Case Study of Mrs. Eleano Hale with Pneumonia and Cardiovascular Issues

Nursing
Student’s name:
Institutional:

This is a case study of Mrs. Eleano Hale, a 56 years old female is an admission for two days and
has been under treatment of pneumonia for two days. She has a history of Hypertension,
Ischemic Heart Disease (IHD) and beginning Peripheral Vascular Disease (PVD). She had
Coronary Artery Bypass Graft Surgery (CABG) six years ago with Saphenous Vein grafts to her
Left Anterior Descending (LAD) coronary artery and diagonal branch. She underwent a
Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary
(RCA) and Posterior Descending (PDA) arteries about two years ago. She lives alone in rented
accommodation and she is a retiree and so she is now relying on her pension as a sole source of
income. She has a history of smoking for 30 years. She currently weighs 88kg and her height is
158cm. Her BMI is 35.2 hence she is obese. She looks psychologically down.
Her vitals initially were; Temperature: 37.3ᵒC, Pulse: 74bpm, regular, volume strong,
Respiratory rate: 14/min, regular, normal depth, BP: 165/90mmHg (normal for her), SpO2: 98%
on room air. About 30 minutes later, she looks diaphoretic and has developed some slight
pressure sensation in her chest. Her vitals read; Temperature: 37.2ᵒC, Pulse: 116bpm regular and
volume is not as strong as previously, Respiratory Rate: 26/min, regular, a little shallower than
previously, BP: 105/70 mmHg, SpO2: 92% on room air. She has developed shortness of breath
and slightly cool peripherals. These are signs of an underlying condition. She is currently
experiencing unstable angina pectoris which come as pain. The etiology of the angina pectoris is
that the cardiac workload and myocardial demand for oxygen exceed the ability of the coronary
arteries to supply enough oxygenated blood to the cardiac muscles. As the myocardium becomes
ischemic, PH of coronary sinus blood falls that is why there is diaphoresis. Cellular potassium
is lost leading to loss of cardiac contractility, lactate (acid formed as a result of anaerobic

respiration) accumulates which essentially causes the pain in the muscle (Bautista-Hernandez,
et.al, 2016). If ECG is done, abnormalities appear, and both systolic and diastolic functions
deteriorate. Left ventricular (LV) diastolic pressure usually increases during angina ( Kemp, &
Conte, 2012), sometimes inducing pulmonary congestion and dyspnea that is why the patient
feels pain in the left side upper hand. Therefore, the pain comes due to oxygen deprivation of
the cardiac muscle (Cabello, et.al, 2016). The heart muscle becomes weakened due to inadequate
break down of bio-molecules to provide essential energy mainly due to a low oxygen supply. As
a result, the heart reduces its ability to maintain cardiac output hence weak but rapid pulse and
significantly reduced blood pressure. This is evidenced by the slightly raised pulse and lowered
blood pressure. The low blood pressure is due to decreased myocardial contractility with reduced
cardiac output while an increased pulse is just a compensation mechanism and the ability to
increase the capacity to transport oxygen from the lungs to the vital organs. There is also
impending cardiogenic shock as evidenced by the slightly cooled peripheries and ultimately
result in cardiac arrest if appropriate interventions are not applied. Such imbalance between the
demand and the supply happens due to the narrowed lumen of the arteries, due to reduced blood
volume in the vessels less than the capacity to carry adequate oxygen. Narrowing results from
atherosclerosis, which is a condition in which substances such as fat or smoke particles or sooth
get deposited along the walls of the arterial lumen leading to narrowing of blood vessels and
even get completely blocked with time if no interventions. For the case of Mrs. Hale, she has a
history of smoking for a duration of 30 years and more so, her body weight is clear evidence that
she is obese. She stands a high chance of having low density lipoproteins circulating together
with cholesterols. These combined together, may have gotten deposited in the arteries over time.
Smoke particles and fats play a major role in the narrowing of her blood vessels. Even though