GCNNK2 Nursing Knowledge 2 Case Study

Running head- ASSESSMENT 1
Formative assessment 1
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Word count: 1652

1ASSESSMENT 1
Introduction
Nursing management comprises of the performance of different leadership functions
that are related to decision making within healthcare organisations and governance (Kitson,
Marshall, Bassett & Zeitz, 2013). The case study is about a patient Mr. Ferguson, a 76 year
old individual who has been admitted to the Emergency department, following complaints of
chest heaviness. The patient also demonstrated diaphoresis, and shortness of breath. Some of
the other abnormalities in the patient’s health are hypertension and tachycardia. The
medications that were administered to the patient include aspirin, metoprolol, rosuvastatin
and glyceryltrinitrate pump spray. This assignment will discuss in details the pathophysiology
of the patient’s condition and will also elaborate on the pharmacokinetics of the prescribed
medications.
Pathophysiology
Tachycardia common referred to as tachyarrhythmia refers to the physiological
condition when the heart rate of a person exceeds the normal resting heart rate. Usually, heart
rate higher than 100 beats per minute is regarded as an indicator of tachycardia. In the words
of Al-Zaiti and Magdic (2016) at the cellular level, higher heart rate is often associated with
abnormal automacity and/or electrical re-entry. Myocardial scarring often occurs as a
manifestation of any physiological processes and usually increases the probability of
electrical reentrant circuits. There is mounting evidence for these circuits to comprise of a
region where standard electrical propagation gets decelerated by the presence of scar (Gupta
& Figueredo, 2014). Previous history of Mr. Ferguson states that he had a past medical
history of angina, hypercholesterolemia, hypertension, and Non-ST Elevated Myocardial
Infarction (NSTEMI). Owing to the fact that the cardiac output gets reduced as a direct
consequence of reduced ventricular filling from increased heart rate and absence of
appropriately timed atrial contraction (Sasaki et al., 2015).

2ASSESSMENT 1
Furthermore, the patient was also found to suffer from hypertension. This condition
refers to high blood pressure and is a medical condition characterised by sudden elevation in
the pressure of blood, flowing in the arteries. The fact that Mr. Ferguson suffered from an
elevated blood pressure can be accredited to the structural narrowing of the small arterioles
and arteries, besides a reduction in the density and number of capillaries (Mollan et al.,
2016).
Shortness of breath was another presenting complaint reported by the patient.
Dyspnoea refers to a situation when a person is not able to breathe enough. Hence, the
condition manifested by Mr. Ferguson could be defined as a subjective experience of
discomfort in breathing that encompasses qualitatively separate feelings that differ in
intensity. According to Anzueto and Miravitlles (2017) three major mechanisms are thought
to contribute to dyspnoea namely, efferent signals, afferent signals, and central information
processing. The central processing present in the brain associates the efferent and afferent
signals, and usually occurs when there is a "mismatch" between the signals. In addition, the
fact that the patient also suffered from angina acts as a major risk factor to the onset of
chronic conditions (Coccia, Palkowski, Schweitzer, Motsohi & Ntusi, 2016). This pressure in
chest occurs due to presence of an imbalance between the demand and supply of oxygen in
the heart.
Pharmacokinetics
Aspirin refers to the medication that is used for treating fever, pain and inflammation.
Aspirin is quickly absorbed through the cell membrane, under conditions that are acidic
inside the stomach. Greater surface area of the small intestine and an elevated pH results in
aspirin to get absorbed in a slow manner, while the rest of it gets ionized (Vane, 2014). The
acetyl group is found to covalently attach to a residue of serine near the active site of the
COX enzyme, thus producing an inhibitory impact on aggregation of platelets. This

3ASSESSMENT 1
antithrombotic property of aspirin helps in reducing heart attack, in people who have had
suffered from angina or TIA. 300mg of Aspirin is the standard dosage for adults and are
taken orally.
Morphine is a pain medication that belongs to the opiate family, and directly acts on
the central nervous system for reducing sensations of pain. This drug is frequently
administered for pain management during myocardial infarction. Morphine is usually taken
orally, sublingually, subcutaneously, intravenously or epidurally. The drug is primarily
metabolized into Morphine 6 gluconoride (M6G) and Morphine 3 gluconoride (M3G)
through the process of glucoronidation (Tzvetkov et al., 2013). The action of the drug on the
receptors present in CNS helps in relieving analgesia and pain. The dosage for adults should
be 5-15 mg for 30 minutes, and 2.5-5.0mg every hour later.
According to De Caterina et al. (2013) heparin sulphate refers to an anticoagulant that
is specifically used for preventing pulmonary embolism, deep vein thrombosis, and arterial
thromboembolism. It is also used for the treatment of unstable angina and heart attack. This
drug binds to antithrombin III (AT), the enzyme inhibitor and results in a conformational
change, which leads to its activation via an elevation in the reactive loop flexibility (Mendell
et al., 2013). Activated AT results in activation of factor Xa, thrombin and other protease. A
ternary complex is formed in between thrombin, AT, and heparin, thus leading to thrombin
inacivation. Fentanyl helps in providing effects that are typical of other kind of opioid drugs
via activation of different types of opioid receptors. High lipophilicity can be cited as a
reason for its strong potency, in comparison to morphine that helps it to easily penetrate the
central nervous system (Barratt et al., 2014). 20–50mcg/kg is considered as a moderate dose
for administration of fentanyl via intravenous route.