The case scenario selected is of Max Johnston. He is a 59-year-old man and works as a principal in the secondary school in Pamutana for the last 19 years. His job is very stressful. He has to travel a lot around the world as he is a member of the national executive organization. He is married and has 3 kids. Because of his jobs, he does not get enough free time but he takes out time to enjoy some social life with his friends. Both he and his wife smoke around 20 cigarettes every day and drink one to two glasses of wine along with their dinner. During his weekends, Max also consumes beer with his friends (Referred to the case study).
His father died of a haemorrhagic stroke 20 years ago. His father also had hypertension. His mother had angina and has been treated for glaucoma. She also has mild osteoarthritis in both her hips. Max was brought to the Coronary Care Unit (CCU) after he felt intense pain in his chest with a pain score of 9 out of 10. He also has nausea and looked very pale and grey. His skin was cold to touch and he was sweating profusely (Referred to the case study).
The issue related to the physical well-being of Max is his excessive smoking. As mentioned in the case study he along with his wife smokes 20 cigarettes per day. Smoking cigarettes not only results in disease and disability but also harms almost every organ present in the body (CDC, 2020). Max’s father has a family history of angina, hypertension, and haemorrhagic stroke. The smoke released from the cigarette contains nicotine and carbon mono-oxide which affects the health of the heart and the blood vessels. Smoking increases the clotting of the blood which blocks the arteries and can result in myocardial infarction and stroke. It also affects the rhythm of the heart and can make it abnormal which can also lead to the sudden death of the person. It damages the arteries and veins and can make them narrow, which increases the heartbeat and can result in hypertension. It can also lead to a condition known as arteriosclerosis which can make the walls of the arteries hard. It also raises the level of cholesterol in the body (Gleeson, 2016).
It is also mentioned in the case study that he and his wife drinks one to two glass of wine every day with dinner. He also drinks beer with his friends on weekends. Drinking alcohol can definitely lift the mood of a person so people tend to drink it frequently too much alcohol can have an adverse effect on their health and mental well-being. Excessive consumption of alcohol can cause hypertension, cardiovascular disease, stroke, digestive issues, stroke, and infection in the liver. It weakens the immune system. Alcohol disrupts the balance of chemical processes, which are the neurotransmitters in the brain. It also affects the serotonin level in the brain which affects the mood of the person. This can altogether affect the mental health of the person (CDC, 2021).
The issue here is his lack of knowledge about the conditions that he is going through. As he is experiencing certain symptoms, he feels that he has sugar diabetes and a high level of cholesterol. Health behaviours are very widely influenced by the traditional values of the person. He is serving his community as the principal of the influence for the past 19 years. He has never got a chance to relax or spend time with his family in a proper way. He always tries to have some leisure time. This does not help him in maintaining his required check up so that he can know what he is suffering from. He has a family history of heart health and such busy schedules and not having time for one’s health can also affect him (MAS Team, 2020).
It is mentioned in the case study that Max is married to Judy and has three children who are settled and married. He stays with Judy and they smoke and drink together which not only affects his health but also his wife’s health. Smoking and alcohol have a very major impact on the health of the person. Max already has a family history of stroke and cardiovascular diseases from both their mother and father’s side and is therefore at a very high risk of developing these conditions. Smoking and alcohol aggravate these conditions (New Zealand Government, 2017).
High respiratory rate: On assessment, it was found that the respiratory rate is 24. The normal respiratory rate of an adult is between 12 to 20 breaths every minute. When the breathing rate is more than 20 it is called tachypnoea. Any kind of change in the rate of respiration is an indicator that the patient is struggling to maintain the normal homeostasis of the body. It is a very good indicator that there is something wrong with the physiological functioning of the body. It can also suggest cardia arrest (Rolfe, 2019). It can help in recognizing if the person’s condition is deteriorating (Nicolò, et al., 2020).
Irregular heart rate: The heart rate recorded for Max was 118 beats per minute which was much higher than the normal range. The normal range of heart beat is between 60 to 100 beats per minute. This irregular situation is known as arrhythmia. This situation is a matter of priority as it indicates that the electrical signals that help in the coordination of maintaining the heart beat are not functioning properly. This results in an irregular heartbeat, faster than usual in the case of Max. this can be threatening to life. It can also indicate injury to the muscles of the heart or an imbalance of electrolytes in the blood (Beckerman, 2021).
High blood pressure: The blood pressure recorded for Max is 168/95. High blood pressure means the force that the blood is exerting against the walls of the arteries is higher than normal. This condition increases the risk of developing other complications such as stroke, heart failure, heart attack and even kidney failure. High blood pressure can cause damage to the arteries and make them less elastic. It reduces the flow of blood and oxygen to the heart (Fuchs & Whelton, 2021).
