Acute B Clinical Reasoning Case Study - Desklib

This clinical reasoning case study discusses the causes, symptoms, and treatment of heart diseases in the case of Mrs. Donna Hovey. It covers topics such as obesity, glyceryl trinitrate, abnormal findings, interventions, SMART goals, and outcomes. The study also highlights the responsibilities of nurses in reducing the side effects of medication and curing chest pain. The article includes references from various books and journals.

ACUTE B CLINICAL
REASONING CASE STUDY

TABLE OF CONTENTS
REFERENCES................................................................................................................................7

Question 1 In the case of Mrs. Donna Hovey, according to her weight and height
which is 95 kg and 158 cm respectively, her BMI is calculated to be
38.1. When BMI becomes above 30.0 then the person is considered to
be obese. This can be evaluated that when the person is obese, this can
lead to building up of fatty material in the arteries which are the blood
vessels which carry blood to the organs. If in case, the arteries which
perform the function of carrying blood to the heart gets damaged or
clogged then this can result in heart attack. Obesity is considered as the
leading cause of heart related diseases (Stepinska and et.al., 2020). This
is because cholesterol plaque build-up happens in the obese people in
the arteries of the heart. Obesity as well as over-weight is mostly related
to the hypertension and enlargement of left ventricle. This increases the
risk for heart failure. High blood cholesterol, high blood pressure and
smoking are considered as the major risk factors for the heart diseases.
Similar happened in the case of Mrs. Hovey which is why she was
suffering from chest pain.
Question 2 (a) Glyceryl Trinitrate (GTN) helps in reducing vascular resistance as it is a
vasolidating agent. The main principle of this is relaxing the vascular
smooth muscle. This also helps in producing dilation of both arterial
and venous beds. This temporarily relaxes the smoothest muscles
including the ones which are found in the blood vessels walls in the
heart (Tan and et.al., 2020). This also helps in reducing the strain on the
heart by making it easier in pumping blood. This basically helps in
preventing and treating chest pain associated with angina.
Question 2(b) There are various side effects of glyceryl Trinitrate (GTN)including
headache, dizziness, weakness or fainting or light-headedness, rapid
heartbeat, redness of skin or flushing, nausea and vomiting, temporary
headaches after taking dose of medicine (Challoumas and et.al., 2019).
Question 2 (c) The nurses have various responsibilities which can help in reducing the
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side effects and curing the chest pain. The patients who are on long
acting or transdermal preparations are more likely to develop tolerance
and therapeutic effects are reduced. The nurses need to evaluate the
therapeutic response. The nurses also need to remove the metal
containing transdermal systems before the cardioversion or the
diathermy (Pearce and et.al., 2017). The nurses also have the
responsibility to check the blood pressure periodically. Carrying out
these responsibilities effectively by the nurses will help in reducing the
side effects of Glyceryl Trinitrate (GTN) and will help in reducing the
chest pain.
Question 3 The two chosen abnormal findings include diaphoresis and shortness of
breath. In the case of Mrs. Donna Hovey, diaphoresis is mainly caused
due to heart attack or other cardiovascular diseases. The lady also
stopped smoking which is why the withdrawal from alcohol or drugs
also leads to diaphoresis. This basically occurs due to activation of
defence mechanism which is known as sympathetic nervous system
which is a kind of flight or fights response. It’s another name is
sweating which can be due to the side effects of medications like
Glyceryl Trinitrate (GTN) (Poldervaart and et.al., 2017). Shortness of
breath is another abnormal finding in Mrs. Hovey which is basically
caused due to heart attacks. This is also known as dyspnea and can be a
sign of heart disease. The pathophysiology of these findings are
complex and also includes activation of several pathways which leads
of increased breathing work and also excessive stimulation of
respiratory centre by central and peripheral chemoreceptor. Shortness of
breath is basically described as intense tightening in chest,
breathlessness or suffocation or difficulty in breathing. In case of the
lady, the major cause of shortness of breath is the obesity as the BMI of
the lady was greater than 30 as calculated by weight and height. This is
why; these two abnormal findings were major cause of situation of the
lady.
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Question 4 This can be evaluated from the case study of Mrs. Hoven that SpO2 in
oxygen therapy is implemented for the hypoxic patients who has SpO2
less than 93%. This is not much effective in the people who are not
hypoxic and can also be prove to be harmful in such cases. This is
possible logically as well as biologically for giving oxygen in such
