Case Study: Comprehensive Nursing Management of Unstable Angina

This case study provides a detailed analysis of nursing care for an 82-year-old female patient, Sarah, diagnosed with unstable angina. It covers key aspects such as prioritizing general nursing care, preventing hospital-acquired complications, promoting adequate hydration and nutrition, providing emotional and psychological support, and planning for patient education and discharge. The study emphasizes the importance of assessing pain, reducing anxiety, and maintaining oxygen levels. It also highlights strategies for preventing infections and pressure injuries, ensuring proper fluid balance and dietary intake, and establishing a therapeutic nurse-patient relationship to address the patient's emotional needs. The discharge plan includes medication management, lifestyle adjustments, and regular follow-ups to minimize angina attacks and improve overall health outcomes.

WRITTEN ANALYSIS OF
CASE BASED SCENARIO

Table of Contents
1. Introduction..................................................................................................................................3
2. Prioritization and Facilitation of General Nursing Care..............................................................3
3. Prevention of Possible Hospital Acquired Complications...........................................................4
4. Promotion of Adequate Hydration and Nutrition........................................................................5
5. Provision of Emotional and Psychological Support....................................................................5
6. Education and Discharge planning..............................................................................................6
7. Conclusion...................................................................................................................................7
REFERENCES................................................................................................................................1

1. Introduction
Sarah is an 82-year-old female who was diagnosed with unstable angina followed with
heavy chest pain and epigastric distress. As per her medical history she has Hypertension,
Hypocholesteraemia along with the habit of smoking. She also has Anxiety issue. The
medication of Sarah includes Aspirin, Morphine, Enoxaparin and Anginine tablets. Her heart rate
is 95 beats per minutes with a 175/90 mm Hg blood pressure. The SaO2 level is 95% at room
temperature. She also faces the issue of Restless, Nausea, Fatigue, feeling anxious and tearful
along with central chest pain.
2. Prioritization and Facilitation of General Nursing Care
The nursing assessment in unstable angina will include the location of pain followed with
characteristics of pain. Looking towards Sarah’s health history is also included in nursing
assessment by registered nurse. The scale of pain, cause and onset of pain will also be included
during assessment (Venable, 2020). The major steps that will be prioritize in respect to unstable
angina involve the treating of angina followed with reduction of anxiety and prevention of pain.
Decreasing level of oxygen in relation with the patient is also important to be monitored in case
of treating with the situation of unstable angina (Katz and Gavin, 2019).
The care which is required in unstable angina include giving of heparin or any other
blood thinner and nitro-glycerine under the tongue or through an IV. This may majorly include
the treating of angina that will include instructing the patient to stop all activities and sit or rest in
semi-flower position during the experience of angina (BELLEZA, 2021). This step also involves
the administration of its medication that which medicines are currently used by Sarah so that
better analysis and treatment will be provided.
The later step involves the reduction of anxiety which may include diagnosis of Sarah as
she has anxiety issue. Providing of adequate treatment and prevention of its progression is
included in this step (Goyal and Zeltser, 2021). Here the factors of subjective aspects like
Nausea, restless, fatigue will be included.
The later step is prevention of pain which involve the identification of activity that lead to
pain i.e. its medical history consideration in case of Sarah which lead to pain. This will also look
towards the medical factors which shows that Sarah has a habit of smoking and an issue of

