NURBN2012 Nursing Practice 3 - Clinical Scenario Assignment Help

Introduction

The patients having serious heart conditions have to be treated based on pathophysiology and psychosocial aspects as it enables the healthcare professional to understand the patient history and  understand the environmental factors affecting the patient (Banasik, 2018). This report discusses the condition of Betsy a 73 year old woman admitted in surgical ward complaining of nausea and shortness of breath. The report analyzes her health condition based on pathophysiology, pharmacology and psychosocial aspects and discusses the related heart conditions and impact of the medicines given to her.

Question 1

Betsy suffers from Chronic Obstructive Pulmonary Disease (COPD) and Coronary Heart Disease highlighting that she has respiratory disorder and her current condition where she is feeling short of breath and nauseous indicate the symptoms of the disease are increasing. COPD is chronic and progressive inflammatory condition that affects central and peripheral airways along with other impact to lung and pulmonary vasculature (Lumb & Biercamp, 2014) This needs to be addressed to avoid further complications as she has also had Coronary Artery Bypass Graft (CAGSs) earlier and her current symptoms can lead to serious consequences such as heart attack. As Betsy is feeling short of breath Electrocardiography (ECG) is essential to monitor if there are any abnormality or changes in the pathophysiology of the airway disease of the patient. ECG request was made by buddy nurse as Betsy has COPD and coronary heart disease. There is coexisting cardiac disease in patients who have COPD and when there are certain symptoms such as shortness of breath, ECG can help in diagnosing whether the underlying cause of breathing difficulty is not cardiac in nature (Larssen et al., 2016). The different respiratory disease are caused due to changes in heart, which ECG can detect, and it can help in updating or changing clinical decisions in patients with respiratory problems (Warnier et al., 2013). ECG in case of Betsy will help in better understanding the dominant pathophysiology of the airway issue that she was facing and to ensure there is not cardiac issue.

Question 2

2a. 

Stable angina refers to a condition in an individual wherein he/she has brief episodes of pain, pressure, squeezing or tightness in chest and is mostly a symptom of coronary heart disease (Kaski, 2016). Stable angina is the result of imbalance between oxygen demand and myocardial blood supply (Henry, 2016). In case of Coronary Artery Disease, free radicals and different inflammatory mediators in atherosclerosis can damage collagen synthesis that is essential for repairing and managing fibrous cap and triggering degradation of the extracellular matrix macromolecules that continues to weaken the fibrous cap of plaque and increases the patient’s vulnerability to rupture, this leads to progression of stable angina to unstable angina the outcome of the same can be patient effected by Myocardial Infraction (MI) (Uppal et al., 2014). Unstable angina also known as acute coronary syndrome leads to unexpected chest pain and occurs mostly while resting . The main cause of unstable angina is the reduced flow of blood to heart muscles as the coronary arteries are narrowed due to atherosclerosis i.e. fatty buildups and can rupture, which leads to blood clotting and blocking blood flow to heart muscle (Henry, 2016). The symptoms of unstable angina include pain or discomfort while resting, sleeping or physical exertion, can get worse over time and rest or medicine do not help relieve it and the outcome can be heart attack if not addressed immediately (Henry, 2016).  NSTEMI or non-ST segment elevation myocardial infraction refers to a type of heart attack and can be detected through ECG and the severity is detected by the GRACE score wherein the factors such as heart rate, systolic blood pressure, ST-segment deviation in the ECG, elevated cardiac marker are detected (Marfella et al., 2017).

 The NSTEMI is diagnosed when a person has symptoms of unstable angina and through ECG it NSTEMI occurrence can be identified (Henry, 2016). In case of patients with NSTEMI and type 32 diabetes can lead to adverse cardiovascular outcomes as compared to one who do not have diabetes (Marfella et al., 2017).  ST Elevation Acute Myocardial Infarction (STEMI) refers to the serious manifestation of coronary artery disease. It causes notable chest pain/discomfort due to STEMI segment elevations that can be observed on ECG and due to elevated troponin levels (Kaski, 2016). The progression of SETMI is that complete occlusions in artery are causes that leads to severe ischemia in myocardium coming though artery (Henry, 2016). The ischemia is transmural highlighting that it affects the entire layer of muscle causing increased risk of heart complications and can lead to death in case patients have diabetes (Birkner, Hudzik & Gasior, 2017). As Betsy has stable angina and her pain is reducing when GTN is administered hence she does not have any major threat related to any cardiac problem. 

2b 

 Acute coronary Syndrome (ACS) is  a range of clinical presentations mainly associated with rupture of atherosclerotic plaque in coronary artery that is followed by partial or complete thrombosis (Phalen & Aehlert, 2018). There are several risk factors that increases the risk of ACS in people. In case of Betsy, the two risk factors that can increase her risk of ACS are

• Hypertension
• Type 2 Diabetes 

Hypertension is associated with increase in atherosclerosis and contributes to progression of myocardial infraction thereby increasing risk of ACS (Lumb & Biercamp, 2014). Type 2 diabetes also accelerates atherosclerosis due to insulin resistance that causes dyslipidemia and hyperglycemia reducing nitric oxide in blood vessel walls and making diabetes a risk factor for ACS (Birkner et al., 2017).