Nursing: Assessment, Pathophysiology, and Interventions

This report discusses the physical assessment, pathophysiology, and nursing interventions for a patient with cardiac complications. It includes recommendations for treatment and monitoring of vital signs.

Running head: NURSING
Nursing
Name of the Student
Name of the University
Author Note

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Introduction
The following report is based on the case study of George who is having certain
cardiac complications. The report will initiate with a detail physical assessment followed by
the description of the detailed pathophysiology of the medication management. At the end,
the paper will highlight the prospective nursing interventions in order to improve patients’
outcome.
Physical Health Assessment
Assessment of the Central Nervous system
The assessment of the central nervous system was done based on the GCS (Glasgow
coma scale) and the reported a score of 15. This is the highest score signifying normal
movement of the eyes, verbal response and motor impulses. The body temperature of George
measured from mouth is 36.5T (normal).
Assessment of the Cardiovascular system
The pulse rate of George is higher than the normal 120 beats per minute (normal 70 to
100), the heart beat is irregular (as per pulse oxymetry), the respiratory rate was 28 beats per
minute (normal 12 to 20) with high level of blood pressure 167/100 mm Hg (normal range:
120/80). George was sweating profusely. There was change in the colour as he was looking
pale (indication of cyanosis) and SpO2 was 88%. The sounds of heart is irregular with
skipping of beats as highlighted in the stethoscope.

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Assessment of the Respiratory system
a) Inspection: Increase in the respiratory rate however, significant change in the rise
and fall of chest. SpO2 is 88% which is lower than the normal (97 to 99% is the normal
range). Thus there are chances of developing cyanosis
b) Palpation: Measurement of pain was done with the help of the PQRST method
(provocation, quality, region, severity and time) showed that George is suffering from pain in
his pain in the left posterior shoulder. The pain is radiating in towards his left arm. The pain
increased on exertion with the level of pain score of 9/10. This high level of pain in the back
of the shoulder might be an indication of the acute coronary syndrome (Australian Heart
Foundation, 2016)
c) Percussion: The sounds of the lungs is not prolong
d) Auscultation: auscultation of his chest was clear.
Assessment of the abdominal cavity
a. Inspection: There are no visible scar over the abdomen however, there are
indication of the abdominal distension along with the signs of nausea and vomiting
b. Ausculation: There was no sensation of pain in the abdominal cavity
c. Percussion: There are no indications of the gas sound present that is tympanic
sound.
d. Palpation: There was no pain scare in the abdominal area
4. Assessment of the renal system
There is no past medical history of renal impairment. However, the abdominal
distension significant renal impairment (Mathew et al., 2017)

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5. Physical assessment
 Normal glass glow coma scale
 Body weight: 29
 Waist circumference: 100 cms
 Appearance: Pale and fatigue with high sweating
6. Recommended blood test
Complete blood count (CBC): This test will help to get a detailed overview of the
percentage of the lymphocytes, erythrocytes and myeloid cells present in the blood serum
along with the percentage of haemoglobin, packed cell volume, macro-corpuscular cell
volume and erythrocyte sedimentation rate. Additional state is blood cholesterol test and
blood glucose test: Random blood glucose (Berman, Snyder & Frandsen, 2016).
ECG: The initial ECG report showed ST elevation in leads V3 and V4 and pathology.
The results showed moderately raised troponin I and T. The ECG test shows possible
indication of the myocardial infarction. The ECG report indicates the possible signs of the
myocardial infarction and this is extremely alarming keeping into consideration of the
elevated blood pressure and pain in shoulder of George. George also has family history of
cardiomyopathy. Patil et al. (2018) stated that in myocardial infarction there occurs elevation
in the ST segment in the anterior leads (V3 and V4) mainly at the J-point and also in the
septal or in the lateral leads. The elevation of the waves change depending upon the severity
of MI and is known as tombstoning. In tombstoning the troponing I and T is also increase
(marker of cardiac health or atrial fibrillation).
The reason behind why the pathological test of the blood serum concentration of
cholesterol, triglycerides, HDL and LDL is suggested. Khan, Alhomida and Sobki (2013)
highlighted the use of potential biomarker of various lipids fractions for detecting the risk of

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acute myocardial infarction is controversial. Thus it is important to compare the lipid profiles
of the person who is expected to be suffering from myocardial infarction. The comparison is
done with the lipid profiles and this includes serum total cholesterol level, the assessment of
the low density lipo-protein (LDL) and high-density lipo-protein (HDL) along with
triglycerides (TG).
Treatment of Pathophysiology
The two large gauge of IVC is done in order to promote the medication administration
through intravenous route and thus providing faster response.
George was given sublingual (given below the tongue) glyceryl trinitrate tablets
(GNT). Sublingual GNT is short acting vasodilator that helps in giving relief from angina
pectoris, decreasing prophylaxis of angina pectoris. It also provides relief from the coronary
artery spasm. Angina pectoris is used to denote chest pain or discomfort in chest due to
cardiac anomalies like narrowing or blockage n the arteries. George was also facing pain in
the back of shoulder, radiating till arm and thus GNT will help in reducing this pain and to
provide comfort. George is also having high blood pressure. Dilation of the arteries with the
help of vasodilator (GNT) helps in the smooth muscle relaxation in the arteries and this helps
in increasing the blood flow and decrease in the vascular resistance. Thus dilation or arteries
and arterioles will help to reduce the arterial blood pressure and increased pulse rate and heart
rate as in case of George (Sandset et al., 2019). Appleton (2019) further stated that GNT is a
nitric oxide donor thus helping in the relaxation of the smooth muscle cells of the arteries
under the action of the cyclic-GMP and helping to reduce the chances of stroke.
George was also given aspirin. This approach is popularly known as initial aspirin
therapy by the Australian Heart Foundation. Ettehad et al. (2016) stated that reduction of the
blood pressure reduces the vascular risk across the different baseline blood pressure level and

