Observation in Nursing Assignment 2022

Nursing Assignment
1

Introduction:
Mr. George Orwell is a 68-year widower living in the rural South Australia. He is admitted to
the hospital with complain of chest pain. His past medical history indicated that he was being
associated with multiple cardiometabolic diseases such as type 2 diabetes mellitus,
hypercholesterolaemia, hypertension, obesity and anterior myocardial infraction. Moreover,
he is being associated with cigarette and alcohol consumption which are risk factors for these
diseases. He has undergone coronary artery bypass surgery 5 years ago. He is being
consuming several medications such as aspirin, candesartan, metoprolol, atorvastatin,
spironolactone and GTN spray. Information about his past medical history and current
medications in addition to current diagnosis would be helpful in the planning his future
nursing plan and discharge plan. It is essential to understand effectiveness of current
medications in George because medications which would be administered to George should
be based on effectiveness of current medications. In this report, different aspects related to
George’s clinical condition such pathophysiology of the disease condition, nursing problems
with its assessment and intervention and discharge plan will be discussed. Management of
health condition of George will be discussed through holistic approach considering physical,
physiological, psychological and social aspects of George.
Pathophysiology (Primary admission diagnosis) :
Central chest pain in George indicates myocardial infraction because acute chest pain is the
prominent symptom of myocardial infraction (Arora & Bittner, 2015). Myocardial infraction
primarily occurs due to rupture of atherosclerotic plaque on artery which supply blood to the
heart. Consequently, blood clot form in the artery which results in tissue death in tissue being
innervated by blocked artery. Atherosclerotic plaque also produces ischemia which results in
metabolic and ionic alarm warning in the affected myocardial tissues. Consequently, it leads
to rapid depression of systolic function. Alterations in the mitochondria are attributable to the
apoptosis and necrosis of cardiomyocytes in the infracted heart. Hence, scar formation occurs
during the healing process of infracted myocardium. Renin-angiotensin-aldosterone pathway
get activated which leads to release of transforming growth factor-β which is responsible for
the conversion of fibroblasts into myofibroblasts. Consequently, deposition of extracellular
matrix occurs. Activation of Renin-angiotensin-aldosterone result in the increase in the blood
pressure (Tibaut et al., 2017).
2

Current observations and past medical history of George also demonstrating hypertension in
him. Main complain of George is central pain which specifically occur in cases of myocardial
infraction. George is also associated with breathlessness. Breathlessness occur in patients
with myocardial infraction due to insufficient supply of blood which result in the inadequate
amount of oxygen supply to tissues. Inadequate amount of oxygen is attributable to
augmented breathing to inhale more oxygen to compensate the oxygen deficiency. Current
observations also indicate George is exhibiting breathlessness. Hypercholesterolaemia is the
indication of the increase in the levels of the low-density-lipoproteins (LDL) which are the
main risk factors for the atherosclerosis and consequently myocardial infraction (Boateng &
Sanborn, 2013).
Medical history of Georg indicated hypercholesterolaemia. Hence, hypercholesterolaemia
might be prominent risk factor of myocardial infraction in George. Recurrent myocardial
infraction is very common; hence, George is experiencing central chest pain due to
reoccurrence of myocardial infraction. He had incidence of myocardial infraction in the past.
The occurrence of life-threatening diseases such as myocardial infraction activate
hypothalamus to secret corticotropin-releasing factor (CRF) and arginine-vasopressin which
activate hypothalamic–pituitary–adrenal (HPA). Dysregulation of HPA axis trigger anxiety in
patients myocardial with infraction. Moreover, anxiety activate renin–angiotensin–
aldosterone system which aggravate the cardiovascular condition (Kumar and Nayak, 2017).
Inability to pump blood in myocardial infraction patients lead to excessive stimulation of the
sympathetic nervous system to compensate for the reduced blood pumping. This augmented
sympathetic outflow results in excessive sweating in myocardial infraction patients like
George. Reduced blood flow in patients with myocardial infraction lead to impaired renal
function. Hence, there are chances of fluid accumulation in the body. Consequently, it leads
to occurrence of pitting oedema in legs in myocardial infraction patients like George (Reed et
al., 2017).
Nursing problem:
Acute pain and risk of anxiety can be considered as the nursing problems in case George.
These nursing problems can be considered as the most relevant nursing problems in his case
because he is exhibiting both these symptoms.
Nursing problem 1 – Acute pain assessment: Assessment of pain in George can be
performed using pain assessment tool. Use of pain assessment tool can be considered as most
3