Analysis of Findings in Nursing 6 Assessment 2: A Detailed Report

This report analyzes a nursing assessment focusing on a patient presenting with symptoms of congestive heart failure and myocardial infarction. It examines the patient's socio-demographic, family, and medical history, highlighting risk factors such as stress, hypertension, hypercholesterolemia, and obesity. The assessment details the patient's presenting signs and symptoms, including chest pain, pale skin, and elevated blood pressure, and the findings from diagnostic tests like electrocardiograms and troponin levels. The report emphasizes the importance of critical thinking, clinical reasoning, and clinical decision-making in nursing practice, including focused assessments and recommendations for pharmacological and non-pharmacological management, such as medication, fluid control, DVT prophylaxis, and patient education on lifestyle changes and psychological support. References to relevant research articles are included to support the analysis.

Running head: NURSING
NURSING
Name of Student
Name of University
Author note

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Assessment 2
a. Analysis of findings
Analyzing the presenting signs and the symptoms of the admitted with the past history
of the patient is critical to the nursing practice and the skills of critical thinking, clinical
reasoning and of clinical decision making that is appropriate and relevant to the case is very
important in the clinical day to day nursing practice (Thomas, 2018). It is highly important
the history of past illness, of present illness according with family history and
sociodecographic data is taken properly by the nurse in order to correlate the same to the
presenting symptoms, based on which the nursing assessments can be started. Comprehensive
history taking followed by comprehensive assessment taking with the right demonstration of
critical thinking, clinical reasoning and apt problem solving is vital to the nursing care. Along
with these components of the clinical practice that is safe and secure – it is also very
important to address the needs of the patient in a very individual manner.
Health history
As for the socio-demographic history, the subject has three children and married. He
works in the high paced work environment of the airport where his work life is highly
stressful. Stress and anxiety in relation to the lack of work-life balance of the subject has been
increasing day by day that has resulted in the development of hypertension in the subject. It is
critical to be noted that the patient has three children who are minor and taking the
responsibility of three children is stressful and this has added and attributed to stress, anxiety
and psychogenic rise of blood pressure, to a great extent. As for the family history of the
subject, it is important to note his father died because of the heart attack or cardiovascular
accident that is also suggestive of a similar high blood pressure that led to the adverse event.
His father died when the subject was just in his adolescent stage and the loss of the parent

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have also led to feelings of stress and anxiety in the subject from a very early age that is to be
correlated to the present symptoms of the patient. His mother died due to cerebrovascular
accident which is also very suggestive of a high blood pressure or hypertension led event. His
uncle recently had a surgery following the bout of a health attack which suggests the similar
pathophysiological process as well (Sulastini et al., 2019). Hence, it can be considered that
the ubject has a family predisposition of high blood pressure or hypertension, cerebrovascular
accidents and the heart attacks that increases his chance of having a heart attack or
cerebrovascular accident. His present symptoms of severely increased blood pressure, chest
pain that is angina and pale skin is suggestive of a congestive heart failure and it is reasoned
with the family history of the patient, moreover as per the history of present illness, when the
subject initially presented flu like symptoms to the doctor, he was already presenting with
abnormally high blood pressure and increased cholesterol and lipid levels that was way
beyond the normal range which lead to the presentation of the current signs and symptoms in
the patient. The normal level of cholesterol level is considered to be less than 2.6 but upto
3.4 millimoles is still considered to be optimal but the levels were more than 7 in the patient
that was suggestive of hypercholesterolemia and as the lipid levels of the patient were as
raised as 5.9, the condition was also suggestive of dyslipidemia that resulted in the
presentation of the heart attack in the patient (Ajaero et al., 2016). The subject has overweight
and near obese with a near body mass index of 29 and obesity and being overweight is
directly with the presentation of the cardiovascular accidents such as myocardial infarction
and congestive heart failure which has happened in the patient. It is highly important to note
that the weight issue in the patient along with excessive levels of stress and an anxiety in the
patient led to increase in the blood pressure of the subject beyond the controllable normal
limits that acted as a predisposing factor to the causation of the cardiac arrest or heart attack
in the patient. The subject is also a coach in her daughter’s team and this is another important

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area in the history that is to be considered and correlated. It is important to note that the role
of coaching demands high energy, high fitness to be able to cope with the needs of high
paced sports environment (Tuttle et al., 2017). The subject did not train or exercised properly,
his body was not being able to meet the high demands that are required to coach the other
players in the field. His body was not adapted at all to the physiological as well as the mental-
physiological needs of the sports and he was not fit enough to coach or to work in such a
highly stress work environment in the airport. As he coped negatively to the situation and did
not make any dietary changes or lifestyle changes as per the health and wellbeing needs, his
blood pressure became uncontrolled and in spite of the doctor having prescribed him the right
medications and the lifestyle changes that he should started as soon as possible and as he did
not properly and continued to live a highly stressful life – the symptoms and the signs of the
subject was aggravated very much. This lead to presentation of symptoms and signs of
nausea, pain in the regions surrounding the chest, pale coloration and he was sweating
profusely that was very much suggestive of a myocardial infarction and congestive heart
failure, in the subject.
Focused assessments
The function of the nurse is to promote the overall physical and mental wellbeing plus
health of the patient and clinical decision making pertaining to the assessment taking and to
the management of the patient is very crucial as well (Stewart & McPherson, 2017). The
undertakings of the focused assessments are very critical to the clinical reasoning of the
presenting symptoms (Shimonishi, Hisamune & Matsui, 2017). The electrocardiogram report
that the nurse has requested would confirm the myocardial infarction of the patient. Hence,
the electrocardiogram report showed the elevated ST waves which was clearly indicative of
the ST-segment elevation myocardial infarction that is also known as STEMI. The tests
requested by the nurse, reported the elevated levels of troponin T and I which are proteins