Capillary refill time: the normal capillary refill time is 1 to 2 seconds and the time that was recorded for Max is more than 3 seconds. This test helps in assessing the flow of blood through the peripheral tissues. It helps in measuring if there is a change in the peripheral perfusion. When the capillary refill time is delayed it indicates dehydration, shock, or hypothermia. It suggests that the tissues are dehydrated as blood is taking too much time in reaching the tissues (Jevon, 2020).
Excessive pain (9/10) on the pain scale: Excessive pain is a priority of care as it indicates that there is something serious health condition that the patient is dealing with. Maybe an internal organ is affected or there is a pathological condition that needs attention immediately. It increases the heart rate and blood pressure of the person which can also have a negative impact on the body of the patients. Pain also interferes with the healing process. It results in causing distress and suffering to the patient. It affects the mental condition of the patient as well and can make a person very anxious. If not managed at the right time it can also lead to disability (Edwards, 2016).
Max’s mother had a history of mild osteoarthritis in both hips. This increases Max’s risk of having the disease. This is a very common disease that affects the joints of people, especially older adults. These risk factors get inherited from one generation to other. Asking these questions to Max is valid as he might be developing the disease and early intervention can be started to prevent the disease from progressing and disrupting his daily life (Pugle, 2020).
The disorders linked with muscles is a very major cause of disability and morbidity all around the world. These questions will help in identifying whether there is any clinical situation that is affecting the functional ability of the muscles. It can help in the early diagnosis and intervention and make the treatment effective. It will help in preventing the excessively high costs of the healthcare system (Vilella & Reddivari, 2019).
It is mentioned in the case study that Max consumes alcohol daily with his wife and on weekends with his friends. Alcohol is known to alter the activities of the brain. Alcohol disrupts the balance of chemical processes, which are the neurotransmitters in the brain. It also affects the serotonin level in the brain which affects the mood of the person. This can altogether affect the mental health of the person. Therefore, asking these questions can help in accessing the mental status of Max (CDC, 2021).
These questions are relevant as Max is worried that he is having diabetes. He is showing these symptoms and therefore after this assessment a diagnosis of diabetes can be made.
Max was brought to the Coronary Care Unit with the complaint of intense pain and nausea. It is very important to ask him these questions to rule out the differential diagnosis and to take proper interventions for treating the underlying disease and preventing it from progressing.
The patient is showing symptoms of shock. Cool skin and excessive sweating are the characteristics of the shock. It is very important to ask him these questions to rule out the differential diagnosis and to take proper interventions for treating the underlying disease.
Max also complained that he has been having the feeling of indigestion. It can be because of other underlying conditions such as inflammation of the stomach, ulcers, intestinal blockage and so on. Therefore, these questions will help in taking further actions regarding this condition (Khatri, 2020).
Assessment of the respiratory system is important because the patient is a heavy smoker. Smoking contains nicotine and carbon monoxide which can affect the lungs and can cause COPD, lung cancer, bronchitis. Therefore, these questions will help in taking further actions regarding the condition, if there is any.
Max is showing the symptoms of diabetes and he drinks alcohol as well. To check if his kidney is functioning well or not and to confirm the diagnosis of diabetes, these questions are important and relevant.
Assessment of the reproductive system is important as it rules out the possibilities of cancers and other complications involving the other organs of the body.
After going through the case study and looking at the symptoms the main health condition that Max is suffering from is Cardiogenic Shock.
Cardiogenic shock is a condition that can be very dangerous to live in and if not managed can become fatal. This shock occurs when the heart is not pumping an adequate amount of blood to fulfil the requirements of the body (Kosaraju, Pendela & Hai, 2020). The pathophysiology of this shock is very complicated and is not understood properly. When there is ischemia to the heart muscles it leads to derangement to both the functions of the left ventricle is systole as well as diastole. This leads to a reduction of the contractility of the muscles of the heart. This eventually leads to an event that can be very catastrophic and further lead to coronary ischemia and complete impairment of the contractility of the heart muscles. This further leads to the initiation of the physiological compensation mechanisms such as peripheral vasoconstriction that is initiated by the activation of the sympathetic system. This might improve the perfusion of the heart at the price of enhanced afterload. The other mechanism is increasing the heartbeat or tachycardia which increases the oxygen demand of the myocardium and reduces the myocardial ischemia (Vahdatpour, Collins & Goldberg, 2019). But these compensatory mechanisms are also counteracted by pathologic vasodilation by releasing interleukin-1, tumour necrosis factor-a, and interleukin-6 along with the release of nitric oxide and peroxynitrite which are toxic to the heart. If proper treatment methods are not taken it can lead to failure of many organs and eventually death (Kosaraju, Pendela & Hai, 2020).
The physical examination assessment that should be prioritized for nursing care is cardiovascular assessment.
