Nursing Management for a Patient with Cardiovascular Disease: A Case Study Analysis

This article discusses the nursing management of a patient with cardiovascular disease. It includes a case study analysis, pathophysiological issues, nursing diagnosis, and pharmacokinetics of prescribed medications. The article also highlights the importance of patient education for long-term outcomes in patient care.

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

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Introduction
Nursing management is an important aspect of patient’s health and well-being. The
following summative assessment is based on the critical analysis of a case study and
recommendation of effective management strategies in order to improve the disease
prognosis. The case study is based on Mr. Ferguson, 76-year old male who was presented in
the emergency ward with chest pain, shortness of breath, high blood pressure and irregular
respiratory rate. He also has previous medical history of Angina and Non-ST Elevated
Myocardial Infarction (NSTEMI), hypertension and hypercholesterolemia. The summative
assessment will initiate with highlighting the anomaly in the vital signs and gaps in
information which demand further investigations. This will be followed by a detailed
pathophysiology of the patient’s condition and followed by effective nursing interventions for
overcoming the condition. At last, the paper will discuss the pharmacokinetic of the
medications prescribed and its associated considerations plus side-effects. The paper will also
highlight the importance of patient’s education for long-term outcome in patient’s care.
Discussion
Deviation from normal finding and further investigation
The first abnormal data recorded in Mr. Ferguson is high level of blood pressure
172/86 (normal range: 120/80-140/90) and irregular heart rate 103 bpm (regular heart beat
range: 60 to 100 bpm) (Pocock, Richards and Richards, 2013). The past medical history of
Mr. Ferguson shows Angina and Non-ST Elevated Myocardial Infarction (NSTEMI) along
with hypertension and hypercholesterolemia. According to Suchy-Dicey et al. (2013) having
a past medical history of hypertension along with chest pain myocardial infarction is
associated with elevated blood pressure. Moreover, Saydah et al. (2014) has reported that

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people who are above 65 years of age and have high level of blood cholesterol is found to
have tendency of hypertension. Mr. Ferguson, 76 years recorded significant medication
against the management of the blood pressure. Thus further nursing intervention will revolve
in the domain of whether Mr. Ferguson takes anti-hypertension pills or whether he has
suddenly discontinued the same. Suchy-Dicey et al. (2013) stated that sudden discontinuation
of anti-hypertension pills might lead to sudden increase in the blood pressure leading to
development of chest heaviness and the vulnerability increases among the patients with
previous reported cases of cardio-vascular complications. Other aspect of further nursing
intervention include making a detailed pain assessment by pain score in order to denote
whether Mr. Ferguson is suffering from pain due to chest tightness. Sabatine and Cannon
(2015) stated that tightness in chest or discomfort is associated with pain in the upper portion
of the shoulder, neck and abdomen.
Additional information
Mr. Ferguson is found have previous reported cases of hypercholesterolemia and
takes Rosuvastatin in order to manage the high cholesterol level. Thus additional nursing
information will be directed towards inquiry about diet plan of Mr. Ferguson and whether he
was/is addicted to alcohol. According to Kooti et al. (2014) consumption of alcohol for a
prolong period of time increase the chances of developing high level of blood cholesterol
during the later stages of life. Kooti et al. (2014) also reported that feeding on unhealthy or
processed food leads to increase in the tendency of developing of high level of blood
cholesterol. Older adults who leave alone mainly thrive on processed food and thus
increasing the vulnerability of hypercholesterolemia (Reedy et al., 2014). Thus the nursing
professional must also investigate about his family condition. Height and weight is another
crucial factor behind diagnosis and treatment of the cardiovascular disease. Hanson et al.
(2014) stated that obesity is associated with the development of cardiovascular disease by

