In this essay, the case study of Kath Harris who is a 65-year old lady who lives alone and recently she had chest pain. Mrs. Harris also had a history of unstable angina, diabetes mellitus type 2, hypertension. Along with this, the patient is also regular smoker who smokes two packets of cigarettes a day. Furthermore, the case study also depicts that the patient is recently experiencing the problem of peptic ulcer and her high BMI of 32 suggested that the patient is Obese. Currently, Harris is taking the medicines like GTN, carvedilol and metformin. She had a chest pain score of 6 out of 10 and GCS score is 15. The vital sign assessment depicted that the patient had blood pressure of 92/58mm hg,, heart rate is 92 beats/min, respiratory rate is 28 breaths/ min and oxygen saturation rate of 91% (SpO2= 91%).
In this essay, the pathophysiology of Harris’s conditions, possible nursing management and the medicines, can be given to the patients, are discussed in a brief manner.
While discussing about the pathophysiology of the myocardial infarction, it can be stated that the problem of myocardial infarction (MI) refers to the sudden deaths of the myocardial tissues and the incident of MI may cause various dangerous health consequences such as stroke or heart failure. Therefore, the necrosis of the cardiac cells due to reduced supply of the oxygen to the tissues of cardiac muscles eventually causes heart failure. According to the study of Lu et al. (2015), it is stated that the main reason of reduced oxygen supply is due to the occlusions of the coronary arteries. In this study, it is stated that due to the gradual accumulation of the plaques in the coronary arteries restricts the flow of blood toward the hearts and reduced blood supply in the heart also alters the supply of oxygen. However, during the resting stage, no severe problem is reported. During any kind of physical activities the myocardial demand is enhanced and as a consequence the flow restriction prevents an enhanced supply of the oxygen causing the development of ischemia (Lu et al., 2015). In this case, Harris had the history of angina pectoris and due to the above said procedure angina pectoris may happen. Moreover, it is reported that the cases of MI mainly takes place due to the presence of coronary atherosclerosis along with thrombosis. It is reported that the rupture of vulnerable plaque causes the formation of the occlusive thrombus in the coronary artery (Heusch & Gersh, 2017). The presence of the vulnerable plaque is correlated with the inflammation process and also for the activation of the macrophages. In case of Mrs. Harris, it can be stated that the patient, the high levels of blood cholesterol level may contribute to the formation of plaque in the coronary arteries and thereby promotes MI. According to the study of Gabriel-Costa (2018), a common consequence of the incidence of MI is associated with the reduced cardiac output and reduced blood pressure. In this case of Mrs. Harris, it was reported that she had lower level of blood pressure that was almost 92/mm Hg. On the contrary, the heart rate was higher as a consequence of the reduced cardiac output that is the enhanced heart rate is reported due to secure the blood supply to the various part of the body. Other clinical manifestations that are observable in case of Mrs. Harris are pale skin, chest pain, breathing problem due to reduced blood oxygen supply to the lung (characterized by higher breathing rate and lower oxygen saturation level).
For managing the condition of MI, it is very important for the nursing care personnel to provide immediate treatment to the patients. In this context, it can be stated that the main goal of the immediate treatment of the patient is associated with the enhancement of the oxygen supply to the cardiac muscle tissues and thereby reduces the myocardial oxygen consumption of the individuals. In case of Mrs. Harris the nurse should initiate the treatment for achieving this goal. In order to do so, the nurse should provide the drug aspirin to the patients. As per the study of Erne et al. (2015), it is stated that the use of aspirin among the patients with acute MI is very common as it helps in breaking the blood clot. Moreover, it is also reported that the use of aspirin in case of MI may also help in dissolving arterial blockage. As the patient had severe chest pain, the problem of MI should be managed at a priority basis. In order to reduce the myocardial oxygen consumptions, the restoration of the normal heart rate is very important and this can be achieved by using the ACE inhibitors, beta blockers, glyceryl trinitrate group medicines. Moreover, this is very important to mention the fact that these medications should be prescribed to the patients of cardiovascular diseases in order to prevent the occurrence of MI (Ohtsubo et al., 2019). Hence, these medications can be prescribed as a part of long term care process for the MI patients. Along with this, Mrs. Harris also should reduce the rate of smoking as smoking is considered as one of the causative factors for the MI (Lu et al., 2015).
Another immediate medical management for this current condition will be the use of oxygen therapy to meet the oxygen demand of the body (Fahlman, 2014). From the case study of the patient, it was observed that the patient had low amount of oxygen saturation rate and higher rate of respiration. Therefore, the use of oxygen therapy will help to enhance the oxygen saturation levels and also helps in reduction of the breathing rate to the normal range. According to the study of Vargas et al. (2015), it is stated that the use of High-flow nasal cannula (HFNC) based oxygen therapy is effective in improving the process of oxygenation and thereby can improve the breathing problems among the patients.
While discussing about the medicines for managing the condition of Mrs. Harris, it can be stated that the ACE inhibitors, aspirin and morphine can be used.
ACE inhibitors
As an ACE inhibitor, Captopril can be used for managing the condition of MI. As per the information of the Drugbank (2020), captopril is competitive inhibitor of angiotensin-converting enzyme (ACE) and this enzyme is responsible for the conversion of angiotensin I (ATI) to angiotensin II (ATII). Captopril 6.25mg can be used as a first dose and it can be enhanced to 25mg twice daily. Captopril exerts its action by antagonizing the activity of the RAAS. The presence of ATII enhances the blood pressure in the body. On the other hand, the application of the Captopril disrupts the conversion process of ATII from ATI. Therefore reduction in the level of ATII level in the body reduces the blood pressure and thereby causes reduction of myocardial oxygen demand (Drugbank, 2020). However, while administering this drug, the nurse should take care about the side effects such as rash, gastric irritation, taste alterations. In case of Mrs. Harris gastric irritation may happen as she already had gastric ulcer.
