Chest heaviness and shortness of breath

Name 1
Nursing Case Study
Student’s Name
University
Date
Course
Instructor

Name 2
Nursing Case Study
Introduction
Mr. Orwell presents the case of heart-related complications that include chest heaviness
and pain. The patient has a medical history of cardiac problems having undergone a coronary
artery by-pass five years and has a history of having had a myocardial infarction (Chow, Chan,
Ho, & Chun 2017, P. 5). Heart disease patients present challenges that require proper
management to lower the risk of a heart attack and at the same time to keep the patient out of
future episodes. The patient history shows that he needs to be assisted to recover from the
symptoms and a proper discharge plane needs to be used so that he can be able to lead a better
life. Evidence-based approaches require that care is designed based on the needs of the patient.
Thus the role of the nurse is to work collaboratively with the patient to achieve the quality of life.
This report gives an overview of the patient through primary diagnosis to identify the nursing
problems which will form the basis of a discharge plan that will be developed for the patient.
Primary diagnosis
The nursing notes for Orwell show that he was admitted for chest pain and shortness of
breath which were not responding to the normal GT spray that is supposed to be used during
episodes. Chest heaviness and shortness of breath are symptoms of cardiac-related problems that
develop due to blocked arteries from extracellular matrix forming atherosclerotic plaques that
narrow the luminal space. Blocked arteries lead to reduced blood circulation that is seen in the
squeezing and discomfort that the patient feels when breathing. In other cases, this leads to
uncomfortable pressure extending from shoulder, neck, and jaw. Berliner, Schneider, Welte, &
Bauersachs (2016, p. 835) suggests that there are different causes of this condition that depend
on the nature and lifestyle of the patient. In most cases, this is related to the exposure to risk

Name 3
situations and the ability of the patient to notice the warning signs of an episode before the
symptoms become serious.
Yasue, Nakagawa, Itoh, Harada, & Mizuno (2014, p. 11) argue that chest pain onset is
dependent on many factors that are mostly dependent on the medical history and the lifestyle of
the patient. Patients who have had heart-related problems are at a risk of these symptoms since
they can be triggered by any cause. In the case of Orwell, the pathophysiology of this problem
relates to the coronary artery disease that he had in the past which was managed through surgery.
Coronary bypass is used to treat coronary artery disease that develops as a result of narrowing of
the blood vessels due to the build-up of fatty material limiting the supply of oxygen. Thus
bypassing is used to treat this blocking restoring the patient to normalcy. However, this is not a
permanent solution to the since the patient is required to have a lifestyle change so that the
exposure to the risk factors can be reduced (Grech, 2013, p 3; Fleg, 2016, p. 9). Orwell seems not
to have managed his problem since he is obese and smokes fifteen cigarettes everyday which can
all increase the risk. The medical notes also show that he is diabetic with high blood pressure and
a tendency to not following the medication as prescribed. This shows that the lifestyle increased
the risk factors which could have led to increased blocking of arteries.
Thus the pathophysiology of the chest pain and breathlessness can be traced to the
lifestyle of the patient. Ewert, Bahr, Henschei, & A Rink (2016, P. 124) states that most patients
who have been able to manage to live with heart-related patients understand what it means by
lifestyle change and the need to live within medical requirements of the condition that they have.
This can be seen in the case of this patient whose lifestyle could have led to the admission and
the episodes that he is experiencing. Orwell suggests that he forgets taking his medication and
does not like taking the fluid balancing medications when going out because of the side effects.