Clinical Reasoning Case Study on Obesity and Chest Pain

This clinical reasoning case study discusses the symptoms, interventions, and nursing responsibilities related to obesity and chest pain. The case study includes information on the patient's medical history, medication, and psychosocial issues. The nursing interventions discussed in the case study include pain management and proper medication. The article also discusses the evaluation of outcomes and the need for different interventions to improve the patient's health.

Clinical Reasoning Case Study

Step 1
Consider the person
and context
According to hovey's case study, obesity is the main cause of
increasing cardiovascular disease in old age. It is because people above
50 who are in obese category needs extra blood to supply the oxygen,
nutrients to their bodies. Deficient which ultimately leads to an increase
in blood-pressure. As per the past medical history of Mrs. hovey,
obesity is also connected with hypertension. Overweight when
associated with elevated visceral adiposity involves main cause of
hypertension (Anzueto (2017)).
Step 2
Collect cues and
information
(a) In context with Hovey's case study, Glyceryl trinitrate is basically
used to treat chest pain (angina) related problems. It works by
broadening the arteries and veins. Increased surface area will ultimately
leads to elevate in blood supply to heart. This response leads to supply
more blood to muscles present in heart and decrease the chest pain.
(b) According to this case study, the most common side effects are
mentioned below:
 Feeling sick (nausea)
 Increased heart rate.
(c) According to Hovey's case study, the responsibilities of nurse with
respect to the side effects of medication which are mentioned above
should be taken as detailed below:
 It is their duty to check whether nitrates are taken or not, failing
can leads to drop in blood pressure that may results in fainting.
 It is also their responsibility to check whether the patient quit
smoking or not. This is because smoking is the main cause of
increased heart beat as it tightens the arteries which may cause
improper heart rhythm (Benson (2019)).
Step 3
Process information
In context with Hovey's case study, the symptoms which are included
in her case are mentioned below:
Decreased blood pressure: In Hovey's case, she is suffering from low
blood pressure i.e. 105/65mmHg. It is a case of hypotension, as it exists

when the systolic pressure is below 90mmHg and the diastolic pressure
is below 60mmHg. It decreases the blood flow which may leads to
reduce the supply of oxygen within organs as well as tissues that may
causes cellular harm and dysfunction (Geng (2021)).
 Increased heart rate: In Hovey's case, she is suffering from
increasing heart rate i.e. 116 bpm. It is considered that the
normal heart rate of a human body is 60 to 100 beats per
minute. Increasing heart rate generally called as tachycardia. In
this, it involves decrease in venous pressure that may results in
reduced stroke volume. Increased heart rate in patients causes
anxiety, stressful emotions. Smoking is one of the major leading
cause of increased heart beat as it contains nicotine in it which
is highly addictive in nature. It is because when someone breath
in cigarette smoke, the contaminated blood is supplied in the
whole body which contains smoke chemical (KNOW (2020)).
Step 4
Identify problems and
issues
According to Hovey's case study, there is no supplemental oxygen was
provided to Mrs. Hovey at this stage because the oxygen treatment is
normally not required to the patient unless the range of SpO2 is less
than 92%. In the case of Mrs. Hovey, her oxygen level is observed as
approximately 92% and therefore, administration of supplemental
oxygen is not required in her case. In other cases, if someone suffers
from heart failure it is quite necessary to provide such patients an
oxygen therapy so that their heart pumps well. It is because this therapy
increases the amount of oxygen which is required in body tissues and
hence helps in decrease the patients heart workload.
Step 5
Establish goal
There is need to provide different intervention which can help in
proving care to the Mrs. Hovey. Nursing intervention can help to
reduce the effectiveness of the diseases. There is discussion about two
different priority nursing intervention includes pain management and
proper medication (Quinn (2017)).