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whose levels are increased in the blood stream following the occurrence of a heart attack. The
troponin T test is another important diagnostic test for heart failure and in the focused
assessment, as the levels of the same was found to be raised, the heart failure was confirmed.
In the focused nursing assessment following the admission of the subject in the
emergency department by the wife of the patient, the intensity of the pain in the patient was
found be raised. It is very important to note that the level of the pain was recorded to be 7
upon 10. It is severely acute and this was due to angina felt by the patient. Angina is caused
by narrowing of the blood vessels due to ischemia and lack of oxygen supply to the heart
muscles or to the specific regions of the heart lead to the causation of angina. The lack of
blood supply and the resultant lack of the oxygen supply to the cardiac tissues cause
myocardial infraction and resultant heart failure. (Alpert et al., 2017).
b. Recommendations
The gyceryl trinitrate was administered to the patient, after the focused assessment in
order aid the vasodilation and decrease of angina. Morphine was given to address the acute
and the severe pain that is caused by angina. The pharmacological management of the patient
includes the analgesics to address the acute in the patient, the blood pressure management
with the anti-hypertensives (Atherton et al., 2018). A safe administration of the drugs that
causes vasodilation and prevents congestion of the heart is also very critical to the care
process. The fluid intake should be controlled in an appropriate manner to address the
systematic, cardiogenic shock and the dehydration risks (Marques et al., 2016). The deep vein
thrombosis prophylaxis should be started in the patient as well in order to prevent as chances
of embolism complications (Sugumar et al., 2019). The non-pharmacological management by
the nurse will include proper positioning of the patient and promotion of sleep and relaxation
of the patient. In case of breathing issues, the breathing exercise should be started pertinently

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(Tee et al., 2019). Educating the patient about the self-care skills such as mindfulness and
relaxation techniques along with healthy diet is important to develop the functional
independence of the patient. Giving psychological support to the patient by the nurse, through
counseling and talk therapy is critical to recovery and care of the patient. Educating the
patient about the ways of weight loss and techniques to develop relaxation again the stress
should also be recommended and taught to the patient. A health low fat diet is critical to be
recommended to the patient and his family as well. The nurse should collaborate with the
physical therapist to start with the activities of daily life training and cardiac rehabilitation.
The nurse should collaborate with the nutritionist to plan the dietary changes for Harry.

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References
Ajaero, C., Chan, A., Arstall, M., Hersztyn, T., McGavigan, A., & Horowitz, J. (2016).
Implications of Cardiac Resynchronisation Therapy (Crt) on the Pathophysiology of
Congestive Heart Failure: Focus on Endothelial Function and Inflammatory
Activation. Heart, Lung and Circulation, 25, S115.
Alpert, C. M., Smith, M. A., Hummel, S. L., & Hummel, E. K. (2017). Symptom burden in
heart failure: assessment, impact on outcomes, and management. Heart failure
reviews, 22(1), 25-39.
Atherton, J. J., Sindone, A., De Pasquale, C. G., Driscoll, A., MacDonald, P. S., Hopper, I., ...
& Thomas, L. (2018). National Heart Foundation of Australia and Cardiac Society of
Australia and New Zealand: guidelines for the prevention, detection, and management
of heart failure in Australia 2018. Heart, Lung and Circulation, 27(10), 1123-1208.
Marques, F. Z., Vizi, D., Khammy, O., Mariani, J. A., & Kaye, D. M. (2016). The
transcardiac gradient of cardio‐microRNAs in the failing heart. European journal of
heart failure, 18(8), 1000-1008.
Shimonishi, M., Hisamune, M., & Matsui, M. (2017). Symptom Management and Factors
Related to Nurses’ Attitudes toward Terminally Ill Patients with Congestive Heart
Failure. Palliative Care Research, 12(4), 723-730.
Stewart, D., & McPherson, M. L. (2017). Symptom management challenges in heart failure:
pharmacotherapy considerations. Heart failure reviews, 22(5), 525-534.
Sugumar, H., Nanayakkara, S., Prabhu, S., Voskoboinik, A., Kaye, D. M., Ling, L. H., &
Kistler, P. M. (2019). Pathophysiology of Atrial Fibrillation and Heart Failure:
Dangerous Interactions. Cardiology clinics, 37(2), 131-138.

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Sulastini, S., Mediani, H. S., Fitria, N., & Nugraha, B. A. (2019). Effect of Progressive
Muscle Relaxation on Anxiety in Congestive Heart Failure Patients. Jurnal
Keperawatan Soedirman, 14(2).
Tee, S. L., Sindone, A., Roger, S., Atherton, J., Amerena, J., D'Emden, M., ... & De Pasquale,
C. (2019). Hyponatremia in Heart Failure. Internal medicine journal.
Thomas, L. R. (2018). Reducing congestive heart failure hospital readmissions through
discharge planning.
Tuttle, C., Reeves, M., Hu, T. C. Z., Keates, A. K., Brady, S., Maguire, G., & Stewart, S.
(2017). Pattern and Outcome of Heart Failure–Related Hospitalization Over 5 Years
in a Remote Australian Population: A Retrospective Administrative Data Cohort of
617 Indigenous and non-Indigenous Cases. Journal of cardiac failure, 23(10), 729-
738.