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increasing the fat deposition in the inner lining of the arteries. Thus, proper assessment of the
weight or basal metabolic index of Mr. Ferguson will help in framing of the person-centred
care plan.
Pathophysiological issues
Mr. Ferguson is presented with high blood pressure, irregular heart rate but with
normal oxygen saturation (Spo2) [97%] and tympanic body temperature of 36.8 degree C and
normal Glassgow Coma Scale (GCS). Mr. Ferguson is suffering from tightness of chest and
chest heaviness 2/24 this has resulted in the development of the irregular heart rate.
Lymperopoulos, Rengo and Koch (2013) stated that under the condition of the persistent and
heavy mechanical load on the heart as defined by heaviness in chest, the calcium signalling of
the heart becomes unstable resulting in the generation of the irregular heartbeats. Irregular
heartbeats results in increase vulnerability towards sudden cardiac arrest. Mr. Ferguson
appears pale, diaphoretic and short of breath however, his oxygen saturation levels are
normal. According to Delacroix, Chokka and Worthley (2014) shortness of breath reflects a
low saturation of oxygen however, it is possible to develop this symptoms even under normal
oxygen saturation. The percentage of oxygen saturation is defined as a measure of oxygen
dissolved in haemoglobin and it is always not proportional to dyspnea. Delacroix, Chokka
and Worthley (2014) stated that patient with chronic obstructive pulmonary disease (COPD),
the mechanism of shortness of breath under normal oxygen saturation is mainly cause by
heart failure. Increase in the blood pressure results in reduction in the cardiac output.
Decrease in the cardiac output is associated with decrease in the volume of blood that the
heart can pump into various part of the body leading to oxygen supply in the organs causing
shortness of breath. Lack of proper supply of oxygen in the body is making Mr. Ferguson
appear pale (Hammer & McPhee, 2014). Glyceryl trinitrate pump generates localised yet

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temporary relaxation of the smooth muscles thus giving minimal relief (Delacroix, Chokka &
Worthley, 2014).
Gokhroo et al. (2016) stated that excessive sweating is a characteristic of ST‐Segment
Elevation Myocardial Infarction and acute coronary artery symptoms. Mr. Ferguson has
previous case history of Non-ST Elevated Myocardial Infarction (NSTEMI) along with
angina and thus increase in the blood pressure might be due to cardiac complications and
sweating is the first sign or manifestation behind the vulnerability of heart attack.
Nursing Diagnosis
Placing Mr. Ferguson will be position in Fowler's or sitting position: It is a standard
patient position where the patient is seated in semi-upright sitting position (60 to 40 degrees
from the surface of the bed) with knees bent towards the chest (Vrachatis et al., 2014).
According to Kuhajda et al. (2015), this posture helps to promote oxygenation through
maximum expansion of the diaphragm and thereby by helping to relive from the respiratory
distress. Fowlers’ position also helps to relax the abdominal muscles and thereby helping to
promote improved breathing. It is the duty of the nursing professionals to instruct the patient
to inhale and exhale slowly through nose by placing the palms upside down over the belly.
Relaxation of the patient and pain management: It is the duty of the nursing
professional to make Mr. Ferguson stay relax and clam in order to ease the process of
breathing and decrease the excessive sweat. This can be done by the application of the proper
music therapy. Loewy et al. (2013) are of the opinion the proper application of the music
therapy helps in mind relaxation and thereby helping to ease the process of breathing. Proper
application of the music therapy is also helpful for reducing pain as in case of Mr. Ferguson
who was suffering from chest heaviness since last day before hospital admission (Gutgsell et
al., 2013).

