Diploma of Nursing: Case Study 2 - Cardiovascular Health Analysis

This case study examines a cardiovascular case, likely involving a patient experiencing chest pain and suspected of having a myocardial infarction. The assignment requires an analysis of the patient's symptoms, including the questions to ask during the acute phase, and common cardiovascular disorder symptoms. It explores diagnostic tests such as ECG, echocardiogram, and troponin levels, and the pathophysiology of myocardial infarction. The case study also covers the identification of modifiable risk factors, the action, side effects, and contraindications of Glyceryl trinitrate (GTN), and nursing interventions, including post-angioplasty care and potential complications. Finally, it identifies the multidisciplinary team members required to manage the patient's risk factors, such as a nutritionist, physical trainer, and counselor.

Running head: Case Study 2– Cardiovascular
Case Study 2– Cardiovascular
Name of the Student
Name of the University
Author Note

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Case Study 2– Cardiovascular
1.In the acute phase of the chest pain list four (4) questions you could ask the person.
In the acute phase of the chest pain, questions that should be asked to the patient are:
 Is there abrupt onset of the chest pain?
 Does the pain show on the neck, back, flank, or abdomen?
 Was the pain sharp or tearing in nature?
 Do you faint (syncope)?
2. List four (4) symptoms commonly associated with cardiovascular disorders.
The four common symptoms experienced by people with cardiovascular disorders are
 Chest pain, chest, tightness, chest pressure, chest discomfort (angina)
 Shortness of breath.
 Weakness or lack of sensation in the legs or arms if the blood vessels from that part of the
body are narrowed.
 Sweating, dizziness and nausea.
3. Explain four (4) observations that are relevant to a patient’s cardiac health.
The following sings are generally observed in the cardiac patients:
 An increased respiratory rate.
 Hypertension.
 An elevated heart rate.
 An increased body temperature.
4. Define myocardial infarction (MI).

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Myocardial infarction (MI) is a concept used to explain a cardiac attack that is the result
of plaques in the inner walls of the arteries that contribute to a decreased blood flow to the heart
muscles and the heart being impaired because of the inadequate supply of oxygen. Symptoms of
MI include shortness of breath, chest pain that passes from left to left neck, fatigue, vomiting,
nausea, irregular heartbeats, anxiety (Lu et al., 2015). MI, commonly known in layman's terms as
a heart attack, is typically triggered by blood flow decline or a blockage into part of the heart
which leads to cardiac muscle necrosis. This is typically developed as a result of blood
coagulation in the epicardial artery, which provides the heart muscle territories (Moussa &
Ambrose, 2018). Some MIs are caused by disease of the coronary artery. Risk factors include
elevated blood pressure, smoke, asthma, activity deficiency, obesity, high blood cholesterol, low
nutrition and heavy drinking. Normally the root cause of the MI is the complete coronary artery
blockage arising from a break of the atherosclerotic plaque. Coronary artery spasms are less
severe, owing, among others, to alcohol consumption, mental stress and intense cold. Several
examinations, including electrocardiogram (ECG), checks for blood and angiography, are
effective in diagnosing these diseases.
5. Describe the pathophysiology of a myocardial infarction.
Acute occlusion of one or more major coronary arteries can contribute to an acute
myocardial infarction during more than 20 to 40 minutes. The occlusion is typically thrombotic
which happens after a clot in the coronary artery is ruptured. The occlusion results in an oxygen-
free circulation of the myocardium and induces sarcolemmal involvement and relaxation of
myofibril. These modifications are one of the first ultrastructural changes in the MI process,
followed by mitochondrial alterations. Lastly, persistent ischemia contributes to liquefactive
myocardial tissue necrosis. The necrosis extended to the subendocardium. The sub-epicardium is

