Nursing Report: Ischemic Heart Disease Nursing Management, Case Study

This report presents a comprehensive nursing care plan for Mr. Ian Dury, a 58-year-old male admitted with chest pain and a history of ischemic heart disease (IHD). The report begins with an introduction to the patient's case, outlining his medical history, current medications, and presenting symptoms, which include Type 2 diabetes, hypertension, and chronic kidney disease. The primary admission diagnosis of chest pain is explored, along with the underlying pathophysiology of IHD and the diagnostic procedures. The report identifies and analyzes nursing problems, such as reduced cardiac output, detailing nursing interventions and rationales for each. Discharge planning is also addressed, encompassing assessment, care plan development, and implementation strategies to ensure a smooth transition of care. The conclusion summarizes the importance of nursing care in managing patients with cardiovascular events and the significance of a well-structured discharge plan. The report provides a detailed overview of the nursing care required, linking it to pathophysiology and pharmacology, and applying an interprofessional model of care.

Nursing

Table of Contents
Introduction......................................................................................................................................1
Primary Admission Diagnosis.........................................................................................................1
Nursing Problems.............................................................................................................................2
Nursing Management.......................................................................................................................3
Discharge Planning..........................................................................................................................5
Conclusion.......................................................................................................................................6
References........................................................................................................................................7

Introduction
Nursing refers to an important profession of medical field in order to provide appropriate care
services to patients for their wellbeing. It includes their role of maintaining safe environment for
people along with delivering better quality of care (Kittan and Hamza, 2020). In context of this
project, it is based on the case study of the patient named Mr Ian Dury having problems of
ischemic heart disease from a long time. He is 58 years old man and has medical history of
several health problems including Type 2 diabetes mellitus, hypertension, chronic kidney disease
etc. This assignment will focus on primary diagnosis and nursing problems which are assessed
earlier related to selected patient. It will also include nursing management and discharge panning
for an individual.
Primary Admission Diagnosis
In context of given case study, it has been analysed that patient has been admitted due to facing
the problem of chest pain. It includes the primary diagnosis of carrying out physical examination
to analyse the quality, intensity, duration and location which helps to assume the reason behind
the same. Meanwhile, it is observed that there are number of reason behind occurrence of chest
pain such as angina, pericarditis, cardiomyopathy, aortic dissection and heart attack. It consist
the criterion of evaluating symptoms such as chest pain, heart attack, breathing difficulty,
breathlessness, abnormal heart rhythm and so on. However, it is observed that several other
pathological procedures are carried out to examine actual condition of ischemic heart disease
(Antman and Braunwald, 2020).
Electrocardiogram (ECG): This method includes the procedure recording electrical signals as
they are responsible for travelling via heart of patient. It is also helpful often in terms of
revealing evidence of a previous heart attack or one that’s in progress.
Echocardiogram: The echocardiogram utilises sound waves in respect of producing images of
heart of patient to determine actual cause of chest pain to make decision of treatment. It is
helpful to doctors for identifying that all the parts of heart wall are contributing to pumping
activity of heart in normal manner.
Exercise stress tests: This method is based on the fact that signs and symptoms are most often
occur at the time of exercise which is known as stress echo. In some of cases, it has been

