According to the presented case study of Mr Johnston, he is a 64 years old male patient who has come to his GP for health checkups. As per his health information, several abnormal signs and symptoms have been noticed. However, most of the symptoms are related to his cardiovascular health. As per the case information, he has a prolonged (20 years) history of hypertension and based on recent assessment findings, his blood pressure (BP) is 155/90. According to studies, hypertension is known as BP, which is more than 140/90 (Leung et al., 2016). Hence it can be stated that he is still suffering from high blood pressure. Prolonged high blood pressure (HBP) can be a significant risk factor for cardiovascular health and wellbeing. Prolonged high blood pressure leads to cardiovascular exacerbation. In addition, it has been noted that the patient has a history of silent myocardial infarction. Myocardial infarction (MI) is a medical condition that generally consider as one of the a significant health issues that occurs due to poor blood flow to the heart muscle. There may be different reasons or factors behind poor blood flow (Song et al., 2017). However, this condition is generally related to the blockages in the heart’s arteries. If this type of condition remains untreated or neglected, there is a high chance of developing heart diseases like stroke, cardiac failure. According to Kaski et al (2018), the previous history of myocardial infarction is a significant risk factor for further heart diseases like heart failure. In addition, he had a habit of smoking, which is also an influencer of coronary heart disease. Hence, after considering his other signs and symptoms, it can be stated that all of these indicate that the patient is developing a severe medical condition such as coronary heart disease, which may lead to heart failure. According to the other signs and symptoms of the patient, such as his respiratory rate, heart rate, spo2 and pain status, most of them are showing abnormal signs. In the context of respiratory rate, it is quite higher than the normal value (12 to 16 beats per minute). According to studies, a respiratory rate over 24 bpm is generally considered a significant sign of a severe health condition. Besides that, in this case, the patient also mentioned his chest pain, and the level of the pain (1/10)was found at the time of the assessment procedure. As per the study of Song et al., (2017), it has been stated that breathing difficulties, increased respiratory rate, centralised chest pain all of these are linked with the risk of heart failure. Due to his breathing difficulties, his oxygen saturation level also slightly decreased to 94%, whereas the normal oxygen saturation level is 95%. On the other hand, his heart rate and body temperature are at the normal range. Hence, after going through the case information and assessment findings, it can be stated that the patient is at risk of developing severe heart diseases like angina pectoris that should be treated in a priority manner.
Cardiovascular health issues are serious health issues; however, they can be treated if people should follow a proper health care plan. In order to maintain a good cardiovascular health condition, complete care planning and proper health education have a significant role. In this context, a holistic care plan should produce for the patient Aaron through considering his physical, social and psychological needs. This care plan would help him in reducing his risk conditions as well as improving his overall health and wellbeing. In the context of a holistic health education plan considering the patient’s physical, social and psychological needs is important. As per the case study of Mr Aaron, physical abnormalities have been found, including chest pain, breathing issues, increased blood pressure and respiratory rate. Hence, all of these need to maintain a normal level. In the context of social needs, the patient expressed that he felt lonely and less energetic after his wife’s death. Besides that, he often does not want to take medication, which is not good for his health, and there is no one to guide him about this. Social support is important in order to live a healthy life. then meeting his psychological need also an important part of this education plan. An evidence-based health education plan has been attached below-
|
Goal |
Actions |
Rationale |
|
|
Physical · Chest pain · Shortness of breathing · High blood pressure · Increased heart rate · Decreased oxygen saturation level |
Reduce the abnormal signs and symptoms of the patient and maintain all vital signs in a stable state. |
· Assessing emergency signs and symptoms. · Educating the patient about taking medication to reduce high blood pressure. · Providing the patient with a diet plan with educating the patient about the effect of a proper diet plan. · Demonstrating the patient some effective physical exercises. And educating him about the significant effect of walking (30minites every day) on maintaining his blood pressure level (Masoumi et al., 2017). |
· To differentiate pain of angina from other types of pain. · Education on medication taking would help him balance his vital signs and symptoms (Wang, Huang & Zhou, 2019). · Diet has an important impact on people’s overall health and wellbeing. · Regular physical activity, including walking, help him in reducing his blood pressure level to normal (Wang, Huang & Zhou, 2019).. |
|
Social |
Address the issue of loneliness and improve his willpower. |
· Providing some contacts of local community helthcare centres (Camero, 2017). |
This would help in communicating and getting services from local care services (Camero, 2017). |
|
Psychological · Anxiety · Depression |
Enhancing his mental pece and reducing the signs and symptoms related to depression and anxiety. |
· Listening music and watching fun activities in television. · Spending time with children or other family member and friends (Tinson et al., 2016). · Practicing meditation (Eng et al., 2016). |
These activities would help the patient in balancing his psychological status. |
Coronary artery disease or CAD can able to manifests angina. Squeezing, tightness, heaviness, pressure, and pain or discomfort in the chest are all some common symptoms and signs of angina. This medical condition can be controlled or treated with medication, lifestyle modifications, surgery or angioplasty according to the severity of the condition.
