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

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

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NURSING KNOWLEDGE
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