Aspirin
Aspirin is mainly an acetylsalicylic acid (ASA) that is used for inhibiting platelet aggregation and thereby prevents stroke, blood clots and myocardial infarction. Aspirin is mainly administered in the form of a tablet and it can be given at a dose of 150-300mg. However, in case of acute myocardial infarction process, extended release form of the medicine should be avoided. Aspirin alters the interference with thromboxane A2 in platelets due to its COX-1 inhibitory capacity (Drugbank, 2020). Thromboxane A2 is considered as a crucial lipid for the process of platelet aggregation that can cause clot formation in the blood vessels. Therefore, inhibition of the conversion process of thromboxane A2 from arachidonic acid prevents the clot formation (Shin et al., 2019). However, the nurse must take care of a few side effects such as nausea, vomiting, loss of appetite, confusion.
Morphine
Morphine is used for the pain management as the patient had severe chest pain morphine can be given to him. Morphine is mainly an opioid drug that blocks the transmission of the nociceptive signals. The consumption of morphine causes agonistic activities mu and kappa opioid receptors (de Alencar Neto, 2018). The binding of morphine to the opioid receptors inhibits the primary afferent nociceptors. A dose of 5mg of morphine can be given to the patient intravenously (Drugbank, 2020). However, Mrs. Harris should tell about the previous head injury before administration of the drug. Moreover, it may cause dizziness, tiredness, sweating as well. Hence, the nurse must take care of all these side effects.
Conclusion
Hence, it can be concluded that the condition of Mrs. Harris must be managed in a priority as if the condition of MI kept untreated the condition may lead to death as he had low oxygen saturation and a higher heart rate. In this case, the nurse should address the issue of MI in a priority basis and take adequate actions to improve the condition of the patients. As a part of the immediate treatment, the nurse can give oxygen therapy, aspirin, beta blocker drugs. However the use of beta blocker drugs, ACE inhibitors can be recommended for long term management of MI. However, while providing medication therapy the nurse should take care of the side effects of these drugs and previous health condition of Mrs. Harris.
References
de Alencar Neto, J. N. (2018). Morphine, oxygen, nitrates, and mortality reducing pharmacological treatment for acute coronary syndrome: an evidence-based review. Cureus, 10(1). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5866121/
Drugbank (2020). Captopril. Drugbank. https://www.drugbank.ca/drugs/DB01197 [Accessed on 7th May 2020]
Drugbank (2020).Aspirin. Drugbank. https://www.drugbank.ca/drugs/DB00945 [Accessed on 7th May 2020]
Drugbank (2020).Aspirin. Drugbank. https://www.drugbank.ca/drugs/DB00295 [Accessed on 7th May 2020]
Erne, P., Bertel, O., Urban, P., Pedrazzini, G., Lüscher, T. F., Radovanovic, D., & AMIS Plus Investigators. (2015). Inpatient versus outpatient onsets of acute myocardial infarction. European journal of internal medicine, 26(6), 414-419. https://www.sciencedirect.com/science/article/pii/S0953620515001764
Fahlman, Å. (2014). Oxygen therapy. Zoo animal and wildlife immobilization and anesthesia, 69-81. https://www.researchgate.net/profile/Asa_Fahlman/publication/281202527_Oxygen_Therapy/links/55dad7bd08aeb38e8a8a2396/Oxygen-Therapy.pdf
Gabriel-Costa, D. (2018). The pathophysiology of myocardial infarction-induced heart failure. Pathophysiology, 25(4), 277-284. https://www.sciencedirect.com/science/article/pii/S0928468017301724
Heusch, G., & Gersh, B. J. (2017). The pathophysiology of acute myocardial infarction and strategies of protection beyond reperfusion: a continual challenge. European heart journal, 38(11), 774-784. https://academic.oup.com/eurheartj/article-abstract/38/11/774/3056918
Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: symptoms and treatments. Cell biochemistry and biophysics, 72(3), 865-867. https://link.springer.com/article/10.1007/s12013-015-0553-4
Ohtsubo, T., Shibata, R., Kai, H., Okamoto, R., Kumagai, E., Kawano, H., … & Arima, H. (2019). Angiotensin-converting enzyme inhibitors versus angiotensin receptor blockers in hypertensive patients with myocardial infarction or heart failure: a systematic review and meta-analysis. Hypertension Research, 42(5), 641-649. https://www.nature.com/articles/s41440-018-0167-5
Shin, J. H., Kwon, H. W., Rhee, M. H., & Park, H. J. (2019). Inhibitory effects of thromboxane A2 generation by ginsenoside Ro due to attenuation of cytosolic phospholipase A2 phosphorylation and arachidonic acid release. Journal of Ginseng Research, 43(2), 236-241. https://www.sciencedirect.com/science/article/pii/S1226845317303019
Vargas, F., Saint-Leger, M., Boyer, A., Bui, N. H., & Hilbert, G. (2015). Physiologic effects of high-flow nasal cannula oxygen in critical care subjects. https://rc.rcjournal.com/content/60/10/1369.short
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