Nursing Care Plan and Intervention

This research seeks to identify the risk factors surrounding Mrs. Hale’s condition, the symptoms experienced, the causes and complications, and the possible treatment options.

Running Head: Nursing care and intervention 1
Nursing Care Plan and Intervention
Student Name
Institutional Affiliation

Mrs. Hale 2
Table of Contents
Introduction................................................................................................................................3
Analysis......................................................................................................................................3
Critical Analysis and Discussion...............................................................................................4
Psychosocial issues....................................................................................................................6
Conclusion..................................................................................................................................7
References..................................................................................................................................8

Mrs. Hale 3
Introduction
Mrs. Eleanor Hale was diagnosed with pneumonia and has been in the ward for two
days. Analyzing the facts surrounding pneumonia is necessary. Pneumonia is a condition that
leads the swelling of the alveoli; the infection can affect either one or the two lungs. The
alveoli become filled with fluid or pus thus instigating cough. Apprehensions, strain in
breathing, fever, and phlegm accompany the cough. The two groups at risk of getting
pneumonia are 2-year old children or younger and 65-year olds or older (Stewart,
Chipperfield, Perry & Hamm, 2016). The other risk factors are: being hospitalized and using
a ventilator to help you breathe, chronic illnesses such as asthma and heart diseases, smoking
(damages the immunity against bacteria), and weak immune system (due to organ transplant
or HIV/AIDS) (Wang, Li, Yang, Tang, Yuan, Deng & Sun, 2016). Bacteria, fungi or viruses
can cause pneumonia.
This research seeks to identify the risk factors surrounding Mrs. Hale’s condition, the
symptoms experienced, the causes and complications, and the possible treatment options.
Does Mrs. Hale have a history of a chronic illness, hospitalization or smoking? What caused
the shift in Mrs. Hale’s symptoms? These are the questions that this study seeks to answer.
Analysis
A low blood pressure, elevated pulse rate, and increased respiratory rate put pressure
on the heart. The average blood pressure of an adult should range between 120/80mmHg to
140/90mmHg (Boddy, Fulford & Kemp, 2018). The blood pressure of Mrs. Hale dropped
from 165/90mmHg (her normal BP) to 105/70mmHg. Her pulse rate increased significantly
from 74 beats per minute to 116 bpm. The patient’s respiratory rate rose considerably from
14 to 26 breaths per minute. The heart adjusts to the low blood pressure by beating faster to
keep up with the pressure. Chest discomfort, nausea, and shortness of breath are symptoms of
high heart rate (tachycardia). Low blood pressure and tachycardia can arise from medications
or a heart disease.
The patient became slightly diaphoretic, nauseous, experienced minor pressure
sensation in the chest, trivial shortness in breath, and felt a slight pain in bottom upper left
hand after administering medications to her. The common vaccine for pneumonia is

Mrs. Hale 4
Pneumococcal Vaccine Polyvalent (Pneumovax 23) (Bonten, Huijts, Bolkenbaas, Webber,
Patterson, Gault & Patton, 2015). The side effects do not include diaphoresis and the other
vital signs that Mrs. Hale portrayed. Diaphoresis is a state whereby a person sweats
excessively due to a medical disorder. Some of the medical disorders associated with
diaphoresis are hyperthyroidism, diabetes, heart attack, anaphylaxis, including certain types
of cancer such as leukemia and liver cancer. Mrs. Hales has an antiquity of IHD meaning she
might be experiencing a similar heart ailment.
Ache in the neckline, back or both hands always accompanies diaphoresis; Mrs. Hales
has minor pain in the upper left arm. Chest pain occurs when the heart receives blood that is
lacking in oxygen. The condition is a sign of an imminent heart attack. Smoking, women
above 55 years old and a history of heart disease are some of the major risk factors of chest
pains (Mozaffarian, Benjamin, Go, Arnett, Blaha, Cushman & Howard, 2016). Mrs. Hales
has a history of IHD, smoking, is suffering a mild pressure responsiveness in the chest, and
she is 56 years old. Nausea and shortness in breath are also associated with heart attacks. The
symptoms exhibited by Mrs. Hales point towards an impending heart attack.
What causes heart attack is blockage of blood supply to the heart. The symptoms
include tightness in the chest, pain in the back, neck or arms, nausea, heartburn, difficulties in
breathing, diaphoresis, fatigue, and dizziness (Bayrak & Tosun, 2018). Mrs. Hale has a high
pulse rate (116 bpm) and a high respiratory rate (she is struggling to breathe). The signs
displayed by Mrs. Hale imply that she is suffering from a heart attack. She is 55 years old,
has a antiquity of IHD, Coronary Heart Disease (CAD), smoking, and has recently been
stressed because she is alone. The patient is definitely experiencing a heart attack.
Critical Analysis and Discussion
The initial interventions to be done by the nurse include blood testing (reveals the
abnormalities and constituents of the blood that may cause ill health), cardiac stress arrest
(measures the change in heart rate and blood pressure), echocardiogram (measures the size,
shape, and functioning of the heart), electrocardiogram (ECG) (displays the electrical activity
taking place in the heart), and tilt table test (measures blood pressure and pulse rate in
response to varying tilts).

