Analyzing Co-morbidities in Mrs. Kennedy's Case: An Essay

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Table of Contents
INTRODUCTION...........................................................................................................................................2
BODY...........................................................................................................................................................3
CONCLUSION...............................................................................................................................................8
REFERENCES................................................................................................................................................9
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INTRODUCTION
The essay is based on the clinical presentation of the case of Mrs. Carole Kennedy who has several co-
morbidities associated with her age. The essay will aim at those co-morbidities, its pathophysiology, and
its management. The essay will be based upon the clinical reasoning cycle which will help understand
the process of evaluation, assessment, and management of the patient condition.
The essay will address the major issues such as ischemic heart disease, coronary artery disease and it's
emergency and first-aid management (Broderick et al.,2013). The topic will include the management of
chest discomfort due to which Mrs. Kennedy was admitted to the hospital. Apart from these factors, the
essay will also include the psychosocial aspects which Mrs. Kennedy is facing currently due to her
condition. The psychosocial aspect is very important to be taken care of while treating any patients as it
helps them provide motivation and will provide them a hope to resume a positive lifestyle.
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BODY
CHANGES IN THE CLINICAL PRESENTATION
Mrs. Carole Kennedy a 56-year-old female retired from her job and stays alone in a rented house is
admitted to the wards for 2 days. She complains of having severe chest discomfort while working in the
house and now recently is been admitted for the treatment of pneumonia. The notes from her history
sheet elaborate her condition further where she has had a history of ischemic heart disease (IHD),
hypertension and beginning of peripheral vascular disease (PVD). Her surgical history revealed that she
had undergone a coronary artery bypass graft (CABG) surgery six years ago and percutaneous
transluminal coronary angioplasty (PTCA) two years ago. Mrs. Kennedy was a chronic smoker for 30
years and was diagnosed with coronary artery disease 7 years back.
Currently, her weight and height are 88 kg and 158 cm respectively. Her assessment done by the nurse
at 08:00 am showed following results- temperature 37.30C, heart rate 74 beats per minute regular and
strong volume, respiratory depth 14 breaths per minute regular with normal depth, BP- 165/90 mmHg
and oxygen saturation of 98% in room air.
After 30 minutes while administering drugs to Mrs. Kennedy the nurse observes her be a little
diaphoretic. On asking her she says that she is feeling mild pressure in her chest and a little ache in her
left upper arm. On again assessing her vital signs the nurse observes that temperature is 37.20C, heart
rate was found to be 116 beats per minute and was feeble, respiratory rate was 26 breaths per minute
which were shallower than previous, BP was 105/70 mm Hg and oxygen saturation was reduced to 92%
on room air. The clinical findings show that Mrs. Kennedy was a little breathless and her limbs were little
cool to touch.
As per the history is taken by the nurse Mrs. Kennedy already had an episode of IHD, is hypertensive and
recently diagnosed with peripheral vascular disease. She has also been a chronic smoker for the last 30
years. Recent researchers say that chronic smoking leads to an increase in the viscosity of blood thereby
increasing the chances of clot formation (Eller et al., 2009). This leads to a decreased supply of blood to
the limbs and other parts of the body thereby leaving them cold and blue while touch and observing
respectively (Broderick et al.,2013). Ischemic heart disease is a condition where the blood flow is
reduced to the coronary arteries of the heart thereby supplying it less blood than required. This leads to
an imbalance between the demand of the musculature of heart and supply to it (Eller et al., 2009).
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Studies suggest that both the IHD and peripheral vascular disease both are inter-related to each other
and are somehow also connected to the chronic use of cigarettes (Gustafsson et al., 2009). The
breathlessness is due to the less supply of oxygen to the body (Shaw et al., 2009). The blood becoming
viscous decreases its ability to flow free and fast thereby reducing the supply of oxygen to the tissues
and thereby increasing shortness of breath (Goldstein et al., 2011). The extremities also feel cool on
touch because of the slow and hampered supply of blood to the distal parts of the body (Gustafsson et
al., 2009).
ANALYSE THE PRIORITIES OF CARE WHICH YOU HAVE INCLUDED IN THE PLAN OF CARE
Mrs. Kennedy is living alone in a rented house where her son barely comes to see her from Melbourne.
