Trevor Name of the University Author Note From Case Study Of Trevor Name of the University Author

Running head: CASE STUDY OF TREVOR 1
Case Study Of Trevor
Name of the University
Author Note

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From the case study, it is observed that Trevor has suffered a silent heart attack. Looking at
his symptoms, it can be said that he may be suffering from coronary heart disease(cdc.gov,
2020), which is characterized by an accumulation of lipids or fats on the walls of the arteries
and vessels of the heart. Due to fat accumulation, the oxygen supply to the chambers of the
heart is hampered, leading to pain and discomfort in the chest area, which Trevor was feeling
at repeated intervals. This frequent pain is usually called unstable angina which ultimately
leads to myocardial infarction or heart attack. This paper aims to discuss the case study of
Trevor, describing the pathophysiology of the disease, the nursing interventions regarding the
diagnosis and the associated complications of the disease following NMBA approach, as well
as the ethical and legal issues concerning the treatment procedures.
Discussion
Pathophysiology of Coronary Heart Disease
A buildup cholesterol-rich deposits or plaques on the linings of the artery and vessels, usually
cause coronary artery disease. This condition is called atherosclerosis(Jaiswal et al, 2017).
These plaques are responsible for the thickening of the arterial wall and vascular wall, thus
narrowing the space through which blood flows to reach the heart(Jinnouchi et al, 2019). The
amount of blood reaching and supplying the heart muscles (myocardium) with oxygen and
nutrients is significantly reduced. The plaque formed also damage or injure the inner lining of
the artery called the endothelium. When the endothelium is damaged, cholesterol, fats,
lipoproteins, and other debris start to accumulate at the site of injury in the wall or intima of
the artery or blood vessels. High concentrations of low-density lipoprotein (LDL) penetrate
the already damaged endothelium which undergoes oxidation to form altered LDL, which
attracts WBC or leukocytes towards the vessel wall. Macrophages present in the circulating

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blood, engulf the lipoproteins to become foam cells which result in the formation of an
atheromatous lesion called the fatty streak.
The fatty streak then attracts the smooth muscle cells to the site of injury, where they start
multiplying and start to produce an extracellular matrix comprising of collagen and
proteoglycan, which converts the fatty streak into fibrous plaque(Pino, Shi & Werstruck,
2018). The lesion then starts bulging into the inner wall of the blood vessel, leading to a
significant narrowing of the luminal space.
Now, the fibrous plaque develops its small vessels to provide it with a supply of blood in a
process called angiogenesis. After that, the plaques begin to calcify as calcium starts to
deposit. The final plaque is made up of a cap of fibrous tissue covering a core that is rich in
lipids as well as necrotic or dead cells. The edge of this cap is critical in acute coronary
disease. This region is prone to rupture, which exposes the underlying core of lipids and
necrotic material to thrombogenic factors in the blood. This can cause the aggregation of
platelets that form a clot across the plaque and further narrow the artery(Pothineni et al,
2017). Arteries that have become narrowed due to the presence of plaques may lead to angina
or chest pain as the muscles of the heart are deprived of oxygen. As the deposits on the
plaques grow in size and dimension, the blood vessels become further narrowed, and there
may be obstruction leading to a heart attack or a myocardial infarction(Mori et al, 2019).
Assessment
The nurse collects information about Trevor's symptoms and activities. One of the essential
care of the patient with myocardial infarction is the assessment; it helps in the establishment
of the baseline for the patient, so that any changes in the values may be identified. The nurse
identifies Trevor's needs and helps him in determining the priority of those needs. Systemic
assessment includes gathering Trevor's health history as it relates to symptoms, evaluates the

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symptoms with regard to time, risk factors and then relives them. Nurses conduct a complete
physical assessment of Trevor to detect complications and any variation in his health status.
The intravenous sites are examined frequently for ensuring that enough access is available for
the administration of emergency medications. Other assessment done by the nurses includes
monitoring of systolic and diastolic blood pressure monitoring, checking of heart rate,
measuring cardiac output and checking of anxiety level of Trevor. For assessing the chest
pain that Trevor was going through, nurses need to perform 'PQRS T' test and document the
vital signs. Then they should perform an ECG(Electrocardiogram) test followed by the access
of Trevor to a defibrillator which prevents early death due to cardiac arrhythmias. Lastly,
they should check the troponin levels(a marker of ischaemia/ infarction) in the blood of
Trevor.
Diagnosis
For diagnosis of the acute pain, the nurse monitors and document the characteristics of pain,
measures the blood pressure or monitor the rate of heartbeat. The should ask Trevor the exact
location of the pain and also interrogate about the intensity and duration of the pain he was
feeling and also discuss family history with him. They should provide a calm and soothing
environment for Trevor and also ask Trevor to perform relaxation activities like deep and
slow breathing(Bayrak & Tosun, 2018). They can also prescribe medications like anti-anginal
or beta-blockers to Trevor, which will reduce the chest pain. For diagnosing the activity
intolerance, the nurses can suggest Trevor to avoid increasing abdominal pressure; they can
review signs and symptoms which reflect on the intolerance and refer him to a cardiac
rehabilitation program. The risk of decreased cardiac output can be evaluated by checking the
blood pressure, monitoring of pulse rate and reviewing ECG reports which provides
information regarding progression and resolution of myocardial infarction. The risk of
invasive tissue perfusion can be checked by maintaining total fluid intake, providing low