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assumed to have enhanced collateral circulation, which allows mortality to delay. The cardiac
activity is jeopardized according to the area impacted by the infarction. If the myocardium is
poorly regenerated, the infarct region recovers by development of a wound and also remodels the
heart through dilation, segmental hypertrophy of healthy surviving tissues, and cardiac failure
(Ojha & Dhamoon, 2019).
6. The diagnostic profile of a person with a cardiac event includes the health history, clinical
manifestations, physical examination and diagnostic investigations analysis. Troponin is the
cardiac enzyme routinely tested when a person presents with a suspected cardiac event. What
does the troponin test detect?
The quantity of troponin T or troponin I proteins are calculated in the blood through a
troponin check. Such proteins are activated when the heart muscle has been injured during heart
attack. The more cardiac injury, the higher is the volume of troponin T and I in the blood. If
roponin is above the reference level, it suggests a heart attack. For instance where the usual
comparison range is 0.00 to 0.40, so 0.41 is theoretically fine, but very poor, and 10 is very
strong (Michos et al., 2014).
7. List three (3) modifiable risk factors that Sally has presented with.
The three modifiable risk factors that Sally is presented with include:
 Smoking: She is a smoker and she is been smoking 5 cigarettes a day for 50 years. She
must quit smoking in order to reduce the risk of developing further complications that
will not only decrease her value of life but also, can direct to mortality.

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 Obesity: She is obese and she can manage her obesity by following self management
strategies. She must adhere to healthy lifestyle in order to manage her obesity and reduce
the risk of further complications.
 Hypertension: Efficient hypertension and CVD self-managing requires self-monitoring
and symptom control, understanding in blood pressure and symptoms; approaches to
appropriate behavior (adjusting medications, undertaking preventive care); improvements
of lifestyle, e.g. avoiding smoking, reduction in alcohol intake, modification of the diet,
loss of weight and improved usage of the medication supplier and engaging in exercise
and daily activities (Shahaj et al., 2019).
8. Identify four (4) diagnostic tests used in cardiac disease and explain how these tests will assist
in the diagnosis of a cardiac disease.
The diagnostic tests used in the cardiac disease include:
 Electrocardiogram (ECG): An ECG tracks the electrical impulses that will help the doctor
identify rhythm that structural abnormalities in the heart. An ECG is performed while at
rest or during exercise (electrocardiogram stress).
 Echocardiogram: This non-invasive examination with an echo of the chest reveals clear
and detailed pictures of the structure of heart.
 Cardiac computerized tomography (CT) scans: This check is commonly used for cardiac
problems. CT is an imaging procedure performed via X-rays to highlight the specifics of
the heart's arteries and veins. The photographs are used for assessing if the blood vessels
have plaque or calcium particles and if they induce blockage. An individual is made lie
inside a doughnut-shaped machine on a table in a CT screening. The X-ray spinning tube
within the system captures pictures of the heart and chest.

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Case Study 2– Cardiovascular
 Cardiac magnetic resonance imaging (MRI): MRI is a method used in radiology for
diagnostic imaging in order to create anatomic representations and physiological
structures of the body. MRI scanners produce pictures of the organs in the body with
intense magnetic fields, radio waves and magnetic field gradients (Grover et al., 2015).
9. Explain the action, side effects and contraindications of Glyceryl trinitrate (GTN) that was
administered to Sally.
Action: Nitroglycerin is a drug used to control elevated blood pressure and chest pain. For
various uses, nitroglycerin is prescribed. It is also recommended for managing angina or chest
pain related to coronary disease and also to control perioperative hypertension or induce
intraoperative hypotension. In patients with myocardial infarction it is often recommended for
managing acute cardiac failure. The activation of this enzyme will be accompanied by cyclic
guanosine synthesis 3',5'-monophosphate (cGMP), which triggering a cascade of protein
phosphorylation events in smooth muscles. This process eventually contributes to the thesis of
nitroglycerine in mitochondrial aldehyde dehydrogenase (MtALDH) and nitrient oxides (NO), an
dynamic material which activate guanylate cyclase. This contributes to reduced cardiac pain,
reduced anginal pains, and improved blood supply through the myocardial system (Drugbank.ca,
2020).
Side effects:
Common side effects include:
 Dizziness
 Rash
 Vomiting

