Analyzing Healthcare Research Articles

This assignment requires you to critically analyze a provided set of research articles focusing on various aspects of healthcare. Examine each article's content, methodology, findings, and conclusions. Evaluate the relevance of the research to current healthcare practices and identify its potential contributions to advancing knowledge in the field.

Running head: CASE ANALYSIS
CASE ANALYSIS: CASE ANALYSIS OF RENDA BALLEY
Name of the Student
Name of the Author
Author Note

CASE ANALYSIS 1
Executive Summary
The report describes the case analysis of a patient named Renda Balley. She suffers from
cardiovascular disorder. She smokes heavily which may be cause of her condition. She
has a history of cardiac diagnoses and surgeries or interventions. She was diagnosed with
cardiac arrhythmia. She underwent radiofrequency ablation in order to overcome the
problem. This report describes the pathophysiology of the disease along with the
symptoms. Moreover, it carries out assessment of the patient reports, provides nursing
diagnoses and defines ethical standards of nursing associated with efficient patient care.

CASE ANALYSIS 2
Table of Contents
Introduction......................................................................................................................................3
Admitting or medical diagnoses......................................................................................................4
Pathophysiology..........................................................................................................................4
Symptoms....................................................................................................................................4
Patient assessment...........................................................................................................................4
Nursing practices and outcomes......................................................................................................5
Systems approach............................................................................................................................6
Discharge Planning..........................................................................................................................7
Culturally competent nursing..........................................................................................................7
Agency specific policies..................................................................................................................8
Ethical and Legal Standards............................................................................................................8
Reflection of additional learning.....................................................................................................9
Conclusion.......................................................................................................................................9
Reference List................................................................................................................................10

CASE ANALYSIS 3
Introduction
Ostial stenosis of the coronary artery causes narrowing of the ostium part. Ostial
lesions involve the presence of aortal wall and are calcified. They are highly prone to
restenosis (Mencel et al., 2013). This report describes the medical condition of a patient
named Renda Balley.
Renda Balley was admitted to Henry Ford Main hospital on October 16, 2017 and
underwent surgery on October 17, 2017. She lives with her husband and family at Central
Avenue, Warren, Michigan. She has no children. She is a cigarette smoker for 12 years.
She has decided to quit smoking with the help of an expensive drug called Chantix,
which stable economic status (Yzer et al., 2015). Renda lives with her husband’s family
indicating strong cultural values. She may have a Native American origin, where
smoking is a part of their ceremonial life. She suffers from high blood pressure, has high
cholesterol levels, suffers from obstructive sleep apnea (OSA), suffered from heart attack,
has coronary and peripheral artery disease. She underwent cardiac catheterization and
was diagnosed with ostial coronary artery disease (CAD). Significant stenosis was
observed at the position of the MLAD, Otitis media 1 or OM, ostial right coronary artery
(RCA), middle and distal RCA, proximal circumflex, left external iliac, left superficial
femoral and the medial branch was occluded. However, after surgery only 10% residual
stenosis was left in the left superficial femoral and 20% in the left external iliac. The right
internal carotid artery had a 85% lesion status but got reduced to less than 10% after
surgery. LAD showed 20-30% in-stent restenosis and 99% occlusion with disease spread
was observed throughout the entire artery. Superficial femoral artery also shows 50-80%
stenosis.
This report at first describes the pathophysiology of the disease, secondly, it
evaluates the results of the various diagnostic tests, thirdly, it provides nursing plans,
discharge planning, cultural competency, agency specific policies, among others.

CASE ANALYSIS 4
Admitting or medical diagnoses
Pathophysiology
Presence of stenosis hampers the capacity of the heart to respond to the higher
oxygen needs of the myocardium (Mahmod et al., 2014). Some of the most important
regulators maintaining blood flow in the coronary artery are intramural pressure,
metabolic rate of the myocardium, diastolic perfusion pressure of the aorta, endothelial
function, blood viscosity and autonomic nervous system control. The anomalies of the
coronary artery include split origin of the left coronary artery, irregular location of the
coronary ostium, irregular position of coronary ostium, irregular origin of the coronary
ostium, Congenital ostial stenosis, coronary hypoplasia split RCA and LAD, arteriolar
ramifications and fistulas, among others (Mazur, Siegel, Miszalski-Jamka & Pelberg, 2013).
Symptoms
Myocardial ischemia, angina or chest pain, pressure in the back, jaws, shoulders
and arms, heart attack, nausea, vomiting, cold sweat, and shortness of breath, fatigue,
swelling of ankles, feet, stomach, legs and veins in the neck are some of the symptoms.
Another symptom is Arrhythmia (Nabel & Braunwald, 2012). Heart diseases like
coronary heart diseases are the leading causes of death among men and women in
America. In the case analysis, the patient has high cholesterol and blood pressure, do not
exercise (activity using cane) and is a smoker, which cause such medical conditions.
Patient assessment
Evaluation of the diagnostic history of the patient reveals that she suffers from
myocardial infarction, arrhythmia since, her ejection fraction is low. She has suffered
from a heart attack. She has also undergone percutaneous coronary intervention (PCI) in
order to open up the blocked coronary arteries (Li et al., 2013). She suffers from
coronary, peripheral arterial diseases and OSA. She has high cholesterol and suffers from
hypertension (high blood pressure). She has nocturnal cardiac dysrhythmia. Patients with
ischemic heart disease usually suffer from antibiotic allergies due to the presence of