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the other co-morbiditees. Aspirin helps in lowering of the blood pressure to systolic blood
pressure (less than 130 mm Hg) and reducing the threat of developing cardiovascular
complications associated with high blood pressure like coronary heart disease, heart failure,
atrial fibrillation, myocardial infarction.
PRN IV (intravascular) Morphine helps in down regulating the immune response. It is
alkaloid opium in nature and is used for the analgesic for chronic management of pain. The
binding of morphine in the opioid receptors inhibits the nociceptive signals transmission. It
activates the signaling of the pain modulating neurons present in the spinal cord and thus
helping to inhibit the transmission of the pain sensory impulses from the primary afferent
nociceptors to the dorsal horn present in the sensory projection cells. The intravenous
injection of morphine initiates its functioning within 6 to 30 minutes post administration and
thus providing fast pain relief (Wilson-Poe & Concepcion, 2016). Since the pain score of
George is high, in order to provide fast pain relief George is given intravenous morphine
injection.
Further Recommendations
Percutaneous Coronary Intervention (PCI) is a non-surgical procedure that makes use
of the catheter to insert a small structure known as stent in order to open the blood vessels in
the heart that is experiencing narrowing for plaque build-up. This condition is known as
atherosclerosis. This indicates that George's blood cholesterol level is high leading to
narrowing of the arteries and development of high blood pressure (Australian Heart
Foundation, 2016).
Monitoring of the vital signs
The main nursing intervention in the coronary care unit will include monitoring of the
blood pressure levels in order to ascertain the dosage requirement of the vasodilators. Special

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focus will be given over the assessment of the fluctuating blood pressure, signs of
bradycardia and hypotension. The monitoring will also include tabulation of the heart rate,
pulse rate and respiratory rate. The rhythm of the heart will be monitored with the help of
ECG machine. Monitoring will also focus on the signs of tachycardia, the signs of
hypotension (high dosage of vasodilators), decreased peripheral perfusion, widening of the
total pulse pressure and sudden fall in the haemoglobin level (Robinson, 2016).
External supply of oxygen in order to increase oxygen saturation
The nursing intervention will also include external supply of oxygen with the help of
nasal canulla in order to increase the oxygen saturation in the body and this will help to
decrease the paleness of skin and state of nausea (Robinson, 2016).
Conclusion
Thus from the above discussion, it can concluded that the main assessment for George
will physical assessment and the assessment of the cardiovascular system, respiratory system,
central nervous system, renal system and abdominal system along with conduction of the
several pathological tests like CBC, cholesterol, LDL, HDL and trigycerides. He was given
morphine intravenously along with aspirin and GNT to reduce the blood pressure and angina
or pain. Nursing intervention post the coronary angioplasty will include monitoring of the
vital signs and external supply of oxygen.

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References
Appleton, J. P. (2019). The role of glyceryl trinitrate, a nitric oxide donor, in acute
stroke (Doctoral dissertation, University of Nottingham).
Australian Heart Foundation. (2016). Heart and Lung Circulation. Access date: 4th
September 2019. Retrieved from:
https://www.heartfoundation.org.au/images/uploads/publications/PRO-
174_ACS_guidelines_2016-WEB.pdf
Berman, A., Snyder, S. and &Frandsen, G., (2016). Kozier&Erb's Fundamentals of Nursing:
Concepts, process and practice. Boston, MA: Pearson.
Ettehad, D., Emdin, C. A., Kiran, A., Anderson, S. G., Callender, T., Emberson, J., ... &
Rahimi, K. (2016). Blood pressure lowering for prevention of cardiovascular disease
and death: a systematic review and meta-analysis. The Lancet, 387(10022), 957-967.
Khan, H. A., Alhomida, A. S., & Sobki, S. H. (2013). Lipid profile of patients with acute
myocardial infarction and its correlation with systemic inflammation. Biomarker
insights, 8, BMI-S11015.
Mathew, R. O., Bangalore, S., Lavelle, M. P., Pellikka, P. A., Sidhu, M. S., Boden, W. E., &
Asif, A. (2017). Diagnosis and management of atherosclerotic cardiovascular disease
in chronic kidney disease: a review. Kidney international, 91(4), 797-807.
Patil, S., Shetty, N., Hidayathulla, M., Ramalingam, R., Kasamsetty, S., Moorthy, N., &
Cholenahally, M. N. (2018). Tombstone ST-segment elevation in acute anterior wall
myocardial infarction. IHJ Cardiovascular Case Reports (CVCR), 2, S11-S13.

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Robinson, A. (2016). 26 Percutaneous Coronary Intervention and Angioplasty. Clinical
Guide to Cardiology, 338.
Sandset, E. C., Appleton, J. P., Berge, E., Christensen, H., Gommans, J., Krishnan, K., ... &
Woodhouse, L. J. (2019). Associations between change in blood pressure and
functional outcome, early events and death: results from the Efficacy of Nitric Oxide
in Stroke trial. Journal of hypertension, 37(10), 2104-2109.
Wilson-Poe, A., & Concepcion, J. M. (2016). (364) Morphine tolerance during inflammatory
pain: role of delta opioid receptors in the midbrain periaqueductal gray. The Journal
of Pain, 17(4), S66.