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The evaluation of the overall interventions will be done based on monitoring of the
vital signs of Mr. Ferguson after every 30 minutes. The main vital signs that will be
monitored include blood pressure, respiratory rate and heart rate and body temperature. The
improvement in the vital signs will indicate positive prognosis of the patient’s condition
(Hammer & McPhee, 2014). Verbal feedback from Mr. Ferguson will also be considered as
an important aspect of evaluation of the nursing interventions.
Pharmacokinetics of prescribed medications
Aspirin is a non-steroidal anti-inflammatory drug (NSAID). It inhibits the activity of
the enzyme cyclo-oxygenase (COX). COX leads to the formation of prostaglandins by
breaking arachidonic acid. Prostaglandins are primary mediators that cause swelling pain and
fever. Thus administration of oral Aspirin will prevent the formation prostaglandins and
thereby helping to Mr Ferguson to recover from pain arising from tightness in chest (Loewy
et al., 2013).
Morphine sulphate is a principal alkaloid in opium. It is a prototype of opiate
analgesic and has widespread effects in the central nervous system and on the smooth
muscles. It mainly helps in the treatment of the chronic pain. In relation to Mr. Ferguson it
can be said that morphine sulphate administered intra-venously generates vaso-dilation of the
smooth muscles and thereby helping to decrease the tightness of chest and creating ease in
breathing (Agewall, 2017).
Heparin infusion: Heparin infusion increases the dilation of the blood and thereby
helping to make the blood thinner. The thin or dilated blood flows swiftly through the blood
vessels and thereby helping to restore the oxygen demand in different organs of the body
(Hammer & McPhee, 2014).

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Fentanyl it is a narcotic analgesic is classified under the mu-opiod agonist. It is used
as an anesthetic for the people with respiratory compression. It causes dilation of the smooth
muscles thereby helping to reduce the chest pain and tightness of chest. At the same time, it
reduces the pain. Çoruh, Tonelli and Park (2013) it also helps to reduce the rigidity of th
chest wall and thereby helping to promote well-being to the patient.
Medication, contradiction and side-effects of the medication
The main contradictions associated with aspirin include renal problem, kidney
dysfunction and hepatic complications along with intestinal ulcer. Reedy et al. (2014) people
who are above 65 years of age are vulnerable in developing several organ dysfunction thus
administration of oral aspirin to Mr. Ferguson must be done after proper validation of the
organ functions. The main side-effects of aspirin include vomiting, nausea, stomach pain and
rapid breathing.
The major contradictions for analgesic-opioid drugs used as the vasodilator include
primary respiratory depression and increase in the intracranial pressure. The side-effects of
the opioid analgesic include nausea, vomiting and constipation. Thus, Mr. Ferguson’s vital
signs like respiratory rate, blood pressure and gastro-intestinal conditions must be monitored
daily in order to avoid complications (Agewall, 2017).
The main contradiction and side-effects of heparin infusion include increased dilution
of the blood thus it might lead to sudden bleeding or delay in wound healing. Thus proper
nursing safety measures must be taken in order to protect Mr. Ferguson from encountering
injury through accidental factor. Weekly PT-INR test must be conducted in order to estimate
the blood dilution rate (Broyles et al., 2017).

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Patient Education
Patient education will be given about the importance of taking medications on time
and weekly monitoring of the vital signs. According to (Broyles et al., 2017), taking cardio-
vascular and respiratory medication on time and regular monitoring of the vital signs helps to
decrease the threat of sudden increase in blood pressure and generation of shortness of breath.
Mr. Ferguson will be educated about importance of diet for effective non-pharmacological
management of hypercholesterolemia. Decrease in the blood cholesterol will help to reduce
the chances of cardio-vascular complications (Reedy et al., 2014).
Conclusion
Thus from the above discussion, it can be concluded that the main deviation from the
normal findings in case of Mr. Ferguson is high blood pressure and irregular heart rate
however, further investigation must be undertaken in order to detect if Mr. Ferguson was
under anti-hypertension pills. Additional information include whether Mr. Ferguson was
alcoholic and about his diet plan to find the main roots behind hypercholesterolemia. The
main pathological issue leading to the development of shortness of breath and chest heaviness
might be associated with his previous reported cases of angina and myocardial infarction. Mr.
Ferguson might also develop Chronic Obstructive Pulmonary Disease (COPD) and this is the
reason why he is looking pale and having shortness of breath while normal oxygen saturation
at room-temperature. Nursing diagnosis will include music therapy for pain recovery and
mood relaxation and use of Fowler's posture to ensure ease of breadth. Mr. Ferguson was
mainly administered with opioid medication which acts as vaso-dilators for the dilation of
smooth muscles and making it easier to breath. However, precaution must be taken taking his
age into consideration. The patient must be educated about importance of taking medication
on time and healthy lifestyle.

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