She feels alone and has to work on her own as there is no one to look after her. She is suffering from
ischemic heart disease, hypertension, and peripheral vascular disease. Recently she has been admitted
to the hospital due to pneumonia. She was having severe chest congestion and discomfort while
breathing due to pneumonia. Pneumonia is an infection where the alveoli of the lungs are dilated and
filled with either the fluid or pus depending on the organism which has invaded the lungs (Stonecypher
et al., 2010). Due to the dilatation of the air sacs the individual feels uncomfortable while breathing
(Goldstein et al., 2011). The elasticity of the alveoli is disturbed thereby reducing the exchange of gases
(Galinato et al.,2019). The primary management of pneumonia is done by giving the antibiotics to clear
the infection and apart from this supportive and palliative care is given to the patient (Galinato et
al.,2019).
Supportive care includes providing of oxygen therapy to the patient so that the exchange of gases is
maintained in the lungs and the saturation of oxygen in the blood is also maintained (Stonecypher et al.,
2010). In severe cases where only oxygen therapy does not work then the person is kept over the
mechanical ventilator (Stonecypher et al., 2010). A mechanical ventilator is a device where the person is
given the air to inhale and exhale out passively through the machine (Shaw et al., 2009).
The airway is first of all made clear of secretions via the suction tube or manually by coughing. The
breathing is either maintained actively or otherwise by a mechanical ventilator. And then, at last, the
circulation is checked for.
Apart from pneumonia Ms. Kennedy has recently complained of discomfort in her chest and she relates
the pain as experienced by her in the past. She says it to be similar as she had an episode of the ischemic
heart disease a few years back. She also felt pain in her left upper arm. This gave an alarming signal to
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the nurse and she again assessed the vitals of Mrs. Kennedy and found the intensity of heart rate to be
slow as from the previous one and also the respiratory rate increased with shallower breaths. The signs
and symptoms explained by Mrs. Kennedy were helpful in early diagnosis and the nurse then looked
after her to maintain and stabilize the heart rate, its intensity, and respiratory rate.
Ischemic heart disease is a condition which needs emergency management to prevent the damage to
the musculature of the heart (Shaw et al., 2009). As the damage caused to the muscles of the heart is
irreplaceable and it causes the myocardium of the heart to get necrosed (Goldstein et al., 2011).
Necrosis is the stage of damage of tissue from where it cannot be brought back to its initial state (Shaw
et al., 2009).
Mrs. Kennedy’s extremities were cool on touch this could be due to the peripheral vascular disease. The
peripheral vascular disease is a condition where the flow of blood to the extremities is reduced thereby
causing the fingers and limbs to be cool and bluish in appearance (Muir et al., 2009). This is because the
viscosity of blood does not let it flow in the vessels and provide the required amount of oxygen thereby
disturbing its thermoregulation and making it cold on touch (Muir et al., 2009). Management of
peripheral vascular disease is medications. The blood thinning agents are used in the case of peripheral
vascular disease as it reduces the viscosity of blood and increases the blood flow to the limbs (Muir et
al., 2009).
Also, the primary interventions follow the rule of ABC where A stands for airway, B for breathing and C
for circulation (Varbo et al., 2013). In all the above problems which Mrs. Kennedy is facing such as
pneumonia, ischemic heart disease, and peripheral vascular disease, ABC management is beneficial.
Airway plays a major role in cases of pneumonia since the air passage is not clear due to the secretions
and phlegm, so it is necessary for the nurse to first clear the airway as this may further embolise in the
passage and may cause blockage or congestion (Varbo et al., 2013).
Breathing is also important in case of pneumonia as due to dilatation of the alveoli the gaseous
exchange is not sufficient and the saturation of oxygen in the blood decreases. So it is important to
either emphasize on active breathing by commanding the patient or if not possible then by the means of
the mechanical ventilator, where the inhalation and exhalation of gases are all done passively (van der
Poll et al., 2009).
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Circulation is important in the case of ischemic heart disease and peripheral vascular disease. This can
be managed by administering intravenous infusions of the respective medications to the patient such as
blood-thinning agents (antiplatelet therapy). These drugs will help reduce the viscosity of blood and will
allow the appropriate blood and oxygen supply to the tissues (Varbo et al., 2013).
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PSYCHOSOCIAL ISSUES
Mrs. Kennedy stayed alone in her house and her son stayed far away from her due to which he was not
able to come to meet her. This thing made her feel down. She felt alone and found herself helpless.
There was no one around her to help her in her work (Broderick et al., 2013). And she felt it bad to ask
for somebody’s help. She was quite stressed about returning to home and feeling the same discomfort
in the chest.