Mrs. Hale 5
Airway, Breathing, Circulation, Disability, Exposure (ABCDE) method can be used
to evaluate and treat the patient. The nurse should look for an airway obstruction, treat it, and
ensure that there is a high oxygen concentration. Assessment of the breathing rate involves
checking the respiratory rate (RR) and SpO2. High RR and low SpO2 could be an indication
of illness and low oxygen concentration. The patient is then given more oxygen if there is
low BP and SpO2 (circulation). Mrs. Hale’s BP is low (105/70mmHg) and her SpO2 is 92%.
Disability involves treating the underlying health problem the patient could be experiencing.
Exposure ensures that the patient is fully exposed to appropriate conditions to avoid heat loss.
Reviewing the patient’s history of previous chest pain is important to the care plan (Vedel &
Khanassov, 2015). The nurse needs to know what has changed in pain experienced by the
patient.
Proper nursing care is mandatory for patients experiencing any medical condition. In
this case scenario, developing Mr. Hale’s awareness program is necessary. The patient needs
to be educated on the state she is in/experiencing. Mrs. Hale should be effectively informed
about the relation between her signs and heart attack (Bray, Straney, Patsamanis, Stavreski &
Finn, 2016). She should be advised on taking a diet healthy to the heart (sodium control),
follow fluid restrictions, and comply with the medications. Moreover, frequent patient
valuation helps in improving patient outcome.
Monitoring and noting the characteristic of pain, diaphoresis, pulse rate, blood
pressure, respiratory rate, and chest pressure of the patient is important to nursing plan and
care (Hong-Ying & Xin, 2016). The nurse ought to assist the patient in quantifying the pain
experienced; this is done by comparing the current situation with past experiences. Mrs. Hale
says that the pain is similar to that she has had previously; the pain is rated as 4/10.
Continuous assessment will help in knowing id the pain intensity is decreasing. The patient
should be directed to engage in relaxation techniques. Deep and slow breathing, guided
imagery, visualization help in relaxing the mind and the body. Relaxation helps in reducing
anxiety and chest tightness (Cooper, 2016). The relaxation techniques will help to decrease
the mild pressure experienced by Mrs. Hale in her chest. The techniques also help in taking
hold of the situation and avoiding panic.
If the patient delays in reporting the pain, the reprieve of pain is impeded; this
necessitates an increase in medication dosage to relieve pain. Severe pain stimulates the
nervous system thus inducing shock which creates further damage and interferes with the

Mrs. Hale 6
analysis and reprieve of the pain. The pain should be advised to report the pain instantly
without fail. The patient should be provided with calm activities, comfort measures, and quiet
environment (Carthon, Lasater, Sloane & Kutney-Lee, 2015). The drugs should be
administered to the patient as prescribed to avoid the risk of complications. The diaphoresis,
pain in the upper left arm, and nausea can be regulated by the administration of antibiotics.
These are the signs associated with a heart attack; nursing intervention for heart failure will
help in elimination these symptoms.
The nurse’s approach should also be calm and confident; this decreases the external
stimuli. Stimuli cause the alleviation of nervousness and cardiac strain and restricts the
handling ability and adaptation to the existing state. The vital signs of the patient should be
checked before and after administration of the medication. The medication could also
aggravate the patient’s condition. Mrs. Hale, for instance, experienced certain changes after
medication. The changes could be the side effects of the drugs administered.
The heart rate & rhythm and the blood pressure should be documented before and
after the patient engages in any activity (Jarvis & Saman, 2017). The patient should also be
instructed to rest initially and limit their engagement in physical activities. The reports on the
patient’s vital signs help in handling the chest pain as well as the shortness of breath. The
trend defines the patient’s activity response and may require lowering the activity level due to
oxygen deprivation. The rest reduces the burden on oxygen consumption thus decreasing the
risk of complications.
Psychosocial issues
Psychosocial issues have a major role in preserving the health of an individual. Mrs.
Hale is a retired worker on superannuation pension. She might have suffered from
psychosocial factors as a worker (probably due to low income). The factors include stress,
family problems, anxiety, giving up smoking, and depression. Mrs. Hale is living with a
chronic disease (pneumonia), has suffered from Ischemic Heart Disease, Hypertension, and
Coronary Artery Disease before. Such conditions can cause anxiety and depression among
patients (Eshah, Bond & Froelicher, 2010). Individuals with excellent coping skills and
support from family can still find it hard to respond to the stress brought by the aftermath of

