Mr Orwell suffers from hyper cholesterolemia

Running head: NURSING CASE STUDY
NURSING CASE STUDY
Student Name
University Name
Author Note

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Introduction
Mr George Orwell is a 68-year-old male who has been transferred to Farquharson
Memorial Hospital with complains of chest pain. It is observed by his medical history that he
has been suffering from diabetes, hypertension, hypercholesterolemia and obesity. He has
been prescribed a lot of medication which he forgets to take. He prefers to not take any fluid
medications before going out as it makes him go to the toilet much often. When he was
brought to the hospital, his vital signs were remarkable but there was visible oedema in both
the legs. He feels breathless on exertion for which a coronary angiogram has been scheduled
the next morning. When the shift of the registered nurse starts, he complains of chest pain. I
check the vital parameters which turn out to be remarkable. In the past, he has undergone
coronary artery bypass and anterior myocardial infarction 5 and 6 years ago. It is by this
which can be understood that his diabetes and hypertension plays a key role in developing of
these illnesses. In the following essay, the patho physiology of the illnesses that have been
experienced by the patient will be critically evaluated with the current situation. The nursing
problems in the diagnosis will be identified with relevant management ideas to reduce it.
Inter professionals in the discharge planning team will be employed to ensure the best quality
discharge procedure for the patient.
Primary Admission Diagnosis
The primary diagnosis for which Mr Orwell was admitted to the hospital was for chest
pain. He has previous medical history of undergoing bypass surgery for his
hypercholesterolemia. It is suspected that he might have to undergo this procedure because of
his obesity (Nagendran et al. 2018). Chest pain is experienced by individuals due to various
reasons. One can experience due to gastroesophageal reflux, gallstones or a panic attack
(Finke, Norton & Gassler 2018). The pain in the chest is felt when there is presence of

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inflammation around the wall of the heart (Comarmond & Cacoub 2017). Because Mr Orwell
suffers from hypercholesterolemia, the arteries in his heart may have been blocked due to
deposition of plaques. Plaques can be termed as “fatty deposits” that get accumulated in the
arteries when there is increased fat in their dietary intake (Garje, Adhav & Bodas 2015).
Plaques do not get accumulate overnight, they take time to get deposited in the arteries. These
deposits disrupt the flow of oxygenated blood from the heart to different parts of the body.
Over constant consumption of fatty food may lead to dangerous deposits of plaques in the
arteries. These may get so bad that they may block the flow of the blood (Raziani et al. 2016).
The individual experiences chest pain when this happens. The situation worsens when the
patient suffers from diabetes as well as hypertension. In the case of Mr Orwell, he is suffering
from all three illnesses that are known to be fatal to man. His long problem with obesity
aggravates the side-effects of the illnesses that he has been suffering from. The chest pain he
has been complaining of may have been caused due to hypertension. It is observed that
patients who have hypertension have a higher likeliness of tearing the wall of the aorta and
disrupting the blood flow (Omstedt et al. 2016). When the walls of the aorta tear, the patient
feels pain in the chest as in the case of Mr Orwell. It is seen that Mr Orwell has also
undergone bypass surgery. Bypass surgery is typically conducted on patients who have
around 60% blockage in their heart. It is well understood that Mr Orwell had blockage for
which the arteries in the heart had to be bypassed with the arteries from some other part of the
body. It is even after this that Mr Orwell experiences chest pain. Over time, it is likely that
the patient may have to repeat the procedure to reduce the occurrence of plaques in the
arteries.

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Nursing Problem
It is by common knowledge that when a patient is experiencing chest pain that is
happening due to a prolonged heart problem, glyceryl trinitrate must be administered to the
patient unless the pain stops. In the case of Mr Orwell, the pain was excruciating which made
him irritable. Glyceryl trinitrate (GTN) should be administered to the patient in the form of a
spray or a tablet every 5 minutes until the pain ceases. Experiencing piercing pain in the chest
for a prolonged period may make the person irritable (Caudil 2016). This might make Mr
Orwell feeling displeasured by the care and treatment that he is being provided with. Because
of his irritability and frustration, he would expect the nurse to administer a higher dosage of
GTN to relieve him from his constant pain. The nursing professional has to abide by the
guidelines that have been set by the organization to treat the patient ethically (Chew et al.
2016). In this case, due to the severity of the pain, the patient might require medication in
every 3-4 minutes. This would lead to higher dosage consumption of the medication which
may prove to be fatal for the patient. GTN is a vasodilating agent which needs to be placed
under the tongue to relax the blood vessels of the stress and let the blood flow smoothly.
Overdose of GTN can cause dizziness with involuntary eye movements, shortness of breath,
convulsions or in extreme cases, coma. The nurse must work ethically and educate the patient
about the side-effects of the overdose to make the patient feel calm during the administration
of the medicine.
Another problem which might arise in the case of Mr Orwell is the cultural competency
of the nurse. As the patient belongs from the rural side of South Australia, language barrier
between the nurse and the patient with the nurse being culturally incompetent is evident. The
nurses in Australia have long been observed to undergo cultural incompetency for patients
who belong the rural rise of the Australia. They are commonly known as indigenous people.
They have long been facing health disparity because of them belonging from a different

