Assessing And Managing Angina: Nurse’s Role In Patient Care

Assessing Chest Pain and Collecting Relevant Data

1.Identify two concerns you have for Mr. Fischy in relation to the case scenario. Why do they concern you and what actions would you take?

2.As his nurse, what other pieces of data would you assess and collect in regards to his chest pain episode?

3.List the most common areas for ischemic cardiac pain to radiate to.

4.As Mr. Fischy’s nurse, what do you need to assess as risk factors for Coronary Artery Disease in order to plan teaching him about lifestyle management? Refer to the readings from the cholesterol/cardiovascular section of articles in the guidelines and protocols of cardiovascular disease- primary prevention March 2008.

5.Despite the fact that Mr. Fischy has been taking SL nitroglycerin for a long period of time, you perform a knowledge assessment of his understanding of the side effects, use and storage of sublingual Nitroglycerin. What approach would you take in order to have Mr. Fischy fully cooperate with your learning assessment prior to discharge? Explain your rationale.

6.Upon assessment, you discover Mr. Fischy enjoys learning via the internet. You suggest to Mr. Fischy that he utilize the Heart and Stroke Foundation website. What is the Heart and Stroke Foundation? Do you have one in your local area? Research the website and list and describe a few other resources, in your local area, that offer information and supports to people affected by Angina.

1.Mr Fischy, the patient is the case study has represented in the care facility with symptoms of cardiac congestion and related disorders. The past medical history of the patient revealed that he had been a patient of hypertension and angina pectoris for close to 6 months. The patient assessment data regarding the patent reveals that he had been awoken multiple times during the night feeling acute chest pain for which he had already taken nitroglycerin sublingually 9 to 11 times in the past week. Researchers are of the opinion that persistent angina is a grave health concern for the elderly patients. As Mr Fischy had been a 65 year old man, the age also could have contributed effectively contribute to possible myocardial infarction and congestive cardiac failure. It has to be mentioned in this context that the patient had cardiac catheterization performed in the past and it was discovered that he had 50% of his right coronary artery and about 50% of his left anterior descending coronary artery to be completely occluded. According to the Fan et al. (2016), both of the arteries play profound and crucial roles in maintaining the pulmonary circulation burden management on the heart. Coronary blockage has been attributed to be the key contributing factor to incidences of myocardial infarction and congestive heart failure. Hence, the first concern for the patient will be the arterial blockage that the patient (Katzung and Chatterjee 2012). It has to be mentioned that blocked arteries that are left untreated can lead to plaque rupturing due to artheosclerosis and can heighten the probability of heart attack. First and foremost I will increase the dosage of aspirin for the patient which will inhibit blood clot formation by reducing the adhesive nature of the platelets. along with that I would also administer beta blockers and ACE inhibitors to reduce the risk of myocardial infarction. The patient has stated that he had been experiencing acute pain in chest, especially in the night which had woken him multiple times in the middle of night and had urged him to take nitroglycerin. Hence the second concern for the patient will be management of angina pectoris. I will administer antianginal drugs such as calcium channel blockers along with mild analgesics for pain management as well (Tegn et al. 2016). 

Risk Factors and Lifestyle Management for Coronary Artery Disease

2.Chest pain or angina can be facilitated by a wide variety of factors and hence as a nurse I would have to assess a range of different assessment data and test results to better understand the contributing factors to his angina and be able to address the issues better to solve his medical concerns. First and foremost, I would perform a PQRST assessment of the chest pain that the patient had been feeling. It will begin with the provoking factors of the chest pain, followed by the quality of the pain asking him to describe the nature of the pain. Then I would assess the radiation statistics of the pain as angina preceding an acute myocardial episode has a characteristic radiation pattern (Www2.gov.bc.ca. 2018). The last two components of the assessment provides valuable data revealing the severity of the pain and the time period which will aid in faster and effective diagnosis and symptom management. The very next assessment data that I will assess will be a thorough analysis of the vital signs of the patient which will help me understand the manifestation of the pain and whether it has affected the heart rate, blood pressure and respiratory rate. Lastly, I would order for ECG and angiogram to be performed for the patient, which will help me understand the spread of the blockage in the heart and severity of the blockages (Radico et al. 2014).

3.Ischemic cardiac pain can originate in any region of chest and it is generally manifested as the symptom for the number of different cardiac emergencies. The medical term for this pain is angina pectoris and it is generally localized to the chest region in case of mild to moderate cardiac congestion. However, with the lack of treatment of management of this pain it can radiate to other sites of the body, the based on the origin it can be of two types; left sided radiation and the right sided radiation. The most common sites for the angina pectoris to radiate to includes the arms, shoulders and even the jaws of the patient. However, in certain rate and exceptional cases the angina pectoris or the ischemic chest pain can radiate to the back of the patient as well. This generally occurs if the patient has aortic dissection associated with Marfan’s syndrome (Li et al. 2013)

4.In order to understand whether the patient has any chances of developing cardiac disorders a few risk factors assessments will be needed to be performed. First and foremost, the age of the patent will be needed to be assessed along with any possible family history of cardiovascular disease. according to the guidelines, any male patient over the age of 55 with a family history of cardiac disorders are highly at risk, hence age and family history will be two primary risk factors that will be assessed for the patient. Few other nonmodifiable risk factors that will be assessed for the patient includes ethnicity, chronic kidney disease, and any auto immune inflammatory disease. The modifiable risk factor that will be assessed includes smoking, level of physical activity, dietary habit, BMI or weight, blood pressure, cholesterol levels, diabetes, socio-economic and psychosocial factors. For the risk assessment the Farmingham Risk score tool can be used (Www2.gov.bc.ca. 2018).