Pain management can be done through performing various activity
like experience and meditation and other physical activity. There is
need for various ways which can help to control on chest pain.
Medication includes different medication which can be provided
through proper diagnosis of Mrs, Hovey. There are various medication
which should be provided to control the situation and deliver pain
medication accordingly (Howell (2019)).
These intervention can help to reduce Mrs. Hovey chest pain and
allows to improve Mrs. Hovey health condition. These can help to
improve the health issues. Pain management will allows to control and
reduce the pain whereas, medication can help instantly to reduce and
control pain within Mrs. Hovey (Frambes (2018)).
Step 6
Take action
Intervention
Pain management
In this, there is need to provide the information and learning about its
benefits to control pain within patient.
This can be evaluated by pain measurement and through asking Mrs.
Hovey which can help to provide the information and its response.
This can be achievable to perform various physical activity which can
allows to manage pain and increase body ability to take oxygen.
This to related with taking better precaution to manage pain further.
This also allows to focus chest pain management.
Physical exercise and meditation can be done on the regular basis and
after two months this can show its impact with improved health
(Barreto (2017)).
Medications
There is need to administer proper medication on right time which can
help to improve Mrs. Hovey health.
This can be evaluated through health improvement and through
diagnosis report.
Medication can play an important role in health improvement and can
be achievable with proper and timely administration of medication.

This is highly effective when there is chest pain and also effective to
avoid and reduce the severe chest pain.
Medication should be provided for one week thrice a day to show its
optimum impact on Mrs. Hovey body (Nadimi (2016)).
Step 7
Evaluate outcomes
There are various way through which nursing intervention can be
measured that are going to be discussed further.
Pain management- This can be evaluated through using the pain scale
which is associated to identify the pain level. Through exercise and
meditation there is impact on the health which is related to pain. Mrs.
Hovey can also help to evaluate its impact by explaining its effect on
the chest pain.
Medication- Through diagnosis report outcomes of medication can be
measured which have the impact on the Mrs. Hovey health. This can
allows to get access to the report which can show the effect of
medication on Mrs. Hovey health (Blake (2017)).
Step 8
Reflect on process and
new learning
There are various psychosocial issues which are related with Mrs.
Hovey's current stage of disease and also her life situation and are
given below:
 Depression: It is defined as a group of situations which are
associated with the increase and decrease of the person's mood.
Depression is a bipolar disorder. In Hovey's case, the most
common symptom of depression is having helpless mind-set.
She is also suffering from anxiety as it causes her feel restless,
tense that leads to irregular heart beat. All these problems which
she is facing are quite difficult for her in life (Onder (2020)).
 Family problems: According to Hovey's case study, she is
suffering from some family issues as she lives alone in rented
house. And her only son lives in Melbourne. S, she is not able
to see her son due to this pandemic. The financial status is also
one of the cause that makes her let down. All these problems

that she is facing makes her to feel depressed (Schreiber
(2016)).

REFERENCES
Books and Journals
Anzueto (2017). Pathophysiology of dyspnea in COPD. Postgraduate medicine, 129(3), 366-374.
Barreto (2017). Exercise or social intervention for nursing home residents with dementia: a pilot
randomized, controlled trial. Journal of the american geriatrics society, 65(9), E123-
E129.
Benson (2019). Cortisol affects pain sensitivity and pain-related emotional learning in
experimental visceral but not somatic pain: a randomized controlled study in healthy
men and women. Pain, 160(8), 1719-1728.
Blake (2017). Predictors of physical activity and barriers to exercise in nursing and medical
students. Journal of Advanced Nursing, 73(4), 917-929.
Frambes (2018). Informal caregivers of cancer patients: review of interventions, care activities,
and outcomes. Western journal of nursing research, 40(7), 1069-1097.
Geng (2021). Effect of evidence-based nursing intervention on diet and pain after subtotal
gastrectomy. American Journal of Translational Research, 13(7), 7944.
Howell (2019). Usefulness of predischarge cardiac testing in low risk women and men for safe,
rapid discharge from a chest pain unit. The American journal of cardiology, 123(11),
1772-1775.
KNOW (2020). Management of post-acute covid-19 in primary care. Bmj, 283.
Nadimi, (2016). Opium addiction as an independent risk factor for coronary microvascular
dysfunction: A case–control study of 250 consecutive patients with slow–flow
angina. International journal of cardiology, 219, 301-307.
Onder (2020). Problematic Internet Use and Digital Gaming in Adolescents: Problems, Nursing
Interventions, and Outcomes. Journal of Psychosocial Nursing and Mental Health
Services, 58(12), 51-59.
Quinn (2017). Strategies to reduce nursing student test anxiety: A literature review. Journal of
Nursing Education, 56(3), 145-151.
Schreiber (2016). Cervical epidural steroid injections and spinal cord injuries. The Spine
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