Medical Surgical Nursing: Comprehensive Cardiac Case Study Analysis

This case study focuses on a 65-year-old male patient, Mr. Fischy, presenting with symptoms of cardiac congestion, angina pectoris, and a history of hypertension. The assignment delves into the patient's medical history, including previous cardiac catheterization revealing arterial blockages. It outlines nursing interventions, such as administering aspirin, beta-blockers, and ACE inhibitors, along with antianginal drugs and analgesics. The study emphasizes the importance of a thorough PQRST assessment, vital sign analysis, and diagnostic tests like ECG and angiogram. It also explores angina radiation patterns, risk factor assessments, and patient education strategies, including nitroglycerin administration. Additionally, the case study highlights resources like the Heart and Stroke Foundation and other governmental and research websites for patient support and information.

Running head: MEDICAL SURGICAL NURSING
Medical surgical Nursing
Name of the student:
Name of the university:
Author note:

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Table of Contents
Question 1:.......................................................................................................................................2
Question 2:.......................................................................................................................................3
Question 3:.......................................................................................................................................3
Question 4:.......................................................................................................................................4
Question 5:.......................................................................................................................................5
Question 6:.......................................................................................................................................5
References:......................................................................................................................................7

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Question 1:
Mr Fischy, the patient is the case study has represented in the care facility with symptoms
of cardiac congestion and related disorders. The past medical history of the patient revealed that
he had been a patient of hypertension and angina pectoris for close to 6 months. The patient
assessment data regarding the patent reveals that he had been awoken multiple times during the
night feeling acute chest pain for which he had already taken nitroglycerin sublingually 9 to 11
times in the past week. Researchers are of the opinion that persistent angina is a grave health
concern for the elderly patients. As Mr Fischy had been a 65 year old man, the age also could
have contributed effectively contribute to possible myocardial infarction and congestive cardiac
failure. It has to be mentioned in this context that the patient had cardiac catheterization
performed in the past and it was discovered that he had 50% of his right coronary artery and
about 50% of his left anterior descending coronary artery to be completely occluded. According
to the Fan et al. (2016), both of the arteries play profound and crucial roles in maintaining the
pulmonary circulation burden management on the heart. Coronary blockage has been attributed
to be the key contributing factor to incidences of myocardial infarction and congestive heart
failure. Hence, the first concern for the patient will be the arterial blockage that the patient
(Katzung and Chatterjee 2012). It has to be mentioned that blocked arteries that are left untreated
can lead to plaque rupturing due to artheosclerosis and can heighten the probability of heart
attack. First and foremost I will increase the dosage of aspirin for the patient which will inhibit
blood clot formation by reducing the adhesive nature of the platelets. along with that I would
also administer beta blockers and ACE inhibitors to reduce the risk of myocardial infarction. The
patient has stated that he had been experiencing acute pain in chest, especially in the night which
had woken him multiple times in the middle of night and had urged him to take nitroglycerin.

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Hence the second concern for the patient will be management of angina pectoris. I will
administer antianginal drugs such as calcium channel blockers along with mild analgesics for
pain management as well (Tegn et al. 2016).
Question 2:
Chest pain or angina can be facilitated by a wide variety of factors and hence as a nurse I
would have to assess a range of different assessment data and test results to better understand the
contributing factors to his angina and be able to address the issues better to solve his medical
concerns. First and foremost, I would perform a PQRST assessment of the chest pain that the
patient had been feeling. It will begin with the provoking factors of the chest pain, followed by
the quality of the pain asking him to describe the nature of the pain. Then I would assess the
radiation statistics of the pain as angina preceding an acute myocardial episode has a
characteristic radiation pattern (Www2.gov.bc.ca. 2018). The last two components of the
assessment provides valuable data revealing the severity of the pain and the time period which
will aid in faster and effective diagnosis and symptom management. The very next assessment
data that I will assess will be a thorough analysis of the vital signs of the patient which will help
me understand the manifestation of the pain and whether it has affected the heart rate, blood
pressure and respiratory rate. Lastly, I would order for ECG and angiogram to be performed for
the patient, which will help me understand the spread of the blockage in the heart and severity of
the blockages (Radico et al. 2014).
Question 3:
Ischemic cardiac pain can originate in any region of chest and it is generally manifested
as the symptom for the number of different cardiac emergencies. The medical term for this pain

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is angina pectoris and it is generally localized to the chest region in case of mild to moderate
cardiac congestion. However, with the lack of treatment of management of this pain it can
radiate to other sites of the body, the based on the origin it can be of two types; left sided
radiation and the right sided radiation. The most common sites for the angina pectoris to radiate
to includes the arms, shoulders and even the jaws of the patient. However, in certain rate and
exceptional cases the angina pectoris or the ischemic chest pain can radiate to the back of the
patient as well. This generally occurs if the patient has aortic dissection associated with Marfan’s
syndrome (Li et al. 2013).
Question 4:
In order to understand whether the patient has any chances of developing cardiac
disorders a few risk factors assessments will be needed to be performed. First and foremost, the
age of the patent will be needed to be assessed along with any possible family history of
cardiovascular disease. according to the guidelines, any male patient over the age of 55 with a
family history of cardiac disorders are highly at risk, hence age and family history will be two
primary risk factors that will be assessed for the patient. Few other nonmodifiable risk factors
that will be assessed for the patient includes ethnicity, chronic kidney disease, and any auto
immune inflammatory disease. The modifiable risk factor that will be assessed includes smoking,
level of physical activity, dietary habit, BMI or weight, blood pressure, cholesterol levels,
diabetes, socio-economic and psychosocial factors. For the risk assessment the Farmingham Risk
score tool can be used (Www2.gov.bc.ca. 2018).

