Nursing Case Study: Coronary Artery Disease, Treatment, and Care

This case study focuses on a 61-year-old male, Trevor, diagnosed with coronary artery disease (CAD). It delves into the pathophysiology of CAD, including plaque formation and its complications like heart attack and angina. The assignment outlines the diagnostic process, including assessments and medical evaluations, and emphasizes a holistic nursing care approach. This includes collaborating with a multidisciplinary team, providing patient education on health risks, prescribing medications, and encouraging physical activities. The study also addresses ethical and legal issues, referencing NMBA standards. References from nursing and medical journals are included to support the analysis of the case and recommended care strategies.

Students, commence typing your assignment here. Pages will be automatically added as you continue to type.
Student Name: Student Number:
Case study number and title [eg. (v) Community / Palliative Nursing ]:
Gathering evidence
Identify where you will search for literature and evidence: Recent articles, government reports
Name the various databases you will access: Nursing database
Identify other resources you will utilise: Nursing textbooks, government websites, organisation websites
Case study structure Introduction, elaboration on the case study of Trevor followed by coronary artery
disease description
Main body
 Pathophysiology of coronary artery disease and its complications
 Assessments of heart disease
 The medical diagnosis of the patient
 Holistic Nursing care approach for treating Trevor identifying his needs,
treatment, education, documentation, working collaboratively with other
health care workers to ensure proper care
 Health promotion strategies and their relationships to NMBA
Introduction
Trevor has been diagnosed with a coronary artery disease, which resulted due to narrowing of the
arterial vessels(Nhlbi.nih.gov, 2020). He felt pain and discomfort in the upper left portion of the chest
frequently. The X-ray report showed that he had suffered a silent heart attack without his knowledge
and might be suffering from a major vessel disease.
Trevor was a fit 61 years old man, one day he felt pain and discomfort in the upper left chest area, and
this pain arised and set down periodically. When the X-ray report showed that he has suffered a heart
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attack, Trevor was very surprised and shocked, as he did not expect this at all. Studies suggest that
there could be some hidden risk factors which can lead to heart attack even in individuals who lead a
virtuous life style.
Main body
Pathophysiology of Coronary Artery Disease
 Coronary Artery Disease is a disease characterised by blockage in the arteries and blood
vessels of the heart due to plaque formation, leading to reduced oxygen supply within the
chambers of heart(Pino, Shi & Werstuck, 2018). As a result, the person suffers myocardial
infarction or a heart attack.
 Plaque is formed due to cholesterol and lipid deposition on the walls of the arteries leading to
narrowing of the arteries and blood vessels. This condition is known as
“atherosclerosis”(Pothineni et al, 2017).
Complication
 Heart attack: Blockage in the arteries causes less oxygenated blood supply within the heart,
leading to heart attack
 Chest pain or Angina: Reduced blood flow in the coronary arteries can give a sensation of pain
or discomfort called angina.
 Heart failure: Heart failure results due to improper or insufficient blood pumping from the heart
to the rest of the body, leading to breathing trouble.
Diagnosis
 Ineffective cardiopulmonary tissue perfusion related to reduced coronary blood flow from the
coronary thrombus and atherosclerotic plaque
 Potential impaired gas exchange related to fluid overload from left ventricular dysfunction
 Anxiety related to fear of death(Bayrak & Tosun, 2018)
 Deficient knowledge about post myocardial infarction self-care
 Acute pain
 Activity intolerance
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Holistic Nursing Care
 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.
 The nurses should encourage 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(Hajbaghery & Mokhtari, 2018).
 The Registered nurse should educate Trevor about health risks and complications that are
associated with cardiac disease.
 The nurse should prescribe drugs to him for lowering cholesterol level, 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, 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)
 Diagnosis of the therapeutic, physiotherapeutic and vocational education and training of the
patient
 Nurses should provide a supervised exercise training to improve cardiovascular fitness, along
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with nutritional counselling and risk factor management
 Discharge planning and referral to multidisciplinary disease management program
 Ensuring effective communication between patient and their families
 In pre-operative surgery, the nurses provide information and emotional support to patients and
their families, also ensure that all the preoperative data is properly accumulated
 Maintaining of baseline hemodynamic status of patients and assessment of risk factors
 Nurses also helps in wound care by dressing the chest of patients to remain intact with
hydrocolloid dressing unless oozing
 Post-operative care include adequate fluid resuscitation, appropriate inotropic support and
ventilator management
Ethical issues
 Lack of respect and empathy towards the patient (Sinclair, Papps & Marshall, 2016).
 Informed consent.
 Negligence(Peter, 2018).
Legal issues
 licensure related issues.
