University Case Study: Trevor's Silent Heart Attack and Treatment

This case study focuses on Trevor, a patient who suffered a silent heart attack, and provides a detailed analysis of his condition. It begins by outlining the pathophysiology of coronary heart disease, including the accumulation of lipids in arteries, leading to angina and myocardial infarction. The assessment section highlights the nursing interventions, such as gathering patient history, conducting physical assessments, and monitoring vital signs. The diagnosis section details the process of identifying chest pain, activity intolerance, and risks associated with decreased cardiac output. The study then discusses potential complications like arrhythmias, angina, and heart failure, followed by a holistic nursing care approach, emphasizing ethical considerations, legal issues, and the importance of family support and patient education. The study also delves into the ethical concerns such as lack of empathy and ensuring access to healthcare. The legal issues encompass licensure, patient privacy, and malpractice. The case study also includes a discussion on holistic nursing care, ethical concerns and legal issues related to the treatment procedures.

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

CASE STUDY OF TREVOR 2
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

CASE STUDY OF TREVOR 4
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

CASE STUDY OF TREVOR 5
sodium diet which will enhance fluid retention and administration of diuretics which is
required to correct fluid overload. The nurse should also provide the necessary knowledge
and information to Trevor about the risk factors, health complications associated with
myocardial infarction and also about the treatment procedures.
Complication
The most common complication which is involved in coronary artery disease is Arrhythmias
which is characterized by abnormal heart rhythm. Other complications that are associated
with this disease are heart attack which results in a blockage in the arteries causes less
oxygenated blood supply within the heart. Chest pain or angina may also arise due to reduced
blood flow in the coronary arteries. And lastly, heart failure results due to improper or
insufficient blood pumping from the heart to the rest of the body, leading to breathing
trouble.
Holistic nursing care
Holism is a philosophical approach in support of the belief that the whole is greater than the
sum of its parts. This philosophy is applied to the health care field as holistic care to ensure
care for all parts of a patient. Holistic nurses recognize and treat every patient differently.
They respect each patient's unique physical, mental, emotional, spiritual and environmental
strengths and challenges and honours each patient's health beliefs, values, and health
experience. The nurses follow the NMBA standards to provide holistic care to
Trevor(Nursing and Midwifery Board of Australia - Registered nurse standards for practice,
2020). In this case study, the registered nurses must collaborate with the multidisciplinary
team and other associates to ensure a positive outcome for Trevor. They should assess,
analyses the condition of Trevor and develop different strategies based on evidence to
provide efficient healthcare to him(Ambrose & Najafi, 2018). The nurses should encourage

CASE STUDY OF TREVOR 6
his wife, Sheila, to be present with him throughout the treatment period and support him in
this difficult time. Family support or support of loved ones is very crucial in the fast recovery
of a patient. Moreover, a family person will be able to give more detailed information about
the patient, his lifestyle and food habits, which helps the nurses to understand the causal
factors contributing to the disease and decide a treatment plan. The Registered nurse should
educate Trevor about health promotion strategies to improve his health, such as healthy
leaving, eating well, keeping active and also educate him about the health risks and
complications that are associated with cardiac disease. The nurse should prescribe drugs to
him for lowering cholesterol levels, and medications to regulate the rhythm of heart, lower
blood pressure, and prevent the formation of blood clots in the coronary arteries. The nurse
should encourage him to take part in physical activities like physical exercise, yoga, and
meditation to nourish both physically and emotionally, reducing stress and relaxing. The
nurse should follow an ethical framework to make clinical decisions when treating Trevor. In
the rehab, the nurse should be involved in the assessment of the physical, mental and socio-
economic condition of the patient and vocational status(Pino, Shi & Werstruck, 2018). They
should provide supervised exercise training to improve cardiovascular fitness, along with
nutritional counselling and risk factor management. Discharge planning and referral to a
multidisciplinary disease management program. The nurse should ensure effective
communication between the patient and their families. In preoperative surgery, the nurses
provide information and emotional support to patients and their families, also ensure that all
the preoperative data is properly accumulated. Nurses also help in wound care by dressing the
chest of patients to remain intact with hydrocolloid dressing unless oozing. Post-operative
care includes adequate fluid resuscitation, appropriate inotropic support and ventilator
management

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Ethical Concerns
One of the common ethical concerns that arise for nurses relates to a lack of respect and
empathy towards the patient. Nurses must find balance in displaying an attitude of care and
compassion while recognizing and maintaining safe boundaries(Peter, 2018). Sometimes lack
of proper communication or negligency can also give rise to misunderstanding and confusion
among the patients. In this case, the nurse must be sympathetic to Trevor, accept his
condition, show him respect without violating his human rights and dignity.
Another area of ethical concern is the nurse's responsibility for ensuring that patients have
access to healthcare. It is complicated to treat a person if he is not getting proper access to
healthcare service and treatment facilities(Sinclair, Papps & Marshall, 2016). It is the nurse's
responsibility to ensure that the health needs of patients are respected and responded
promptly. Nurses must ensure that Trevor is getting enough care and health services;
otherwise, his health condition will deteriorate.
Informed consent can also serve as an ethical issue in nursing. It includes moral obligations
for promoting autonomy levels, providing information and avoiding the unethical means of
bias. Patients have the right to refuse a particular therapy if he is not comfortable, so it is
essential to inform them about the treatment plan beforehand. Treatment procedures should
only be initiated if the patient agrees to it. For this particular case study, Trevor and his
family members should be pre-informed about the treatment options that the healthcare
professionals decided for him, and wait for his consent. Only then, the nurses can further
proceed with the treatment(Morin, 2017).
Legal Issues
The legal issues that impact on nurses and nursing practice are: licensure related issues,
failing to safeguard patient privacy such as health records or patient data due to lack of

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competent practice, malpractices such as unable to deliver healthcare to patients, sharing
incorrect information to them leading to confusion and misunderstanding among the patients.
Assault can also act as a legal issue when a nurse or other healthcare professional touches a
patient without his consent(Subedi, Timalsina & Bhele, 2018).
The nurses who are in-charge of Trevor should have a license to practice nursing in their
respective state of practice. Practicing nursing without any verified license is considered
illegal. The nurse should be able to maintain the privacy of Trevor, protecting his valuables,
personal possessions, health records, and data and return it to him when he is discharged from
the hospital. The treatment procedure for Trevor should be free from any malpractice. The
nurses should be dedicated to their responsibilities and perform their duties carefully,
following the NMBA standards, while curing Trevor(Constantino et al, 2018).
Conclusion
In conclusion, it should be noted that heart disease can be prevented if the patients get proper
access to healthcare and lead a healthy life. In most countries such as America, Australia,
Canada, and the United Kingdom, heart disease has been proven to be the biggest health issue
apart from cancer. More than 35 percent of people die of heart disease without their
knowledge since the diseases do not necessarily manifest themselves in the before mentioned
symptoms. Therefore, there is a need to sensitize people on the need to visit their healthcare
providers regularly to check on their heart conditions. That may prevent more future deaths
due to heart disease.

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