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Case Study 2– Cardiovascular
 Fast heart rate
 Flushing (reddening and warming of your skin)
 Headache
 Weakness
 Nausea
Contraindications: Nitroglycerin is contraindicated in individuals who have reported adverse
reactions to the drug. Recent histories of elevated intracranial pain, extreme anaemia, right-sided
myocardial infarction, or nitroglycerin hypersensitivity are common contraindications of
nitroglycerin therapy (Kim, Kerndt & Schaller, 2020).
10. How will nursing assist Sally on bed rest in the management of her condition?
Patients are expected to stay in bed for 4 hours for diagnostic catheterization and 6 hours
for interventional catheterization. Sally must be allowed to switch side-by-side when sleeping
in bed to improve comfort. However, the nurse must make sure the bed head will not reach 30
degrees for the rest time on bed (Rch.org.au, 2020).
11. List four (4) potential complications of the coronary angioplasty that Sally underwent.
 85% Artery blockage.
 Coronary artery damage.
 Blood clots.
 Abnormal heart rhythms.
12. Sally has some risk factors that have contributed to her myocardial infarction. Her recovery
depends on a collaborative health team approach. Which health personnel or allied health

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personnel will Sally need to be referred to manage her risk factors? Describe their specific role in
managing the risk factors.
Considering Sally’s current heath condition, a multidisciplinary and a collaborative care
team is recommended in order to develop and implement intervention strategies addressing the
heath concerns of the patient. A nutritionist or a diet consultant, who can advise and support in
creating healthy lifestyle decisions in terms of intake of nutritious foods since she has obesity
(Jennings & Astin, 2017). A physical trainer, who will motivate her to work out and to control
her body weight to avoid hypertension and other co-morbidities. Sally can also be directed to a
counsellor who can assist her to quit smoking during a counselling session.

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References
Drugbank.ca. (2020). Nitroglycerin - DrugBank. Retrieved 27 March 2020, from
https://www.drugbank.ca/drugs/DB00727
Grover, V. P., Tognarelli, J. M., Crossey, M. M., Cox, I. J., Taylor-Robinson, S. D., & McPhail,
M. J. (2015). Magnetic resonance imaging: principles and techniques: lessons for
clinicians. Journal of clinical and experimental hepatology, 5(3), 246-255. Doi:
10.1016/j.jceh.2015.08.001
Jennings, C., & Astin, F. (2017). A multidisciplinary approach to prevention. European journal
of preventive cardiology, 24(3_suppl), 77-87. Doi:10.1177/2047487317709118
Kim, K. H., Kerndt, C., & Schaller, D. J. (2020). Nitroglycerin. In StatPearls [Internet].
StatPearls Publishing. Retrieved 27 March 2020, from
https://www.ncbi.nlm.nih.gov/books/NBK482382/
Lu, L., Liu, M., Sun, R., Zheng, Y., & Zhang, P. (2015). Myocardial infarction: symptoms and
treatments. Cell biochemistry and biophysics, 72(3), 865-867. Doi: 10.1007/s12013-015-
0553-4
Michos, E. D., Berger, Z., Yeh, H. C., Suarez-Cuervo, C., Wilson, L. M., Stacy, S., & Bass, E. B.
(2014). Cardiac Troponins Used as Diagnostic and Prognostic Tests in Patients With
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Moussa, S., & Ambrose, J. A. (2018). Understanding myocardial infarction. F1000Research, 7.
Doi: 10.12688/f1000research.15096.1

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Ojha, N., & Dhamoon, A. S. (2019). Myocardial Infarction. In StatPearls [Internet]. StatPearls
Publishing. Retrieved 27 March 2020, from
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Rch.org.au. (2020). Clinical Guidelines (Nursing) : Care of the patient post cardiac
catheterisation. Retrieved 27 March 2020, from
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ost_cardiac_catheterisation/
Shahaj, O., Denneny, D., Schwappach, A., Pearce, G., Epiphaniou, E., Parke, H. L., Taylor, S.,
& Pinnock, H. (2019). Supporting self-management for people with hypertension: a
meta-review of quantitative and qualitative systematic reviews. Journal of
hypertension, 37(2), 264–279. Doi: 10.1097/HJH.0000000000001867