CASE ANALYSIS 5
cardiac mast cells, and in this case, the patient suffers from medicines like Benadryl and
those that contain penicillin (Kounis, Soufras & Hahalis, 2013). She is on a cardiac diet
to reduce her cholesterol and blood pressure levels.
Nursing practices and outcomes
The three nursing diagnoses associated with this case could be: hypertension,
myocardial infarction and dysrhythmias.
Nursing diagnoses associated with hypertension, myocardial infarction and
dysrhythmias involves decrease in cardiac output, acute pain, anxiety, insufficient tissue
perfusion, activity intolerance, digitalis toxicity, among others (Ding, Yehle, Edwards &
Griggs, 2014).
Nursing care plan for hypertension involves interventions like describing to the
patient about the limits of a desired blood pressure level, explaining hypertension and its
effects on the heart, helping the patient to identify risk factors associated with the diet
like high sodium, cholesterol and saturated fats, planning exercises, following a treatment
regimen, among others. The rationale is poor understanding about blood pressure and
misconceptions like high blood pressure is only present in patients with symptoms and
those who are sick. It is necessary to carry out proper evaluation of the patients to
understand whether they have a sound knowledge about the disease and its treatments
after carrying out the nursing care plan (Cicolini et al., 2014).
Nursing care plan for myocardial infarction involves interventions like assessing
chest pain characteristics, identifying location, duration, intensity, quality, determine
history of cardiac pain, assess respiration, heart rate and blood pressure after every chest
pain, bed rest during chest pain, administer medications and monitor drug therapy,
nitroglycerin SL administration, identify medication side-effects, carry out
Electrocardiogram (ECG), among others. The rationale behind these is to assist the
patient to rate pain, to make the patient understand that respiration may increase as a

CASE ANALYSIS 6
result of pain, reduction in consumption and demand of oxygen, ECG can help to
determine cardiac damage, use of morphine during chest pain. Such nursing plan will
provide the patient with comfort, reduced chest pain, reduced tension and anxiety, among
others (Bermudez, 2012).
Nursing care plan for dysrhythmias involves interventions like hemodynamic
regulation to determine the pulse rate, amplitude, regularity, pulse deficit, monitoring
cardiac output, blood pressure, respiration, changes in skin color, urine output, determine
ventricular contractions, tachycardia, fibrillation, among others (Gazarian, 2014). The
rationale behind these interventions involve the ability to determine differences in pulse
rate, regularity, hearing heart beats, identifying myocardial infarction, digitalis toxicity,
among others.
Systems approach
A systems-based approach was used with regard to the care of the patient. Apart
from cardiac surgeons, general practitioners, telemetry technicians and radiofrequency
ablation experts were present during cardiac interventions.
Telemetry is an electronic system that helps to monitor the heart activity of
patients. Differences in heart rhythms indicate various problems that require specific
treatments (Walsh, Topol & Steinhubl, 2014). A telemetry technician needs to be
accurate in analyzing the readings of the electrical impulses, since; the doctors base their
treatment plan according to their analysis.
The patient described in this case study has blockage in many of her coronary
arteries that leads to ischemic heart disease, cardiac arrhythmias, allergies to antibiotics
like penicillin. These were revealed by telemetry. Thus, necessary steps were carried out
to ensure the safety of the patient during cardiac intervention and planning treatments.

CASE ANALYSIS 7
Discharge Planning
The patient was asked to follow a cardiac diet and was advised reduced movement
and exertion. She was advised to use cane for carrying out any activity. She was asked to
use BIPAP during sleeping. Antibiotics like penicillin was advised to be avoided. Thus,
following a proper diet and medications will help the patient to prevent such cardiac
problems in the future.
The patient can be referred to nutritionists who can provide a suitable diet plan and
sleep specialists who can monitor her progress regarding OSA. Community resources like
health programs by institutes like the National Heart, Lung and Blood institute should be
attended. Moreover, the Center for Disease Control and prevention (CDC) carries out
many health programs in relation to ethnic and racial groups. Other community resources
include educational programs, health programs by doctors and telephone based help
facilities.
Prevalence of pain after surgery should be included in the anticipatory guidance.
Information about pain management, addressing symptoms, management techniques
should be provided to the patients in a comprehensive manner.
Culturally competent nursing
From the various informations provided about the patient, it can be said that she is
a Native American. Native Americans consider smoking a part of their spiritual life. The
characteristic features about them are, they are soft spoken people, good listeners, impart
importance to personal space and do not express feelings of discomfort. The nurse needs
to be soft spoken, always alert, not make eye contact, well versed in their native language
and be aware of alternative methods that help in quitting tobacco smoking. The nurse can
also recommend the patient to use herbs like Lobelia inflate (Willyard, 2015).

