Application of Clinical Reasoning Skills for Clinical Patient Scenario

Application of clinical reasoning skills for clinical patient scenario
A case study of angina
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NURSING CASE STUDY
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Contents
1.1 Pathophysiology of Angina-...................................................................................................................1
1.2 Nursing assessment in the case study-..................................................................................................3
1.3 Nursing intervention for Jon-.................................................................................................................4
1.4 Patient education on sublingual Glyceryl trinitrate therapy-.................................................................5
1.5 Findings in ECG report-..........................................................................................................................6
References-.................................................................................................................................................7

NURSING CASE STUDY
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NURSING CASE STUDY
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1.1 Pathophysiology of Angina
The development of myocardial ischemia occurs when the coronary blood flow gets
inadequate in order to meet the demand for oxygen. It causes the switching of myocardial cells
from aerobic to anaerobic metabolism and impacts the electrical, mechanical and metabolic
functions of cells. The most common clinical manifestation of this heart condition is Angina
pectoris (Nakashima et al., 2016). Angina is caused because of mechanical and chemical
stimulation of sensory afferent nerve ends present in the myocardium and coronary vessels.
Reports suggest that adenosine is the major chemical involved in anginal pain. Adenosine is
formed as a degradation product of ATP and gets diffused to extracellular spaces. The process,
therefore, causes arteriolar dilation and leads to anginal pain (Iqbal, Ashraf, & Muhammad,
2016). Angina induced by the adenosine occurs because of A1 receptor stimulation in the cardiac
nerve endings. The myocardial wall tension, inotropioc state, heart rate are the major
determinants of metabolic activities and oxygen demand in myocardial cells. The myocardial
contractile state and an increase in heart rate results in high oxygen demand in myocardial cells.
Increase in aortic pressure and ventricular diastolic volume leads to proportional elevation of the
tension in the myocardial wall and hence the myocardial oxygen demands increases (Blonski and
Ritcher, 2018).
Risk factors-
There are several risk factors associated with angina pectoris. The major ones include
increased age and high cholesterol. The increased ages with male gender are highly prone to
angina. The health history of the family also associated with the occurrence of angina. Family