carotid stenosis and patients with risk of heart attack (McColgan, Bentley, McCarron, & Sharma, 2012).
He also has a high waist circumference (WC) of 44inches (normal for males is below 40) (Gibney, Margetts, Kearney, & Arab, 2013). Lastly, his pedal pulses are below the required ranges, and he has lower limbs edema.
Lab Tests and Results
During hospitalization, he had a lipid profile that indicated hyperlipidemia (cholesterol level of 210, lower density lipid level of 200, high-density lipid level of 25 and triglycerides level of 250).
Moreover, he had a high fasting blood sugar of 140 and glycosylated hemoglobin level of 7.5, possibly indicating a diabetes status.
Finally, he had a chest x-ray that indicated lungs’ hyperinflation, probably due to prolonged exposure to cigarette smoking.
Client’s Locus of Control and Readiness to Learn
He has an internal locus of control as he seeks medical services without coercion from another person. Furthermore, he shows a high level of readiness to learn since he returns to the health institution for an enlightenment exercise about his risk factors.
ICD-10 Diagnoses/Client Problems
The potential ICD-10 diagnoses for this patient included Non-ST elevation myocardial infarction (code I21.4), unspecified angina pectoris (code I20.9), hypertension (code I10), Type 2 diabetes mellitus (code E11.59), unspecified obesity (code E66.9) and carotid stenosis (code I65.21) (Centers for Medicare & Medicaid Services, 2016).
Moreover, other possible client problems evident from the scenario are adjustment disorder with a mixture of anxiety and depressed mood (code F43.23), tobacco use (code Z72.0), dyspnea on exertion (code R06.09) and localized edema (code R60.0) (Centers for Medicare & Medicaid Services, 2016).
Advanced Practice Nursing Intervention Plan
Primarily, the nurse should order for diagnostic tests before instituting other nursing interventions. The caregiver must explain to the patient the importance of these tests before ordering them so that he can fully consent to the procedures.A patient must give informed consent before receiving health care interventions by health care professionals (Shekelle, Wachter, &Pronovost, 2013). Central to this scenario, lipid profile tests, random or fasting blood sugar, and the blood pressure measurement are all necessary in diagnosing this patient. The indication for lipid profile test is to ascertain the serum lipid levels since the patient has a history of hyperlipidemia during his hospitalization. A blood sugar monitoring exercise is to determine the sugar levels, which were also high. Also, blood pressure reading will help the nurse evaluate the control of patient’s blood pressure.
Besides, addressing the patient’s problems is also a priority in the nurse’s list of activities. The nurse should administer appropriate medications to relieve the presenting life-threatening symptoms. For instance, in this case, morphine as well as Junior Aspirin (as an adjuvant to Morphine) for angina, Nitroglycerin for vasodilation and Oxygen therapy to assist in delivering more oxygen to lungs due to exertion dyspnea. The four treatment strategies are the goal standard for management of heart attack, which is a possibility for this patient (Steg et al., 2012).
Moreover, non-pharmacological interventions are also essential in managing this patient. For instance, assuming a semi-fowler position is of the essence in a cardiac patient. Such a position will relieve patient’s shortness of breath through promoting lung expansion (Kubota, Endo, & Kubota, 2013).
That notwithstanding, the nurse must utilize interdisciplinary collaboration to effectively manage this patient. Interdisciplinary collaboration is an essential element of patient-centered care that wholesomely meets the patient needs (Sidani & Fox, 2013). In this case, the nurse must refer the patient to a cardiologist to seek specialist advice regarding the suitability of the patient’s treatment.Finally, utilizing of the available pulmonary rehabilitation center to address the patient’s habit of smoking is necessary in preventing the possibility of causing respiratory conditions.
Nevertheless, health education is also an essential nursing strategy. One should teach the patient about his condition, its management, and prevention of its potential complications. An important topic that a nurse must include in the lesson plan is the dietary modification. The patient must address his dietary practice since he is a risk factor for diabetes and cardiovascular complication. Characteristic to his dietis low contentof fat, sodium as well as carbohydrates and high quantity of vegetables and fruits (Gibney, Margetts, Kearney, & Arab, 2013). Additionally, lifestyle modification is also a priority in the patient education.Exercises enable an individual to break down the body fats and reduce their adverse effect on his/her body. Thus, reinforcing on the vitality of exercises to the patient can influence a behavior change, which will save the patient from harsh complications of his conditions.
Furthermore, the nurse must emphasize the need for drug adherence. Compliance with the treatment regimen is fundamental in the management of the cardiac patients (Brown & Bussell, 2011). Without adherence, the patient is at risk of severe complications and eventually death.
Lastly, in the follow-up care, a nurse should help the patient establish support systems in the local community. Support systems are invaluable components for sick individuals that improve their quality of life (van Houtum, Rijken, Heijmans, & Groenewegen, 2013). In this case, one can contact the patient’s children on his behalf and encourage more involvement in the health care issues of their parents. Consequently, this will relieve the patient’s depression symptoms and improve his prognosis.
Conclusion
In closure, cardiac patients are at significant risk of developing complications if not well managed. Thus, health care professionals should institute appropriate nursing care plans that will dictate the care given in the community and hospital. Without such a strategy, the challenge of cardiovascular disorders is indeed set to increase further.
References
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
Centers for Medicare & Medicaid Services,. (2016). Medicare Coverage Database – Centers for Medicare & Medicaid Services. Cms.gov. Retrieved 30 October 2016, from https://www.cms.gov/medicare-coverage-database/staticpages/icd-10-code-lookup.aspx?KeyWord=hypertension&bc=AAAAAAAAAAAQAA%3d%3d&
Gibney, M., Margetts, B., Kearney, J., & Arab, L. (2013). Public Health Nutrition. Somerset: Wiley.
Kubota, S., Endo, Y., & Kubota, M. (2013). Effect of upper torso inclination in Fowler’s position on autonomic cardiovascular regulation. The Journal Of Physiological Sciences, 63(5), 369-376. http://dx.doi.org/10.1007/s12576-013-0273-8
McColgan, P., Bentley, P., McCarron, M., & Sharma, P. (2012). Evaluation of the clinical utility of a carotid bruit. QJM, 105(12), 1171-1177. http://dx.doi.org/10.1093/qjmed/hcs140
Mozaffarian, D., Benjamin, E., Go, A., Arnett, D., Blaha, M., & Cushman, M. et al. (2015). Heart Disease and Stroke Statistics—2016 Update. Circulation, 133(4), e38-e360. http://dx.doi.org/10.1161/cir.0000000000000350
Shekelle, P., Wachter, R., & Pronovost, P. (2013). Making health care safer II.
Sidani, S. & Fox, M. (2013). Patient-centered care: clarification of its specific elements to facilitate interprofessional care. Journal Of Interprofessional Care, 28(2), 134-141. http://dx.doi.org/10.3109/13561820.2013.862519
Steg, P., James, S., Atar, D., Badano, L., Lundqvist, C., & Borger, M. et al. (2012). ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). European Heart Journal, 33(20), 2569-2619. http://dx.doi.org/10.1093/eurheartj/ehs215
van Houtum, L., Rijken, M., Heijmans, M., & Groenewegen, P. (2013). Self-management support needs of patients with chronic illness: Do needs for support differ according to the course of illness?. Patient Education And Counseling, 93(3), 626-632. http://dx.doi.org/10.1016/j.pec.2013.08.021
