Impact of Chronic Diseases on Mental Health

The given report highlights the significance of nursing in managing chronic illnesses. It emphasizes the importance of electrocardiograms (ECGs) in diagnosing acute coronary syndromes, including angina, nonSTEMI, and STEMI. The report also discusses the benefits of using aspirin and ticagrelor together to reduce heart attack and stroke risks. Furthermore, it underscores the link between chronic illnesses and depression, emphasizing the need for proper medication to mitigate these effects.

Nursing

Table of Contents
INTRODUCTION...........................................................................................................................1
MAIN BODY...................................................................................................................................1
1. Rationale for ECG request......................................................................................................1
2. Pathophysiology of Angina.....................................................................................................2
3. Interpretation of ECG for nausea and shortness of breath......................................................3
4. Central findings which potentially lead to diagnosis of Acute Coronary Syndrome..............3
5...................................................................................................................................................3
6. Mechanism of action of aspirin and ticagrelor........................................................................5
7. Use of morphine......................................................................................................................5
8. Increased risk of depression with chronic illness....................................................................6
CONCLUSION ...............................................................................................................................6
REFERENCES................................................................................................................................7

INTRODUCTION
Nursing is a gum which grip patient's healthcare journey together. It can be described as
science and an art; mind and heart. Heart lies central respect for the human dignity and intuition
for patient's requirements, which is supported by the mind, in form of the strict core learning.
Nurses who are verified in the field of nursing have many responsibilities of providing care and
of treatment decision. Nurses are foremost to take all broad view of patient's well being (Ball &
et. al., 2014). This assignment is mainly focus on case study and pathophysiology, psychosocial
and pharmacology aspects of scenario.
MAIN BODY
1. Rationale for ECG request
Electrocardiogram is one of fastest and simplest tests used to evaluate heart. Electrodes
are located at particular spots on chest, arms and legs. Electrodes are attached to ECG machine
by the lead wires. In this test no electricity sent into the body of an individual. Electrical activity
of heart is interpreted, measured and printed out. According to the case Betsy Blogger is 72 years
old women with the nausea and shortness of breath. And Betsy had uncomplicated fixation of
right fibula and tibia fracture. Past medical history shows that Betsy had coronary artery bypass,
coronary heart disease, chronic obstructive pulmonary disease, type 2 diabetes mellitus and
hypertension.
There are some reasons to request electrocardiogram which include to check reason of
the chest pain, to identify trouble which are heart affiliated like shortness of breath, fainting and
tiredness and to check irregular heartbeats. This also help to determine overall health of heart
before any procedures like surgery and treatment for; such as heart attack, endocarditis and
infection or inflammation of heart valves (Bastable, 2017). ECG can be requested to check
particular heart medicines are working properly or not and to get the baseline tracking function
of heart during the physical exam, it can be used to comparing with the upcoming ECGs to check
if there are any kind of modification. In case of Betsy nurse requested for ECG even if patient
did not feel chest pain. As patient had shortness of breath and nausea which can be evaluate with
the health of ECG.
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2. Pathophysiology of Angina
Angina is a kind of chest pain which is originated by reduced blood flow to heart. It is
symptom of the coronary artery disease. It can also called angina pectoris, that described as,
tightness, pressure, squeezing and pain in the chest. Some individuals with angina symptoms
depict angina feels like tightness in the chest.
Causes: In condition of angina blood flow become reduced which flow to the heart
muscle. Blood takes oxygen that heart muscle requires that is need for the survival. When heart
muscle does not getting sufficient oxygen, it causes ischemia condition (Brennan & Bakken,
2015). Common reason for flow of blood to the heart muscle is coronary artery disease.
Coronary arteries can become constricted by fatty deposits are called plaque which is known as
atherosclerosis. The less blood flow is supply problem, in which condition heart is not receiving
sufficient oxygenated blood.
Stable angina: This angina is normally activated by the physical exertion, usually when
person climb up stairs, walk, exercise and heart needs much blood but it becomes difficult for
muscle to get the sufficient blood in case when arteries are narrowed.
Unstable angina: If fatty deposits in the blood vessel get injured and blood clot forms,
which can rapidly reduce or block flow the constricted artery, and severely reduce blood flow to
the heart muscle (Cañadas-De la Fuente & et. al., 2015). Unstable angina may caused by the
blood clots which reduce or block heart's blood vessels.