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Question 5:
Patient education and information sharing is a very important aspect of adequate care
delivery and ensuring that the construct of patient autonomy and shared decision making. it has
to be mentioned that safe storage and self administration following the safety protocol is very
important for the welfare of the cardiac patients and hence educating the patent regarding the
nitroglycerin storage and administration is a crucial requirement of the nursing responsibility.
However, in order to ensure that the patient has understood the information is vital for the
success of the patient education program. A few strategies can be incorporated to ensure getting
undivided attention from the patient. First and foremost, I would have to establish a therapeutic
relationship with the patient to ensure that the patient can get the communication comfort of the
patient so that the patient is able to relax. I would start with the importance of this educational
session and ask him questions to assess his level of health literacy level. And based on that, the
patient will be given the information in the most easily understandable manner. Along with that,
I would utilize patient teach back method to ensure that the patient has understood the details of
the educational session and is capable of repeating it (Barello, Graffigna and Vegni 2012).
Question 6:
the heart and stroke foundation is a charitable organization that attempts to reduce the
percentage of heart diseases and strokes by the means of advocating, educating the target
population about the health promotional and prevention to ward off the risk for strokes (Heart
and Stroke - Canada.ca, 2018). Along with that this organization also attempts to fund research
studies based on heart diseases and strokes through their charity. They provide a wealth of
information in their website regarding the risk factors to cardiac problems, the common signs
and symptoms and how to recognize them and along with that the primary actions to be taken in

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any cardiac emergencies. This website also provides key information regarding the lifestyle
changes such as healthy diet and physical exercise to reduce the risk for stroke. They have
headquarters in Ottawa, Ontario and divisional branches across different cities of Canada and
hence we have a foundation in our local area (Heart and Stroke Foundation of Canada 2018).
Other resources that can help the patient include the government website of Canadian health and
welfare has a segment for heart and stroke. The official website of the Heart Research Institute of
Canada can also be of help to the patient. The website of diabetes Canada also provides key
information regarding cardiac diseases, its symptoms and stroke (Canadian Diabetes Association
2018).

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References:
Canada, H. 2018. Heart and Stroke - Canada.ca. [online] Canada.ca. Available at:
https://www.canada.ca/en/health-canada/services/health-concerns/diseases-conditions/heart-
stroke.html [Accessed 13 May 2018].
Canadian Diabetes Association. 2018. Heart Disease & Stroke. [online] Available at:
https://www.diabetes.ca/diabetes-and-you/complications/heart-disease-stroke [Accessed 13 May
2018].
Fan, Y., Li, Y., Chen, Y., Zhao, Y.J., Liu, L.W., Li, J., Wang, S.L., Alolga, R.N., Yin, Y., Wang,
X.M. and Zhao, D.S., 2016. Comprehensive metabolomic characterization of coronary artery
diseases. Journal of the American College of Cardiology, 68(12), pp.1281-1293.
Heart and Stroke Foundation of Canada. 2018. Our partners. [online] Available at:
http://www.heartandstroke.ca/what-we-do/partners [Accessed 13 May 2018].
Hricanada.org. 2018. Facts about Heart Disease | The Heart Research Institute - Heart Research
Institute. [online] Available at: http://www.hricanada.org/about-heart-disease/facts-about-heart-
disease [Accessed 13 May 2018].
Katzung, B.G. and Chatterjee, K., 2012. Vasodilators and the treatment of angina pectoris. Basic
and clinical pharmacology, 7, pp.20-25.
Li, C., Fang, Z., Jiang, T., Zhang, Q., Liu, C., Zhang, C. and Xiang, Y., 2013. Serum microRNAs
profile from genome-wide serves as a fingerprint for diagnosis of acute myocardial infarction
and angina pectoris. BMC medical genomics, 6(1), p.16.

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Radico, F., Cicchitti, V., Zimarino, M. and De Caterina, R., 2014. Angina pectoris and
myocardial ischemia in the absence of obstructive coronary artery disease: practical
considerations for diagnostic tests. JACC: Cardiovascular Interventions, 7(5), pp.453-463.
Tegn, N., Abdelnoor, M., Aaberge, L., Endresen, K., Smith, P., Aakhus, S., Gjertsen, E., Dahl-
Hofseth, O., Ranhoff, A.H., Gullestad, L. and Bendz, B., 2016. Invasive versus conservative
strategy in patients aged 80 years or older with non-ST-elevation myocardial infarction or
unstable angina pectoris (After Eighty study): an open-label randomised controlled trial. The
Lancet, 387(10023), pp.1057-1065.
Www2.gov.bc.ca. 2018. Acute Chest Pain - Evaluation and Triage. [online] Available at:
https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/bc-guidelines/
chestpain.pdf [Accessed 13 May 2018].
Www2.gov.bc.ca. 2018. Cardiovascular Disease - Primary Prevention - Province of British
Columbia. [online] Available at: https://www2.gov.bc.ca/gov/content/health/practitioner-
professionalresources/bcguidelines/cardiovasculardisease?
keyword=cardiovascular&keyword=disease-primary&keyword=prevention#risk-assessment
[Accessed 13 May 2018].