 Failure in safeguarding patient privacy (Subedi, Timalsina & Bhele, 2018).
 Malpractice.
NMBA standards ( Nursing and Midwifery Board Australia, 2016)
 Registered nurses must follow an ethical framework for decision making while treating
Trevor(Nursing and Midwifery Board of Australia - Registered nurse standards for practice,
2020)
 They must accept and analyse the condition of Trevor, keep him under strict observation,
execute proper planning and decision making skills to make suitable treatment plan and
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evaluation.
 The nurses must work as a team, collaborating with the multidisciplinary team to ensure the best
outcomes for Trevor.
 The nurses should encourage Trevor to take part in yoga or physical exercise.
 The nurses should suggest a proper diet chart for Trevor, restricting the intake of oily and fatty
food.
 The nurses should also ask Trevor to quit smoking or drinking alcohol, which has detrimental
effects on the heart.
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References
Ambrose, J. A., & Najafi, A. (2018). Strategies for the Prevention of Coronary Artery Disease Complications: Can We Do Better?. The
American journal of medicine, 131(9), 1003-1009.
Bayrak, D., & Tosun, N. (2018). Determination of nursing activities for prevention of heart attack and stroke in hypertension
patients. International Journal of Caring Sciences, 11(2), 1073.
Bromley, P. (2018). Capability in nursing. Australian Nursing and Midwifery Journal, 26(1), 42-43.
Cardiology, I., Cardiology, P., Initiative, S., & Health, W. (2020). Diagnosis. Stanfordhealthcare.org. Retrieved 24 February 2020, from
https://stanfordhealthcare.org/medical-conditions/blood-heart-circulation/coronary-artery-disease/diagnosis.html.
Constantino, R. E., Cobb, J., Brayden Kameg, F., Maranzana, G., Ebube, A., Wu, L., ... & Reyes, A. T. (2018). Ethical, Legal, and Sociocultural
Issues (ELSI) in Nursing Viewed through a Complex Synergistic System Lens.
Coronary Artery Disease | CAD | MedlinePlus. Medlineplus.gov. (2020). Retrieved 24 February 2020, from
https://medlineplus.gov/coronaryarterydisease.html.
Coronary Artery Disease | cdc.gov. Centers for Disease Control and Prevention. (2020). Retrieved 24 February 2020, from
https://www.cdc.gov/heartdisease/coronary_ad.htm.
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Coronary Heart Disease | National Heart, Lung, and Blood Institute (NHLBI). Nhlbi.nih.gov. (2020). Retrieved 24 February 2020, from
https://www.nhlbi.nih.gov/health-topics/coronary-heart-disease.
Jinnouchi, H., Kolodgie, F. D., Romero, M., Virmani, R., & Finn, A. V. (2019). Pathophysiology of Coronary Artery. Vessel Based Imaging
Techniques: Diagnosis, Treatment, and Prevention, 211.
Mori, H., Kolodgie, F. D., Finn, A. V., & Virmani, R. (2019). Pathology and Pathophysiology of Coronary Atherosclerotic Plaques. In CT of the
Heart (pp. 211-226). Humana Press, Totowa, NJ.
Morin, K. H. (2017). Ethical Issues in Nursing Education: A Scoping Review of the Literature.
Nursing and Midwifery Board of Australia - Registered nurse standards for practice. (2020). Retrieved 28 February 2020, from
https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx
Peter, E. (2018). Overview and summary: Ethics in healthcare: Nurses respond. OJIN: The Online Journal of Issues in Nursing, 23(1).
Pino, D. E. V., Shi, Y., & Werstuck, G. H. (2018). Extensive Atherosclerosis, Coronary Artery Disease and Myocardial Infarction in the
ApoE-/-: Ins2+/Akita Mouse Fed a Diet Rich in Fat. Atherosclerosis Supplements, 32, 104-105.
Pothineni, N. V. K., Subramany, S., Kuriakose, K., Shirazi, L. F., Romeo, F., Shah, P. K., & Mehta, J. L. (2017). Infections, atherosclerosis, and
coronary heart disease. European heart journal, 38(43), 3195-3201.
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Sinclair, J., Papps, E., & Marshall, B. (2016). Nursing students' experiences of ethical issues in clinical practice: A New Zealand study. Nurse
education in practice, 17, 1-7.
Subedi, K. K. P., Timalsina, K., & Bhele, R. L. (2018). Nurse’s awareness on ethico-legal aspects of nursing profession. Journal of Nepal
Health Research Council, 16(1), 49-52.
Terry, K., Stirling, C., Bull, R., & Fassett, D. (2017). An overview of the ways nurses understand and utilise the existing Australian Competency
Standards for Registered Nurses. Collegian, 24(2), 109-116.
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