CASE ANALYSIS 8
Agency specific policies
One of the policies of the hospital is the pay for performance. Payments are made
according to the performance of the provider. These payment methods help to provide an
organized system of care delivery to patients and enable them to opt high quality care,
which was observed in this case. Thus, this hospital policy acts as a facilitator for care of
the patients (Www.henryford.com, 2017).
Nursing leadership can provide for safe and quality care. The nurse should be
highly trained, have high degrees in education, carry out quality data collection, effective
work planning, policy making and partner with doctors for improvements.
Ethical and Legal Standards
The National Code of Ethics consists of ethical guidelines and responsibilities that
are needed to be followed by nurses. These ethical responsibilities are classified under
“Nurses and People”, “Nurses and Practice”, “Nurses and Profession”, “Nursing,
Education and Research” and “Nurses and co-workers”. These codes help the nurses to
carry out ethical conducts and decisions when performing the roles of clinical nurses,
administrators, researchers and policy makers. Patient and family dignity is to be
respected and maintain cultural sensitivity.
End of life decision making is highly important because of advances in medical
science. Some medical interventions do not guarantee that the patient can lead a
meaningful life without life support systems. As a result, the patient can choose their
preferences in treatment when prioritizing end of life care. An advance directive either
proxy or instructional, enables an individual to document and design their decision plan
regarding healthcare, so that they can take necessary steps regarding any illness in the
future.
The ethical rights of the patients include autonomy and beneficence. Autonomy
refers to the right of every person to take his/her own decisions and earning respect from

CASE ANALYSIS 9
others with regard to their decisions associated with medical care. Beneficence refers to
the duty of the physician to respect and favor the decisions that are beneficial for the
patients (Reynolds, Drew & Dunwoody, 2013).
Reflection of additional learning
Additional learning that can be carried out to enhance patient care involves the
nurses to be more people oriented rather than task oriented, develop a connection with the
patient, provide undivided attention, and carry out research to provide best possible care.
Conclusion
This report describes the case study of a patient suffering from cardiovascular
disease. Smoking and other lifestyle factors were responsible for her medical condition.
She had undergone a number of surgical interventions that helped her to overcome her
problems. This report describes the severity of the medical condition of the patient.
Moreover, it also carries out assessment of the patient reports, provides nursing
diagnosis, discharge plans and defines various ethical standards associated with nursing.

CASE ANALYSIS 10
Reference List
Bermudez, N. (2012). ACS: A triad of troubles sets the stage for MI. Nursing made Incredibly
Easy, Vol: 10(6), pp: 14-17, doi: 10.1097/01.NME.0000421577.99021.b3.
Cicolini, G., Simonetti, V., Comparcini, D., Celiberti, I., Di Nicola, M., Capasso, L. M., &
Manzoli, L. (2014). Efficacy of a nurse-led email reminder program for cardiovascular
prevention risk reduction in hypertensive patients: A randomized controlled
trial. International journal of nursing studies, Vol: 51(6), pp: 833-843,
doi:10.1016/j.ijnurstu.2013.10.010.
Ding, Q., Yehle, K. S., Edwards, N. E., & Griggs, R. R. (2014). Geriatric Heart Failure:
Awareness, evaluation, and treatment in primary care. The Journal for Nurse
Practitioners, Vol: 10(1), pp: 49-54, doi:
10.1016/j.nurpra.2013.06.014.
Gazarian, P. K. (2014). Nurses’ response to frequency and types of electrocardiography alarms
in a non-critical care setting: a descriptive study. International journal of nursing
studies, Vol: 51(2), pp: 190-197, doi: 10.1016/j.ijnurstu.2013.05.014.
Kounis, N. G., Soufras, G. D., & Hahalis, G. (2013). Anaphylactic shock: Kounis
hypersensitivity-associated syndrome seems to be the primary cause. North American
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Li, J., Elrashidi, M. Y., Flammer, A. J., Lennon, R. J., Bell, M. R., Holmes, D. R. & Lerman, A.
(2013). Long-term outcomes of fractional flow reserve-guided vs. angiography-guided
percutaneous coronary intervention in contemporary practice. European heart
journal, Vol: 34(18), pp: 1375-1383, doi: 10.1093/eurheartj/eht005.
Mahmod, M., Francis, J. M., Pal, N., Lewis, A., Dass, S., De Silva, R., & Ashrafian, H. (2014).
Myocardial perfusion and oxygenation are impaired during stress in severe aortic stenosis
and correlate with impaired energetics and subclinical left ventricular
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10.1186/1532-429X-16-29.

CASE ANALYSIS 11
Mazur, W., Siegel, M. J., Miszalski-Jamka, T., & Pelberg, R. (2013). Coronary Artery
Anomalies. In CT Atlas of Adult Congenital Heart Disease (pp. 183-202). Springer
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6_16
Mencel, G., Kowalczyk, J., Swierad, M., Swiatkowski, A., Honisz, G., Kalarus, Z., & Sredniawa,
B. (2013). Ostial stenosis of the left main coronary artery as the result of the previous
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