Family Nurse Practitioner Cardiac Assessment Essay: Case Study

This essay provides a detailed analysis of a case study involving a 68-year-old female patient presenting with chest pain. The assignment begins with an introduction to cardiac assessment, emphasizing the importance of identifying factors impacting cardiovascular health. It then delves into subjective data, including the patient's symptoms, medical history of hypercholesteremia and anxiety, and family history of myocardial infarction. The essay explores the significance of lifestyle factors like smoking, alcohol consumption, and exercise. Objective assessment findings, such as elevated blood pressure, abnormal lipid levels, and high glucose, are discussed in relation to the patient's overweight status. Potential diagnoses, including myocardial infarction, aortic stenosis, and ischemia, are presented. The essay covers patient and family teaching, including the use of vasodilators, comfort measures, and lifestyle modifications. A treatment plan is outlined, including diagnostic tests like the exercise ECG test and the administration of beta-blockers like metoprolol. The essay also includes a critique of a research article and addresses billing considerations. The conclusion summarizes the key elements of a focused cardiac assessment and treatment plan. References are also provided.

Running head: ESSAY 1
Family nurse practitioner (Cardiac assessment)
Name of the Student
Name of the University
Author Note

ESSAY 2
Introduction
Conduction of a thorough and comprehensive cardiac assessment facilitates easy
identification of the substantial factors that create an impact on cardiovascular health
outcomes such as, cigarette smoking, hypertension, high blood cholesterol, alcohol
consumption, obesity, or diabetes mellitus. This assignment will provide answers to different
questions related to a 68 year old female patient.
Subjective data
Subjective data generally encompass the information by taking into consideration the
point of view of the patient (symptoms), and commonly comprises of feelings, discernments,
and anxieties acquired through comprehensive interviews. She reported feelings of chest
pain at the time of doing laundry. This can be a direct manifestation of angina that occurs due
to lack of adequate blood flow to cardiac muscles. On assessing the patient, it has been found
that the female has a previous medical history of hypercholesteremia and anxiety. The
former refers to the presence of excess cholesterol in the plasma and cells of the circulating
blood, which in turn might have resulted in the development of atheromatous plaques in the
patient’s arteries (Padró, Vilahur & Badimon, 2020). Her history of anxiety can be associated
to an increase in blood pressure, thereby making the patient more likely to suffer from chest
pain (Tully, Harrison, Cheung & Cosh, 2016). The family history of myocardial infarction
also suggests that she might inherit cardiac disorders from her father. She needs to be
questioned about signs and symptoms of sweating, palpitations, dizziness, or shortness of
breath, since they represent heart failure or an irregular heart rhythm or heart failure. It is
imperative to ask her questions about her medical history like heart murmurs, rheumatic
fever, congenital heart disease, recurrent tonsillitis, and unexplained joint pain during youth
and anemia (Lapum et al., 2019). Moreover, her current lifestyle also needs to be investigated
in relation to habits of smoking, alcohol, exercise, drugs, and nutrition.

ESSAY 3
Objective assessment
The patient reports increased blood pressure, excess LDL, low HDL,
high glucose levels, and is overweight. Owing to the fact that
obese persons necessitate more blood for supplying nutrients and oxygen,
there occurs an increase in blood pressure (Ortega, Lavie, & Blair, 2016).
Moreover, HDL cholesterol is significant for the elimination of bad
cholesterol and its inadequacy might have also triggered hypertension in
the patient (Varbo & Nordestgaard, 2019). Hypertension has might have
resulted in excess strain, thereby narrowing the coronary arteries due to
accumulation of cholesterol and fat, and subsequently causing chest pain
(Kjeldsen, 2018). During objective assessment, the patient needs to be
subjected to palpation, percussion, and auscultation to detect the heart
beats and rhythm. Presence of murmur will provide indication for
abnormal blood flow or inadequate valves. In addition, she will also be
subjected to examination of the thorax, eyes, Central Venous Pressure (CVP),
and jugular veins.
Diagnosis
The patient might be suffering from myocardial infarction, aortic stenosis,
hypertrophic cardiomyopathy, or ischemia. Myocardial infarction occurs due to decrease or
stoppage in blood flow to a region of the heart, thus damaging the cardiac muscles and
involves discomfort or chest pain that travels to the jaw, back, arm or shoulder (Thygesen et
al., 2019). Aortic stenosis involves narrowing to the left ventricle exit such that there occurs
chest pain during physical activity (Chin et al., 2017). Hypertrophic cardiomyopathy also
manifests in the form of chest pain and might have occurred due to hypertrophy of
interventricular septum, eventually obstructing the outflow of left ventricle (Marian &