5.Patient education and information sharing is a very important aspect of adequate care delivery and ensuring that the construct of patient autonomy and shared decision making. it has to be mentioned that safe storage and self administration following the safety protocol is very important for the welfare of the cardiac patients and hence educating the patent regarding the nitroglycerin storage and administration is a crucial requirement of the nursing responsibility. However, in order to ensure that the patient has understood the information is vital for the success of the patient education program. A few strategies can be incorporated to ensure getting undivided attention from the patient. First and foremost, I would have to establish a therapeutic relationship with the patient to ensure that the patient can get the communication comfort of the patient so that the patient is able to relax. I would start with the importance of this educational session and ask him questions to assess his level of health literacy level. And based on that, the patient will be given the information in the most easily understandable manner. Along with that, I would utilize patient teach back method to ensure that the patient has understood the details of the educational session and is capable of repeating it (Barello, Graffigna and Vegni 2012).

Patient Education on Sublingual Nitroglycerin

6.the heart and stroke foundation is a charitable organization that attempts to reduce the percentage of heart diseases and strokes by the means of advocating, educating the target population about the health promotional and prevention to ward off the risk for strokes (Heart and Stroke – Canada.ca, 2018). Along with that this organization also attempts to fund research studies based on heart diseases and strokes through their charity. They provide a wealth of information in their website regarding the risk factors to cardiac problems, the common signs and symptoms and how to recognize them and along with that the primary actions to be taken in any cardiac emergencies. This website also provides key information regarding the lifestyle changes such as healthy diet and physical exercise to reduce the risk for stroke. They have headquarters in Ottawa, Ontario and divisional branches across different cities of Canada and hence we have a foundation in our local area (Heart and Stroke Foundation of Canada 2018). Other resources that can help the patient include the government website of Canadian health and welfare has a segment for heart and stroke. The official website of the Heart Research Institute of Canada can also be of help to the patient. The website of diabetes Canada also provides key information regarding cardiac diseases, its symptoms and stroke (Canadian Diabetes Association 2018).

References:

Canada, H. 2018. Heart and Stroke – Canada.ca. [online] Canada.ca. Available at: https://www.canada.ca/en/health-canada/services/health-concerns/diseases-conditions/heart-stroke.html [Accessed 13 May 2018].

Canadian Diabetes Association. 2018. Heart Disease & Stroke. [online] Available at: https://www.diabetes.ca/diabetes-and-you/complications/heart-disease-stroke [Accessed 13 May 2018].

Fan, Y., Li, Y., Chen, Y., Zhao, Y.J., Liu, L.W., Li, J., Wang, S.L., Alolga, R.N., Yin, Y., Wang, X.M. and Zhao, D.S., 2016. Comprehensive metabolomic characterization of coronary artery diseases. Journal of the American College of Cardiology, 68(12), pp.1281-1293.

Heart and Stroke Foundation of Canada. 2018. Our partners. [online] Available at: https://www.heartandstroke.ca/what-we-do/partners [Accessed 13 May 2018].

Hricanada.org. 2018. Facts about Heart Disease | The Heart Research Institute – Heart Research Institute. [online] Available at: https://www.hricanada.org/about-heart-disease/facts-about-heart-disease [Accessed 13 May 2018].

Katzung, B.G. and Chatterjee, K., 2012. Vasodilators and the treatment of angina pectoris. Basic and clinical pharmacology, 7, pp.20-25.

Li, C., Fang, Z., Jiang, T., Zhang, Q., Liu, C., Zhang, C. and Xiang, Y., 2013. Serum microRNAs profile from genome-wide serves as a fingerprint for diagnosis of acute myocardial infarction and angina pectoris. BMC medical genomics, 6(1), p.16.

Radico, F., Cicchitti, V., Zimarino, M. and De Caterina, R., 2014. Angina pectoris and myocardial ischemia in the absence of obstructive coronary artery disease: practical considerations for diagnostic tests. JACC: Cardiovascular Interventions, 7(5), pp.453-463.

Tegn, N., Abdelnoor, M., Aaberge, L., Endresen, K., Smith, P., Aakhus, S., Gjertsen, E., Dahl-Hofseth, O., Ranhoff, A.H., Gullestad, L. and Bendz, B., 2016. Invasive versus conservative strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. The Lancet, 387(10023), pp.1057-1065.

Www2.gov.bc.ca. 2018. Acute Chest Pain – Evaluation and Triage. [online] Available at: https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/bc-guidelines/chestpain.pdf [Accessed 13 May 2018].

Www2.gov.bc.ca. 2018. Cardiovascular Disease – Primary Prevention – Province of British Columbia. [online] Available at: https://www2.gov.bc.ca/gov/content/health/practitioner-professionalresources/bcguidelines/cardiovasculardisease?keyword=cardiovascular&keyword=disease-primary&keyword=prevention#risk-assessment [Accessed 13 May 2018].