analysed that medication is also used by physician at place of exercise in order to stimulate heart
of patient.
Nuclear stress test: This diagnosing method is similar to ECF recordings as it is based on the
criterion of measuring blood flow to heart muscle at rest ad during stress. It consist the way of
injected a tracer into blood stream of patient along with special cameras that are capable in
detecting areas in heart which are responsible for receiving less blood flow.
Cardiac catheterisation and angiogram: This method can be defined as a process in which doctor
insets a catheter gently into an artery or vein in groin, neck or arm up to the heart of patient at the
time of cardiac catheterisation (Tseng and et. al., 2018). It includes the utilisation of X-rays for
guiding the catheter to correct position and dye is injected via catheter. The dye helps blood
vessels to indicate better on the images along with outlining any blockages.
Cardiac CT Scan: The CT scan is most commonly used diagnosing method which is favourable
for doctors to observed calcium deposits in arteries that are responsible for narrowing them. It
includes the evaluate that if substantial amount of calcium the coronary artery disease may be
likely present for which desired treatment should be provided for their welfare.
Nursing Management
Reduced cardiac output
Nursing Interventions Rationale
It includes to provide oxygen as per patient
symptoms, oxygen saturation and ABGs.
It is favourable to assist for alleviating signs of
hypoxia and subsequent activity intolerance.
It consist the criterion of applying strategies to
treat fluid and electrolyte imbalances.
This will helps to reduce risk of developing the
cardiac output due to imbalances.
It involves to administer cardiac glycoside
agents as indicated for symptoms of left sided
failure along with monitoring for toxicity.
It will helps to strengthen the contractility that
results into improved cardiac output.
It contains to motivate periods of rest and assist
with all activities.
It is favourable decrease cardiac workload and
reduces myocardial oxygen consumption.
It includes the criterion of assisting client in It will permit for better chest expansion that

assuming a high Fowler’s position. enhances pulmonary capacity.
It involves the way of educating patient
regarding pathophysiology of disease and
medications.
This will facilitate in providing needed
information to client in order to manage the
disease and for compliance.
It is necessary to reposition patient in every
two hours and instruct the nurse not to leave
client unattended.
It will provide support to prevent occurrence of
bed sores and promote relaxation to the human
body.
It is required to encourage rest, semi recumbent
in bed or chair along with assisting them with
physical care as per indications.
It is suitable for maintaining at the time of
acute or refractory HF to improve efficiency of
cardiac contraction along with reducing
myocardial oxygen demand or consumption as
well as workload (Levine and et. al., 2016).
It is essential for providing peaceful
atmosphere to client and defines about
therapeutic management that helps them to
ignore stressful conditions, listen and respond
to expressions of feelings.
It will facilitate decrease the emotional stress
that can develop vasoconstriction, elevating
blood pressure and increase the heart rate.
It is required to render bedside commode to
avoid activities eliciting a vasovagal.
It is favourable reduce work of getting
bathroom or struggling to use bedpan and
reduce risk of vagal stimulation.
It includes the criterion of elevating legs
ignoring pressure under knee, encourage active
& passive exercise and enhance the activity as
tolerated (Vilaro, 2019).
It is helpful to reduce the venous stasis and it
may decrease incidence of thrombus or
embolus formation.
Considering the above mentioned interventions, it is required to use appropriate medications to
treat actual cause behind the problem of Mr Ian Dury which facilitates to make them healthy. It
includes the use of several medications such as diuretics, vasodilators, arterial dilators,
combination drugs, ACE inhibitors, angiotensin II receptor II receptor antagonists, digoxin,
inotropic agents, beta adrenergic receptor antagonists, morphine sulphate, antianxiety agents &
sedatives, anticoagulants, administer IV solutions etc.

Discharge Planning
Discharge planning can be defined as process including the transition of a patient’s care from
one level of care the next. It includes the criterion of carrying out formalities of of
documentation and provide all the information to intake proper dosage of medication for
improving client condition. However, it has been analysed that discharge planning should
formulated for Mr Ian Dury with the help of considering the four components effectively.
Initially, it includes to conduct the assessment of condition of client by considering their
physiological, psychological, social and cultural needs. Secondly, it is necessary for associated
care professionals to develop care plan with the help of determining discharge strategies of
patient, carer and community provider (He and et. al., 2020). Thirdly, it is observed that doctors
are required to apply the plan including information delivered, education provided and service
referral.
Conclusion
From the above assignment, it has been concluded that nursing is an important professional in
healthcare for providing care services and attend patients all the time for their better health
condition. It includes the criterion of evaluating actual health problem of patient which helps to
make accurate decision making of treatment. It is necessary for select nursing problems and
make plan treating them along with formulating discharge plan when client become completely
wellbeing.