The underlying pathophysiology of this condition is basically Reduced blood circulation to the heart muscle. In human body blood transports significant nutritions and oxygen to the muscle of the heart, in order to survive both are required. However, when blood supply to the heart get decresed this condition is called Ischemia, and during this condition the heart muscle become unable to receive adequate amount of oxygen (Ford, Corcoran & Berry, 2018). Coronary artery disease or CAD is one of the most prevalent reasons behind restricted blood supply to the heart muscles. Forming plaques in between the arteries, which are fatty deposits, can prevent the heart (coronary) arteries to get enough oxygen (Van Hecke et al., 2017). This medical condition generally known as atherosclerosis. During time of poor oxygen demand, such as while people sleeping, their heart muscle may be able to perform with low blood flow without occurring any symptoms of angina. However, angina can occur when the oxygen demand get increased, for example when people exercise in general (Ford, Corcoran & Berry, 2018). Hence, it can be stated that the basic or major pathophysiological charecteristic of this situation is restriction of blood flow in the heart muscles. There are some significant risk factors behind developing this medical condition. The following risk factors are able to develop the risk of coronary artery disease as well as angina among human. Such as excessive use of tobacco, different types of diseases including diabetes, high cholesterol level in blood, high blood pressure, family history, age, lack of physical activity,obesity and stress (Ruan et al., 2018). Tobacco use is one significant cause of this kind of medical condition. the interior wall of the arteries can get damage due to the habit of smoking. Diabetes is another important risk factor, it can increase the risk of CAD, people who develop coronary artery disease the chance of developing angina is also higher among throse people. High blood pressure affects arteries over time by hastening artery hardening. Cholesterol is a key component of the deposits that can constrict arteries all over the body, even those that feed the heart. Low-density lipoprotein (LDL) cholesterol, sometimes referred to as “bad” cholesterol, raises the risk of angina as well as heart attacks. Triglycerides, a kind of blood fat linked to the food, are also dangerously high. When a family member has cardiovascular diseases , a person is more prone to develop this medical condition. Over the age range from 45 to 55, male and female both are at a larger risk for developing this medical condition. Lack of physical activity has a significant role for developing angina. High cholesterol level in blood, High blood pressure, type 2 diabetes, as well as obesity are all linked to a sedentary lifestyle (Ford, Corcoran & Berry, 2018). However, before beginning an exercise regimen, one should consult a doctor. Obesity is one of the signficant risk factors and it is linked to other comorbidities including high blood pressure, hypercholesteromia as well as diabetes, and all of these medical conditions can induce the risk of different types of heart diseases as well as angina (Lee et al., 2020). Stress can aggravate angina and also heart attacks. Blood pressure might increase substantially due to stress and anger. Stress-related hormone spikes can narrow arteries and worsen angina.
Angina is a form of chest discomfort that is produced when blood flow in the heart get reduced. It might occur over time or sudden. Angina is a significant medical condition that should be treated in a priority manner. It is a medical condition that can be treated by using some medications. β-adrenergic receptor blockers is one of the significant medications that can help in reducing the issues behind development of angina (Frishman, 2016). The beta-blockers comprise a class of drugs those are commonly used to treat various types of cardiovascular disorders including, cardiac arrhythmia, ischemic heart disease or hypertension. Each one of these medications has at least one chiral centre and a greater level of enantioselectivity when it comes to interacting to the beta-adrenergic receptor (Frishman, 2016).
Pharmacokinetics – From a pharmacokinetic standpoint, beta blockers are highly variable as a class, with a variety of parameters in plasma protein binding, percentages of drug removed by metabolism or unaltered in the urine, or hepatic extraction ratio (?ižmáriková et al., 2019).
In most circumstances, the enantiomers of beta-blockers exhibit only a minor degree of stereoselectivity when it comes to plasma concentrations obtained following oral or intravenous dosage. In plasma, the relative magnitude of the enantiomer concentrations, on the other hand, is not consistent in all scenarios and differs from one drug class to another class of drug. The gastro-intestinal system appears to absorb all beta-adrenoreceptor blocking medications pretty quickly and thoroughly. However, in comparison to younger people, the rate of absorption appears to be decreased in older patients and potentially also in patients with renal failure. The amount of bioavailability varies significantly amongst beta-blockers. Due to a strong first-pass elimination effect, some of these medications such as alprenolol or propranolol have a limited bioavailability, but pindolol or practolol, for example, are altered relatively slightly by this impact. The beta-blockers that have so far been studied travel fast throughout the body. The t1/2 time of the dispersion ranges from 5 to 30 minutes (?ižmáriková et al., 2019).
Pharmachodynamics – Antiarrhythmic properties or charecteristics are also noticed in -blockers (class II antiarrhythmics). Blockers reduce conduction velocity, lengthen the refractory period through indirectly reducing calcium entry to cardiac cells and delay automaticity(?ižmáriková et al., 2019). Beta blockers function by inhibiting the impacts of the adrenaline-like hormone epinephrine. Beta blockers reduce blood pressure by causing the heart to pump more gradually and with much less power. Beta blockers also assist to enhance blood flow by widening arteries and veins (Maideen et al., 2021). Through these kind of activities this class of medication can reduce signs and symptoms of angina among people. Similarly this medication would help the patient Aaron in treating his current situation.
References
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Eng, H. S., Jin, J. T. A., Ching, L. L., & Fong, W. P. (2016). Information Needs in Relation to Physical Activity among Angina Patients before Percutaneous Coronary Intervention (PCI) at a Private Hospital in Penang, Malaysia. Journal of Krishna Institute of Medical Sciences (JKIMSU), 5(4).https://search.ebscohost.com/login.aspx?direct=true&profile=ehost&scope=site&authtype=crawler&jrnl=22314261&AN=118723707&h=LAlx1WrtZJuo4p9bVynufwZ6UbltOSF161%2FeGgtGC0Dt8uT64%2FmyAZhsCoUmU1SaIqGgq3vVQSfDt5pWD4OHmQ%3D%3D&crl=c
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