situations where there is a need of oxygen in the body of people having
chest pain (Senecal and et.al., 2018). This will help in improving the
oxygenation of the ischemic myocardial tissue and also helps in
decreasing the ischemic pain. The patients who have acute coronary
syndrome need oxygen supplementation. The people who have normal
chest pain can be treated by oxygen supplementation but the people
who have severe chest pain cannot be always treated with oxygen
administration and this can prove to be harmful in them.
Question 5 Assessing the rhythm, rate and depth of respiration, use of accessory
muscles and chest movement.
Auscultation lung fields, noting areas of absent airflow and adventitious
breath sounds: wheezes and crackles (Costa and et.al., 2021).
The hydration status of the patient must be assessed. The sputum
colour, odour and viscosity must be observed and changes must be
recorded.
Question 6 SMART goals for the interventions mentioned.
Mrs. Hoven will demonstrate or identify the behaviours which help in
achieving airway clearance.
The lady will also maintain or display patent airway with clearing
breath sounds; absence or cyanosis or dyspnea. This can be evidenced
by keeping the airway patent and also clearing secretions effectively.
The patient will able to report the chest discomfort to the nurse
immediately (Nonnenmacher, Pires, Moraes and Lucena, 2018).
Demonstrating relief of pain which can be evidenced by stable vital
signs, restlessness or absence of muscle tension.
The patient becomes able to report angina episodes which are decreased
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in duration, frequency and severity.
Question 7 The outcomes can be evaluated by reduced pain in the upper left arm
and she must feel less nauseated and diaphoretic (Eekholm and et.al.,
2020). The pain in the chest must be reduced. The problem of shortness
of breath must be reduced and improved. The symptoms of chest pain
must be reduced such as dizziness and weakness, nausea and vomiting,
burning and tightness in chest, cold sweats etc. The symptoms of
pneumonia must also be reduced such as loss of appetite, fatigue or low
energy, fever, seating and shaking chills etc.
Question 8 The current situation of Mrs. Donna Hovey is that she does not smoke
now but she used to smoke earlier 2 packs per day. She lived alone in
rented flat and her only source of income is superannuation pension.
She was also in depression because she could not meet her son who was
in Melbourne due to pandemic and closing of borders. When she was
doing her housework, she was feeling pain in her chest (Wu and et.al.,
2017). She feels very bad to take help from anyone in case of doing any
kind of work. Her BMI was more than 30 which means that she was
obese as calculated by her extreme weight and height at the age of 60.
She felt seating because of her overweight and also this affected her
lungs and chest. The main reason behind her heart diseases is her high
cholesterol and blood pressure.
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REFERENCES
Books and Journals
Challoumas, D. and et.al., 2019. Topical glyceryl trinitrate for the treatment of tendinopathies: a
systematic review. British journal of sports medicine, 53(4), pp.251-262.
Costa, A. and et.al., 2021. Assessment of Swallowing Disorders, Nutritional and Hydration
Status, and Oral Hygiene in Students with Severe Neurological Disabilities Including
Cerebral Palsy. Nutrients, 13(7), p.2413.
Eekholm, S. and et.al., 2020. Gaps between current clinical practice and evidence-based
guidelines for treatment and care of older patients with Community Acquired
Pneumonia: a descriptive cross-sectional study. BMC infectious diseases. 20(1). pp.1-
12.
Nonnenmacher, C.L., Pires, A.U.B., Moraes, V.M. and Lucena, A.D.F., 2018. Factors that
influence care priority for chest pain patients using the manchester triage
system. Journal of clinical nursing, 27(5-6), pp.e940-e950.
Pearce, A. and et.al., 2017. Incidence and severity of self-reported chemotherapy side effects in
routine care: A prospective cohort study. PloS one, 12(10), p.e0184360.
Poldervaart, J.M. and et.al., 2017. Effect of using the HEART score in patients with chest pain in
the emergency department: a stepped-wedge, cluster randomized trial. Annals of
internal medicine. 166(10). pp.689-697.
Senecal, C. And et.al., 2018. Association of search engine queries for chest pain with coronary
heart disease epidemiology. JAMA cardiology. 3(12). pp.1218-1221.
Stepinska, J. and et.al., 2020. Diagnosis and risk stratification of chest pain patients in the
emergency department: focus on acute coronary syndromes. A position paper of the
Acute Cardiovascular Care Association. European Heart Journal: Acute Cardiovascular
Care. 9(1). pp.76-89.
Tan, S. and et.al., 2020. Does glyceryl trinitrate cause central sympatholytic effects? Insights
from a case of baroreflex failure. Internal medicine journal, 50(1), pp.114-117.
Wu, W.K. and et.al., 2017. Documentation of HEART score discordance between emergency
physician and cardiologist evaluations of ED patients with chest pain. The American
journal of emergency medicine. 35(1). pp.132-135.
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