Mr Orwell suffers from hyper cholesterolemia

Running head: NURSING CASE STUDY
NURSING CASE STUDY
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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