Old-aged people who live alone in their houses are found to be more stressed and anxious by the
thought of getting ill and having no one around to take care of (Hanna et al., 2014). They stop socializing
themselves also and stop going out and met with people (Simmons., 2010). They stay at home and due
to this, they end themselves into more troubles.
This also could be one of the reasons for Mrs. Kennedy to have so many co-morbidities. Ischemic heart
disease is also caused due to stress and anxiety (Warriner et al., 2012). The pain and discomfort felt in
the chest might also be due to some emotional and psychological reasons (Broderick et al., 2013). Stress
also adds to obesity and this can also lead to ischemic heart disease and gradually peripheral vascular
disease too (Warriner et al., 2012).
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CONCLUSION
The essay included all the parts of the clinical reasoning cycle right from considering the patient
situation to reflecting on what all ways can be implemented to provide better treatment. Apart from
this, the conditions which Mrs. Kennedy was facing were all described by keeping in view the patient
situation and complaints (Broderick et al., 2013). The history given by the patient proved to be helpful in
further diagnosing and assessing the condition. The essay also analyzed all the factors responsible for
IHD, hypertension and peripheral vascular disease and how to prevent it further and its primary
management.
The essay also discussed the psychosocial aspect of the patient and how the disease can relate to the
psychological and emotional status of the individual is also explained. Thus for an individual to be
healthy, it is necessary that the person is not only fit physically but also mentally, socially, emotionally
and psychologically (Simmons., 2010).
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REFERENCES
 Broderick, M. C., & Coffey, A. (2013). Person‐centred care in nursing
documentation. International journal of older people nursing, 8(4), 309-318.
 Hanna, T., & Mona, E. (2014). Psychosocial work environment, stress factors and individual
characteristics among nursing staff in psychiatric in-patient care. International journal of
environmental research and public health, 11(1), 1161-1175.
 Simmons, B. (2010). Clinical reasoning: concept analysis. Journal of advanced nursing, 66(5),
1151-1158.
 Eller, N. H., Netterstrøm, B., Gyntelberg, F., Kristensen, T. S., Nielsen, F., Steptoe, A., & Theorell,
T. (2009). Work-related psychosocial factors and the development of ischemic heart disease: a
systematic review. Cardiology in review, 17(2), 83-97.
 Gustafsson, A. B., & Gottlieb, R. A. (2009). Autophagy in ischemic heart disease. Circulation
research, 104(2), 150-158.
 Goldstein, L., Bushnell, C., Adams, R., Appel, L., Braun, L., Chaturvedi, S., ... & Hinchey, J. (2011).
American Heart Association Stroke Council; Council on Cardiovascular Nursing; Council on
Epidemiology and Prevention; Council for High Blood Pressure Research; Council on Peripheral
Vascular Disease, and Interdisciplinary Council on Quality of Care and Outcomes Research.
Guidelines for the primary prevention of stroke. Headache, 51(6), 1011-1021.
 Galinato, J. I. T. (2019). DEGREE OF SUSPICION OF PERIPHERAL ARTERY DISEASE AMONG
GERIATRICS AND POLICEMEN IN ILIGAN CITY, PHILIPPINES. Belitung Nursing Journal, 5(2), 83-91.
 Stuart, G. W. (2014). Principles and practice of psychiatric nursing-e-book. Elsevier Health
Sciences.
 Stonecypher, K. (2010). Ventilator-associated pneumonia: the importance of oral care in
intubated adults. Critical care nursing quarterly, 33(4), 339-347.
 Muir, R. L. (2009). Peripheral arterial disease: Pathophysiology, risk factors, diagnosis,
treatment, and prevention. Journal of Vascular Nursing, 27(2), 26-30.
 Shaw, L. J., Bugiardini, R., & Merz, C. N. B. (2009). Women and ischemic heart disease: evolving
knowledge. Journal of the American College of Cardiology, 54(17), 1561-1575.
 Varbo, A., Benn, M., Tybjærg-Hansen, A., Jørgensen, A. B., Frikke-Schmidt, R., & Nordestgaard, B.
G. (2013). Remnant cholesterol as a causal risk factor for ischemic heart disease. Journal of the
American College of Cardiology, 61(4), 427-436.
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 van der Poll, T., & Opal, S. M. (2009). Pathogenesis, treatment, and prevention of pneumococcal
pneumonia. The Lancet, 374(9700), 1543-1556.
 Warriner III, R. A., & Hopf, H. W. (2012). The effect of hyperbaric oxygen in the enhancement of
healing in selected problem wounds. Undersea & Hyperbaric Medicine, 39(5), 923.
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