ST segment elevation myocardial infraction: STEMI is a type of the heart attack, in
which long disruption to blood supply. It can caused by complete blockage of coronary artery
that can cause large impairment to large area of heart.
Non-ST segment elevation myocardial infraction: It can be less serious than the
STEMI, because blood supply to heart can be partially instead of fully, blocked. As a result,
smaller part of heart can get disrupted.
Progression and outcomes: Value of malonyldialdehyde can significantly increased in
the patients of CAD compared to those who are in control. Transition from stable to the unstable
angina and later progression to the myocardial infraction are connected with the atherosclerotic
plaque fissuring at sites of the coronary artery stenosis and later evolution of thrombus (Giger,
2016). Thrombus constitution is initiated by the platelet aggregation & adhesion. It can increased
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risk of the heart attack, if it is not treated for long time. And sometimes the untreated condition
of angina can cause heart attack.
In case of Betsy, hypertension and type 2 diabetes is risk factor which may increase risk
of acute coronary syndrome.
3. Interpretation of ECG for nausea and shortness of breath
ECG is a physical examination which is a part of cardiac exercise stress test. During ECG
rhythms are checked whether it is irregular or abnormally fast, as it can be slow sometimes.
Abnormal conduction of the cardiac impulses that any suggest underlying metabolic or cardiac
disorders. In this case patient had seventy six beats per min heart rate both within the normal
physiologic ranges. Rate of the respiration was twenty four breath per min, with the oxygen
permeation of eighty two percent by the pulse oximetry, breathing in the room environment air
(Hayden & et. al., 2014). Regular rhythm and rate without murmurs and without elevation of
jugular venous pressures. P wave denotes atrial depolarization, it happens when sinus node
which known as sinoatrial node, forms action potential that depolarizes atria. P wave must be
vertical in lead 2 if action potential is developing from SA node. P wave can be interred at end of
QRS complex by causing short RP which can be observed in atrioventricular reentrant
tachycardia.
4. Central findings which potentially lead to diagnosis of Acute Coronary Syndrome
Acute coronary syndrome involve chest pain, vomiting, nausea and referred pain.
Sometimes individual may present without the chest pain, pain can be referred to jaw, arm, back
or sometimes abdomen. Sometimes person feels dizziness and shortness of breath which are
associated with this syndrome. Chest pain can caused by the acute coronary syndromes can come
all of a sudden without any warning that occurs during heart attack. Unpredictable pain which is
symptom of the unstable angina (Hoeve, Jansen & Roodbol, 2014). These findings can lead to
the diagnosis for acute coronary syndrome. As such conditions are sings for this syndrome and if
it is not being diagnosed, it can cause heart attack.
5.
Generic name GTN Diltiazem Pravastatin
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Drug group Nitroglycerin Cardizem HMG CoA reductase
inhibitors
Mechanism of action GTN is vasodialating
agent it helps
relaxation of the
vascular smooth
muscle. Glycerol
trinitrate produces,
dilation of both arterial
and venous beds.
Arteriolar relaxation
decreases systemic
vascular resistance.
Myocardial oxygen
consumption reduced
by venous and arterial
effects of Gylceryl
Trinitrate in case of
Betsy.
Possibly by inhibiting
ion control. It inhibits
influx of the
extracellular calcium
across vascular and
myocardial smooth
muscle cell
membranes. And also
result in inhibition of
contractile processes
of myocardial smooth
muscle cells that leads
to dilation of
systematic and
coronary arteries and
also improved oxygen
delivery to myocardial
tissue.
Pravastain acts as
lipoprotein lowering
drug. Reduction
increase number of
cellular low density
lipoprotein receptors,
LDL uptake increases
and helps in removing
it from blood stream.
Complications/side
effects
Tachycardia,
hypotension, muscle
twitching, bradycardia,
methaemaglobinaemia
and decreased PaO2.
Headache,
constipation and
weakness may occur.
Fast heart beat, sudden
weigh gain and
abdominal pain.
Statins may worsen
diabetes. Sometimes it
can also cause muscle
related problems.
Nursing
considerations
GTN should not
administered with
other drugs.