anxiety that may also associate with the occurrence of pain. With such identification adequate
steps in relation with pain reduction will be taken.
The last step involves the measuring of oxygen level and giving of oxygen therapy if the
level of SaO2 is less than 93%. In case of Sarah it is not required because her SaO2 is 95%.
While evaluating the patient i.e. Sarah after giving care it is noted that her reported pain
has been lower down. The level of anxiety is also fall now. The evaluation step will enable to
know that after giving of care the condition and issue of the patient has been resolved or not
(BELLEZA, 2021).
3. Prevention of Possible Hospital Acquired Complications
While providing care it is highly important that hospital acquired complication like the
infections and other acquired diseases will never arise (Badgery-Parker and et.al. 2019). During
assessment it will be make ensured that the patient will not infected by any hospital acquired
complication. This will involve ensuring that the equipment is hygienic, the floor must be clean
and hygienic so that the injury of fall will be prevented (Fernando and et.al. 2021). Likewise, the
aspect of health and hygiene will be kept focus so that there will be no chances of spreading of
infections and complications.
In order to manage such complication in case of Sarah it will be kept ensured there will be
no chances of the occurrence of medical complication. This will have kept made with the
checking of medicines expiry dates along with sterilisation of injections and other equipment
specially in case when the patient need intensive care unit support (Kolasiński, 2019). Likewise,
the pressure injuries will also be prevented with the scheduling of active walking and adequate
care. The floor of the hospital will be inspected so that the patient will not be suffered from any
infection and the injury related with slip will be avoided (Monegro, Muppidi, and Regunath,
2020). DVT can be counted as major hospital acquired complication under which the bllod clots
would be form in deep vein (Kruger and et.al. 2019). With the practice of regular walk and
reducing the proportion of incident that may prevent the clotting and flowing of blood or related
with the clotting of blood will be avoided so that the issue of DVT will not occur in case of
Sarah.
As per the evaluation i.e. after taking of relevant steps it will be kept ensured and evaluated
that the hospital acquired complication will be reduced and minimised. An adequate

consideration towards the hygiene factor will also lead to result in the reduction of the rate of
infection i.e. hospital acquired infection and complications.
4. Promotion of Adequate Hydration and Nutrition
In order to access the adequate hydration, the aspect of body weight, urine and
haematological parameter, heart rate, blood pressure changes, bioelectrical impedance are
included (Young, 2021). Here an asking model under which the relevant questions in relation
with the patient related with concerned aspects will be asked. In the same way in order to access
adequate nutrition, body weight including the aspect of weight loss, calculation of BMI,
thickness of various body part is included (Feteira-Santos and et.al. 2021).
In order to promote the adequate nutrition and hydration in body the dietary type of the
patient will be focussed. Likewise, it will be kept ensured that the fluid balance in body along
with appropriate size and frequency of fluid in the body will be maintained so that the issue of
lack of hydration will never arise. With a focus towards the fluid and dietary aspects the
adequate hydration and nutrition can be promoted among patient.
During evaluation it can be analysed that the taking of necessary steps and action in relation
with the adequate hydration and nutrition will lead to improve the body nutrition and hydration
or not. With the aspect of enabling adequate care the evaluation will shows that the patient body
shows adequate proportion of hydration and nutrition.
5. Provision of Emotional and Psychological Support
Emotional and psychological support also plays an important role in relation with the
health of Sarah. This is because as she is 82 years old and live with her husband who is 85 years
old and both are retired. While making an assessment of Sarah in relation with emotional and
psychological support it was noted that as she lives alone with her husband which need a
support. As she also had an issue of anxiety and stress under which providing of emotional and
psychological support plays an important role. As per the analysis it can be said that the
implication of therapeutic nurse patient relationship proves to be very helpful wherein the aspect
of mutual trust and faith is involved (Unhjem, Vatne and Hem, 2018). As the subjective
information of Sarah shows that she feels tearful and anxious which will be improved with the
implication of the therapeutic nurse patient relationship. She also has an issue of Nausea and

fatigue and restless which shows that she need emotional support along with medication. Thus,
enabling emotional and psychological support in terms of understanding her emotions and
mental situation will prove to be very helpful. Likewise, in order to address the issues of Sarah,
personal support network of her husband proves to be helpful. In the same way other allied
health professional in terms of assignment of personal carer or home care nurse will also proves
to be helpful in case of Sarah. This is because it will enable care to Sarah in relation with her
disease and issue along with enabling emotional and mental support.
6. Education and Discharge planning
The main goal behind the education of the patient is related with the reduction of frequency
and severity of angina attacks (Kourbelis, and et.al. 2020). This will also be being made so that
the occurrence of complications in relation with the health of the Sarah will be reduced. This
may include planning of activities that may reduce the chances of the angina attacks. This may
also include the step of follow up wherein Sarah will be called for follow up so that the
monitoring in relation with the health condition of Sarah can be made established. This may
include the periodic blood laboratory testing as well as performance of ECGs (Kourbelis, and
et.al. 2018). Another step that may involve is related with adherence wherein the home care
nurse will monitor the Sarah’s adherence towards dietary restriction along with prescribed
antianginal medication.
In medication management the in taking of sublingual nitro-glycerine is recommended to
Sarah so that sudden angina attacks can be treated adequately along with preventing angina
which may occur during certain activities that may involve moving in lawn and various other. In
the same way medical equipment like the oximeter will be recommended so that the oxygen
level of the Sarah will be monitored. Likewise, with the step of regular follow up, her health
issues and condition in relation with heart rate and condition can be monitored that proves to be
highly important in case of unstable angina (Acara, and et.al. 2018). During discharge it will also
be guided to Sarah that after considering and taking all the suggested steps in relation with
angina, if she will not get positive outcome then she can anytime take medical assistance so that
the issue of angina followed with high chest pain can be deal adequately.
Here an education related with predisposing factor i.e. stairs climbing, emotional stress,
smoking, heavy meals, stress, cold temperature and various other will also be provided so that