ESSAY 4
Braunwald, 2017). Dislodging of thrombi or interruption in arterial blood supply due to
embolism or trauma might have also caused ischemia in the patient, manifested in the form of
chest pain.
Patient and family teaching
The patient will be educated about the effectiveness of vasodilators that help in
relaxation if the smooth muscles that are located in the large arteries and veins. Patient
education will focus on explaining the fact that vasodilators increase blood flow, as a direct
response to the localized oxygen demand (Singh, Laribi, Teerlink & Mebazaa, 2017). She
will be educated about different vasodilators like nitroglycerine and beta blockers and their
adverse effects that commonly include hypotension, headache, reflex tachycardia, and
circulatory collapse. Comfort measures will include placing the patient at semi-Fowler’s
position that will result in chest expansion and facilitate easy breathing (Sakr, Metwaly &
Taha, 2019). Moreover, she will also be advised about dietary modifications such as, limiting
the amount of saturated fat and consumption of fruits, vegetables and whole grains. Health
promotion will involve recommending smoking cessation, maintenance of a healthy body
weight, diabetes management, abstaining from alcohol consumption, and engagement in
moderate exercise (Shah et al., 2019).
Treatment plan
Diagnostic test will involve the exercise ECG test, commonly referred to as the
treadmill test. This test will prove effective in measuring the ability of the heart to adequately
respond to the external stress induced by exercise. On asking the patient to perform exercise
to her maximum potential, the test will document changes in ECG, thus providing a definite
conclusion about angina (Wright, Bishop, Linken & Hurst, 2019). Considering the fact that
the primary goal of treatment would be to provide relief, while delaying progression of the
condition and averting heart attack, the patient will be administered Beta blockers like

ESSAY 5
metoprolol. This drug belongs to the class of beta blockers and is generally used for the
management of chest pain and hypertension, based on its blocking action on the β1
adrenergic receptors in cardiac muscles that decreases slope of phase 4, in relation to the
nodal action potential (Fowler et al., 2018). The treadmill stress test has been described to
report a specificity, sensitivity and positive predictive value (PPV) of 78%, 70%, and 46%
respectively (Gurunathan et al., 2017). The cost of the treadmill test in the US is around $175
or more (AAFP, 2019).
Research article critique
Ali, Shehzad, Qureshi and Hashmi (2017) conducted a cross-sectional study for
determining the effectiveness of high duke treadmill score in diagnosing abnormal coronary
angiographic patterns. The researchers selected patients having stable angina, with high
scores for the treadmill test (<11), aged 35-60 years, and belonging to both genders. The
exclusion of patients having history of myocardial infarction, heart failure, unstable angina
and pregnancy was correct since these conditions might affect the scores. Following coronary
angiography, it was found that triple vessel disease was the most prevalent angiographic
finding and reported by around 82 (37.27%) patients, in addition to left main stem disease in
73 patients (33.18%). Double vessel disease, no stenosis and single vessel disease were
observed amid in 39 (17.73), 08 (3.64%), and 18 (8.18%) patients, respectively, thus
providing the definite conclusion that high scores in treadmill test act as markers for
angiographic pattern severity.
Billing
Illegible or incomplete records often lead to payment denial for services that are
services billed to Medicare. The guidelines require all medical records to be legible, complete
and they must include: relevant history, cause of encounter, test results, findings, assessment,
plan of care with observer identity and date, documents identifying rendering supplier of a

ESSAY 6
service not just for claim transactions but for planning policy, review and fraud services, and
records substantiating the needed level of care (Noridian Healthcare Solutions, 2019). The
major components of the Evaluation and Management code are namely, (i) chief complaint,
(ii) present illness history, (iii) review of symptoms, (iv) family, past and social history, (v)
examination, and (vi) medical decision making (AAFP, 2019). The aforementioned
components form the foundation of the family physician’s practice
Conclusion
To conclude, while conducting a focused cardiac assessment, it is necessary to review
for the concerning symptoms, following which the location, intensity, duration, and type of
chest pain must be assessed, in order to determine the alleviating factors. On analysing the
case study, it can be suggested that the patient might be suffering from angina, thus calling
for the need of conducting the treadmill stress test, following which beta blockers must be
administered.

ESSAY 7
References
Ali, S. N., Shehzad, A., Qureshi, B. A., & Hashmi, K. A. (2017). PATTERN OF
ANGIOGRAPHIC FINDINGS IN PATIENTS WITH STABLE ANGINA HAVING
HIGH RISK DUKE SCORE ON EXERCISE TESTING. Pakistan Heart
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ESSAY 8
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token=AQECAHi208BE49Ooan9kkhW_Ercy7Dm3ZL_9Cf3qfKAc485ysgAAArUw
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hdt3K5shRBckP9MIw3xsYx-
_UqndejS4Mvmk8159cEAfMhlMMKg0mdMEjlNs8CZlqsPwBPA

ESSAY 9
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ESSAY 10
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