It should be used with
Hypersensitivity to
diltiazem, hypotension
and heart failure and
safety not constituted
Myopathy should
considered in any
individual with diffuse
myalgias, weakness of
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caution in infants with
the liver
compromise(Holloway
& Galvin, 2016).
Systematic blood
pressure, heart rhythm
and rate should be
regulated carefully.
for pregnancy,
children lactation.
muscle (Kourkouta &
Papathanasiou, 2014).
Dosage adjustment is
required in patients
with the severe renal
impairment.
6. Mechanism of action of aspirin and ticagrelor
Aspirin: Aspirin effects differs with the dosage. Low dose are enough to directly
acetylate serine 530 of cyclooxygenase. The effect suppress platelets generation of the
thromboxane A2, which results in antithrombotic effect. Intermediate dose inhibit COX-2 and
COX-1, blocking prostaglandin manufacture and have antipyretic and analgesic effects.
It is used decrease fever and relive pain like headache and muscle aches. It also known as
salicylate and nonsteroidal anti inflammatory drug. Effect of this drug reduces stroke and heart
attack risk.
Ticagrelor: It has binding site is different from the ADP, by devising it allosteric
antagonist and blockage is reversible. Ticagrelor is not require hepatic activation that might
function better for the patients who are with the genetic variants in respect to enzyme CYP2C19.
It can be used to control or prevent stroke and heart attack after certain heart surgeries (McEwen
& Wills, 2017). Ticagrelor functions through blocking platelets from sticking with each other
and prevents them to from forming the harmful clots. It is also known as anti platelet drug.
In case of Betsy these drugs can be used together to reduce risk of strokes and heart
attacks in individuals. Patients who are with myocardial infraction should be provided low dose
of anti-clotting drug which is ticagrelor with aspirin for long time. These drugs together more
beneficial for those who has acute coronary syndrome so that it can prevent the major risks like
strokes. As aspirin reduces muscle pain which is beneficial for those who have severe muscle
pain.
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7. Use of morphine
Morphine is used to blunt the pain in response of secondary to ischemic tissue destruction
along with the providing anxiolysis that beneficial to the patients with AMI. And also morphine
causes vasodilation which reduces preload and can also reduce blood pressure and heart rate
leading to reduction of the myocardial oxygen demand. There are many benefits of morphine
such as it relives moderate to the severe pain (Parahoo, 2014). It works in brain to change the
body responds to pain. In this case it helps to reduce nausea and fainting. Morphine in the
present case is helping to the patient to reduce tiredness and nausea which are one of problems of
particular individual.
As morphine belongs to opioids class, which is used for drug abuse. The high dosage of
this drug can affect person and there are chances to get addicted to this drug group. Sometimes it
can cause more sweating, drowsiness, dizziness and vomiting (Tourangeau & et. al., 2016). It
can also affect to the mental health and moods of patient. In some cases patient start taking high
dosage of this drug which can have negative impact on the individual's body.
8. Exaggerated risk of the depression with chronic diseases
Betsy is suffering with coronary heart disease which is increasing risk of depression.
There are increasing risk of depression which is related to chronic diseases such as stroke,
diabetes and heart disease. Prevalence of the depression associated with chronic illness which
affect the patients. Depression can also disrupt like in many aspects, which can be work related
or personal life. Hypertension, arthritis and diabetes greater the depression (Zaccagnini & White,
2015). Depression can affect patient in many ways such as impaired nutrition and sleep, lack of
exercise and lead to an unhealthy behaviour.
As given in the case Betsy is suffering with different chronic illness which is increasing
depression, which is having negative impact on individual's life and health. Major depression can
lead to different mental disorders and other diseases like diabetes. Individual who is having
chronic illness, those are more likely to suffer from depression and it can also increase the risk of
heart attacks and strokes.
CONCLUSION
The given report is concluded as nursing is very important because it help to patients to
get over with diseases. Nurses helps to patient with their issues and provide appropriate care and
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treatment. Electrocardiogram is essential to get to know about any disease in detail. Angina
refers the chest pain and causes include different angina such as stable, unstable, nonSTEMI and
STEMI. Acute coronary syndrome is required central finding before the diagnoses. Aspirin and
ticagrelor is used together which increases the effect of drugs. These drugs decrease the risk of
heart attacks and strokes together. Chronic illness causes depression in patients which can be
lethal. Proper and earlier medication can decreases chronic illness.
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