This intervention should be a priority in nursing care because a comprehensive cardiovascular assessment will aid in the identification of important variables that can impact the health of the heart, such as high blood cholesterol, use of cigarettes, diabetes, or high blood pressure. As a result, a cardiovascular assessment must be included in both shortened and comprehensive assessments. When a comprehensive assessment reveals a prospective cardiovascular issue, a centered cardiovascular assessment is generally recommended. When a period or shortened evaluation demonstrates a transformation in condition from the preceding evaluation or the notify, they obtained, whenever a new symptom arises, or the patient evolves any emotional pain, the centred cardiovascular assessment is also noted. The concentrated assessment has the benefit of allowing nurses to ask about symptoms and rapidly transition to a centred physical test. They may decide how frequently to undertake interval evaluations to supervise the patient’s recognised issue based on the assessment outcomes (Pedgogy, 2022).
References
Beckerman, J. (2021). Arrhythmia. https://www.webmd.com/heart-disease/atrial-fibrillation/heart-disease-abnormal-heart-rhythm
(2020). Health Effects. https://www.cdc.gov/tobacco/basic_information/health_effects/index.htm#:~:text=Smoking%20causes%20cancer%2C%20heart%20disease,immune%20system%2C%20including%20rheumatoid%20arthritis.
(2021). Alcohol Use and Your Health. https://www.cdc.gov/alcohol/fact-sheets/alcohol-use.htm#:~:text=Long%2DTerm%20Health%20Risks,liver%20disease%2C%20and%20digestive%20problems.&text=Cancer%20of%20the%20breast%2C%20mouth,liver%2C%20colon%2C%20and%20rectum.
Edwards, R. R., Dworkin, R. H., Sullivan, M. D., Turk, D. C., & Wasan, A. D. (2016). The role of psychosocial processes in the development and maintenance of chronic pain. The Journal of Pain, 17(9), T70-T92.
Forte, A.V. (2020). Medical History and Physical Examination in Musculoskeletal Disorders. https://www.msdmanuals.com/en-in/home/bone,-joint,-and-muscle-disorders/diagnosis-of-musculoskeletal-disorders/medical-history-and-physical-examination-in-musculoskeletal-disorders
Fuchs, F. D., & Whelton, P. K. (2020). High blood pressure and cardiovascular disease. Hypertension, 75(2), 285-292.
Gaieski, D. F., & Mikkelsen, M. E. (2016). Definition, classification, etiology, and pathophysiology of shock in adults. UpToDate, Waltham, MA. Accesed, 8, 17.
Gleeson, J.R. (2016). 5 Ways Smoking Hurts Your Heart. https://healthblog.uofmhealth.org/heart-health/5-ways-smoking-hurts-your-heart
Henderson, R. (2017). Neurological History and Examination. https://patient.info/doctor/neurological-history-and-examination
Jevon, P. (2020). How to measure capillary refill time in patients who are acutely ill. https://www.nursingtimes.net/clinical-archive/assessment-skills/how-to-measure-capillary-refill-time-in-patients-who-are-acutely-ill-20-07-2020/
Khatri, M. (2020). Indigestion. https://www.webmd.com/heartburn-gerd/indigestion-overview
Knott, L. (2021). Gastrointestinal History and Examination. https://patient.info/doctor/gastrointestinal-history-and-examination
Kosaraju, A., Pendela, V. S., & Hai, O. (2020). Cardiogenic Shock. StatPearls [Internet].
MAS Team. (2020). Well in every way – Te Whare Tapa Wh?. https://www.mas.co.nz/hub/well-in-every-way-te-whare-tapa-wha/
New Zealand Government. (2017). M?ori health models – Te Whare Tapa Wh?. https://www.health.govt.nz/our-work/populations/maori-health/maori-health-models/maori-health-models-te-whare-tapa-wha
Nicolò, A., Massaroni, C., Schena, E., & Sacchetti, M. (2020). The importance of respiratory rate monitoring: From healthcare to sport and exercise. Sensors, 20(21), 6396.
Pedgogy. (2022). Importance of Proper Cardiac Assessment. https://www.pedagogyeducation.com/Main-Campus/News-Blogs/Campus-Blog/July-2013/Importance-of-Proper-Cardiac-Assessment.aspx
Pugle, M. (2020). Is Osteoarthritis Genetic? https://www.verywellhealth.com/is-osteoarthritis-genetic-5088913
Rolfe, S. (2019). The importance of respiratory rate monitoring. British Journal of Nursing, 28(8), 504-508.
Sansone, C. M., Prendin, F., Giordano, G., Casati, P., Destrebecq, A., & Terzoni, S. (2017). Relationship between capillary refill time at triage and abnormal clinical condition: a prospective study. The open nursing journal, 11, 84.
Tiddy, C. (2022). Cardiovascular History and Examination. https://patient.info/doctor/cardiovascular-history-and-examination
Vahdatpour, C., Collins, D., & Goldberg, S. (2019). Cardiogenic shock. Journal of the American Heart Association, 8(8), e011991.
Vilella, R. C., & Reddivari, A. K. R. (2019). Musculoskeletal Examination. https://www.ncbi.nlm.nih.gov/books/NBK551505/#:~:text=The%20musculoskeletal%20exam%20helps%20to,in%20early%20diagnosis%20and%20intervention.
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