the situation of unstable angina in Sarah will not occur. Providing education and related
precautionary measures and medication will all be done while discharging Sarah so that she will
not face the issue of angina and in case if she will face then with such measures she will easily
handle it.
7. Conclusion
From the above report it can be concluded that in order to deal with the situation of
unstable angina nursing assessment followed with the nursing care and evaluation process proves
to be highly effective. With the performance of concerned steps an effective treatment of patient
will be provided. The report also explains the concept of discharge and education under which
necessary education in relation with the unstable angina will be provided to patient so that the
immediate situation of unstable angina can be deal and handled adequately. This will also
involve care planning so that further complication in relation with the unstable angina can be
avoided and minimised.

REFERENCES
Books and journals
Acara, & et.al. (2018). A novel biochemical marker for predicting the severity of ACS with
unstable angina pectoris: asprosin.
Badgery-Parker, & et.al. (2019). Measuring hospital-acquired complications associated with
low-value care. JAMA internal medicine. 179(4). 499-505.
Fernando, & et.al. (2021). Reliability of Patient-Report, Physician-Report, and Medical Record
Review to Identify Hospital-Acquired Complications: A Prospective Cohort
Study. American Journal of Medical Quality. 36(5). 337-344.
Feteira-Santos, & et.al. (2021). Looking ahead: Health impact assessment of front-of-pack
nutrition labelling schema as a public health measure. International journal of
environmental research and public health. 18(4). 1422.
Goyal, A., & Zeltser, R. (2021). Unstable angina. StatPearls [Internet].
Katz, D., & Gavin, M. C. (2019). Stable ischemic heart disease. Annals of internal
medicine. 171(3). ITC17-ITC32.
Kolasiński, W. (2019). Surgical site infections–review of current knowledge, methods of
prevention. Polish Journal of Surgery. 91. 41-47.
Kourbelis, & et.al. (2018). Effectiveness of discharge education on outcomes in acute coronary
syndrome patients: a systematic review protocol. JBI Evidence Synthesis. 16(4). 817-824.
Kourbelis, & et.al. (2020). Effectiveness of discharge education strategies versus usual care on
clinical outcomes in acute coronary syndrome patients: a systematic review. JBI evidence
synthesis. 18(2). 309-331.
Kruger, & et.al. (2019). Deep vein thrombosis: update on diagnosis and management. Medical
Journal of Australia. 210(11). 516-524.
Monegro, A. F., Muppidi, V., & Regunath, H. (2020). Hospital acquired infections. StatPearls
[Internet].
Unhjem, J. V., Vatne, S., & Hem, M. H. (2018). Transforming nurse–patient relationships—A
qualitative study of nurse self‐disclosure in mental health care. Journal of clinical
nursing. 27(5-6). e798-e807.
Venable, N. A. (2020). Day-case discharge of patients undergoing percutaneous coronary
intervention. British Journal of Cardiac Nursing. 15(1). 1-7.
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Young, C. (2021). Using the ‘aSSKINg’model in pressure ulcer prevention and care
planning. Nursing Standard (Royal College of Nursing (Great Britain): 1987).
Online reference
BELLEZA, M., 2021. Angina Pectoris. [Online]. Available from <
https://nurseslabs.com/angina-pectoris/ >
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