Mrs. Hale 7
chronic illnesses. Mrs. Hale lives alone; she could be struggling with maintaining a healthy
living due to chronic illnesses. She is out of work (living on superannuation pension) and
lives alone. There is a possibility that Mrs. Hale is experiencing financial constraints. This is
because she is struggling to pay for medical bills as well as make both ends with her meagre
pension money. The psychosocial issues could be the reason for Mrs. Hale’s persistent ill
health.
Conclusion
Depression and stress have proven to be the cause of many deaths in the current
world. Mrs. Hale is finding it hard to cope with her health condition as well as her financial
status. The old lady lives alone and is thus forced to do all the house chores and work alone.
The workload has brought about chest pain on the patient. Moreover, she is suffering from
pneumonia and is facing an imminent heart attack. The psychosocial issues affecting Mrs.
Hale should be effectively discussed with her family. Airway, Breathing, Circulation,
Disability, and Exposure (ABCDE) is an effective way of evaluating and treating the patient.
Monitoring and understanding pain, diaphoresis, pulse rate, blood pressure, respiratory rate,
and chest pressure of the Eleanor is significant to nursing plan and care. Mrs. Hale should be
effectively educated on her condition, closely assessed, monitored and treated, encouraged to
engage in relaxation activities, exercise regularly, adhere to drug prescriptions, and properly
counselled (Patiraki, Katsaragakis, Dreliozi & Prezerakos, 2017). These is a characteristic of
holistic evidence based care that can improve Eleanor’s life towards treatment.

Mrs. Hale 8
References
Bayrak, D., & Tosun, N. (2018). Determination of nursing activities for prevention of heart
attack and stroke in hypertension patients. International Journal of Caring
Sciences, 11(2), 1073.
Boddy, I. J., Fulford, S., & Kemp, C. R. (2018). A custom made interface to integrate
recording of pulse rate and blood pressure during urodynamics
investigations. Journal of medical engineering & technology, 42(5), 381-388.
Bonten, M. J., Huijts, S. M., Bolkenbaas, M., Webber, C., Patterson, S., Gault, S. & Patton,
M. (2015). Polysaccharide conjugate vaccine against pneumococcal pneumonia in
adults. New England Journal of Medicine, 372(12), 1114-1125.
Bray, J. E., Straney, L., Patsamanis, H., Stavreski, B., & Finn, J. (2016). Australian’s
Awareness of Heart Attack Symptoms and Action Improves with a Mass Media
Warning Signs Campaign. Circulation, 134(suppl_1), A20858-A20858.
Carthon, J. M. B., Lasater, K. B., Sloane, D. M., & Kutney-Lee, A. (2015). The quality of
hospital work environments and missed nursing care is linked to heart failure
readmissions: a cross-sectional study of US hospitals. BMJ Qual Saf, 24(4), 255-263.
Cooper, B. (2016). The Case Files: Symptoms Chest Pain, Dyspnea, and
Diaphoresis. Emergency Medicine News, 38(4B).
Eshah, N. F., Bond, A. E., & Froelicher, E. S. (2010). The effects of a cardiovascular disease
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Jordanian working adults. European Journal of Cardiovascular Nursing, 9(4), 244-
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Hong-Ying, P. I., & Xin, H. U. (2016). Nursing care in old patients with heart failure: current
status and future perspectives. Journal of geriatric cardiology: JGC, 13(5), 387.
Jarvis, S., & Saman, S. (2017). Diagnosis, management and nursing care in acute coronary
syndrome. Nursing Times, 113(3), 31-35.

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Mozaffarian, D., Benjamin, E. J., Go, A. S., Arnett, D. K., Blaha, M. J., Cushman, M. &
Howard, V. J. (2016). Heart disease and stroke statistics-2016 update a report from
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