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culture. The nurses are unaware of their language which makes the availability of treatment
difficult for the patients. In this case, because the patient is from the rural background, the
nurse may find it difficult to converse with the patient, or the patient might be unable to make
their symptoms clear to the nurse. This miscommunication may lead to a different treatment
than usual which might turn out to be fatal for the condition of the patient. The patient, due to
language difference, may be unable to make the nurse understand their symptoms effectively.
This will deter the organization in providing the patient with the best quality of patient-
centric care to improve their condition.
Nursing Management
One of the most common assessments that are performed by nurses when a patient
with chest pain arrives is the ‘PQRST’ assessment (Driscoll & Smith 2019). This assessment
helps in critical evaluation of the chest pain as to whether it is cardiac in nature. It helps in
assessing the Provoking factors as to what makes the pain come and what makes it go. The
nurse constantly questions the patient whether repositioning alters the likeliness of the pain or
reduces the degree of the pain (Doenges, Murr & Moorhouse 2016). It is after this that the
nurse questions the Quality of the pain that is experienced by the patient in terms of dull ache,
stabbing pain, sharp pain or crushing pain. The Radiation of the pain to other parts of the
body is questioned by the nurse. In typical cardiac cases, it spreads to the jaws, shoulders and
the left arm of the individual (Fazlyab et al. 2015). The Severity of the pain is evaluated next
in terms of one to ten. In addition to these, supplementary symptoms felt by the patient are
asked. Nausea, vomiting and dizziness are the usual supplementary symptoms felt by a
cardiac patient. The amount of Time that the patient experiences the pain is important.
Typically the pain is felt for 3 minutes in cardiac patients but can also be felt for a much
longer time in critical cases. In the case of Mr Orwell, due to the language incompetency of

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the nurse, use of sign languages is recommended. This will make it easier for the patient to
communicate with the nurse effectively and make them understand about the prevalence of
the symptoms.
The most usual nursing intervention that is recommended for patients experiencing
chest pain is administration of Glyceryl Trinitrate (GTN) by the registered nurse to the patient
to ease the pain. Administration of GTN is recommended because of its vasodilating ability
and improving the transfer of oxygenated blood to different parts of the body (McIntosh &
O’Connor 2018). It is typically administered in spray, tablet or intravenous forms. It is placed
under the tongue to dilate the coronary vessels and improve the coronary perfusion. GTN acts
as a vasodilating agent that relaxes the blood vessels and improving the blood flow from the
heart to different parts of the body (Tarki & Kaskin 2016). The patient needs to be educated
calmly during this critical situation to avoid further deterioration of the condition. Proper care
to the patient must be provided by making them understand as to what are they administered
to ease the occurrence of the symptoms. The patient must be dealt with calm to improve the
patient-centric care in the acute care setting. During this critical time, the most important
thing for the registered nurse is to look for possible ways to reduce the prevalence of the
chest pain that the patient experiences often (Bellchambers, Deanne & Pottle 2016). The
patient needs to be relieved of the constant pain for further medical tests and procedures to be
conducted.
Discharge Planning
When the treatment has been provided to the patient with significant improvement,
they are discharged from the inpatient care and sent to their home (Ulin et al. 2016). Every
hospital has an inter disciplinary team that handles the discharge procedure for each and
every patient that has been admitted in the respective hospital (Langhorne, Baylan & Trislists

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2017). A typical inter professional team involved in the discharge planning procedure
includes a nurse, a general physician, a specialized doctor, a dietician, a physiotherapist and
in some cases, a representative from a support group (Bahr et al. 2017). Each of the members
has a role to play in delivering a smooth discharge of the patient from the hospital to their
home. The involvement of people from different professions enables the patient to be getting
a diverse care even after leaving the hospital. Inter professional teams help in treating the
patients belonging to the culturally different background with an efficient healthcare
(Mekonnen et al. 2017). In the case of Mr Orwell, his wife had passed away of breast cancer
and he has not informed his son about his medical condition. The first thing that the nurse
must ensure is to inform his son of the critical condition of his father. The son should be
taking the responsibility of the father and must ensure proper health care for him. Just in case,
the son is not available to look after his father, a support group will be arranged where the
patient will be provided with the appropriate care for the medical condition they have been
suffering from. The registered nurse must ensure proper communication with the patient by
informing him about the necessary changes that will be made to his discharge plan keeping in
mind his improvement as the top-most priority (Tobiano et al. 2015). The dietician in the
team would ensure a proper, balanced diet for the patient to be implemented considering his
hypertension, diabetes, cholesterol and obesity. Regular exercises will be recommended to
him by the physical trainer suitable for a 68-year-old male. It is the responsibility of the
registered nurse to assume the role of a leader towards the patient and ensure a follow-up for
the patient to have a better outcome of the treatment (Goldman et al 2016). The follow-up
will ensure proper check-up of the patient with the critical condition. The support group will
ensure the patient to be comfortable in the new environment with people with the same
problem around. This will ensure in better communication of the issues faced by each of them
and their interventions which have helped them overcome from this difficult situation.

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Conclusion
Finally, it can be understood that the medical condition of Mr Orwell is indeed a
cardiac case of chest pain. He has been suffering from hypertension, cholesterol, diabetes and
obesity. These conditions have led him to suffer from excruciating chest pain with immediate
hospital administration. The registered nurse should have administered GTN for decrease in
the chest pain and conducted a thorough assessment of the pain experienced by the patient.
The primary reason why he was admitted to the hospital was because of frequent chest pains.
These pains are likely in patients who have been suffering from hypertension with high
cholesterol. Mr Orwell had undergone bypass surgery for his hypercholesterolemia which
must have surfaced again due to an improper diet. During the treatment, he has been
administered with proper medicines to improve his condition. During discharge, his condition
is assessed and proper plans have been made to ensure a better recovery after getting
discharged from the hospital.

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