Case Study: Nursing Management of a Patient with Chest Heaviness

This case study presents the nursing management of Mr. Ferguson, a 76-year-old patient admitted to the emergency department with chest heaviness, tachycardia, hypertension, and dyspnea. The case details the medications administered, including aspirin, morphine, heparin, and fentanyl, along with the rationale for their use. It also outlines nursing interventions such as beta-blocker and verapamil administration, 'PQRST' pain assessment, and patient education regarding potential adverse effects of the medications, such as aspirin's side effects, and opioid-related complications. The study emphasizes the importance of educating both the patient and their family on the potential risks and benefits of the prescribed treatments, ensuring safe and effective patient care. References are included to support the information provided in the case study.

N A M E O F T H E S T U D E N T
N A M E O F T H E U N I V E R S I T Y
Formative assessment

Introduction
Nursing management
encompasss performance of
various leadership functions
that are associated to decision
making within healthcare
organisations (Kitson,
Marshall, Bassett & Zeitz,
2013).
The case study is about a
patient Mr. Ferguson, a 76 year
old person, admitted to the
Emergency department, after
complaints of chest heaviness.

Tachycardia
Usually, heart rate greater than 100
beats per minute is considered as
an indicator of tachycardia.
Tachycardia common known as
tachyarrhythmia refers to the
physiological state when the heart
rate of an individual exceeds the
usual resting heart rate.
In the words of Al-Zaiti and Magdic
(2016) at the cellular level,
increased heart rate is often allied
with electrical re-entry and/or
abnormal automacity .

Hypertension
The patient suffers from high
blood pressure
This state refers to increased
blood pressure and is a medical
condition marked by sudden
upsurge in the pressure of blood
that flows in the arteries.
Structural narrowing of arteries
and small arterioles, besides a
lessening in the number and
density of capillaries lead to the
condition (Mollan et al., 2016).

Dyspnoea
Shortness of breath was
another presenting complaint.
According to Anzueto and
Miravitlles (2017) three
primary mechanisms contribute
to dyspnoea namely, afferent
signals, efferent signals, and
central information processing.
Angina or pressure in chest
might be due to imbalance
between the oxygen demand
and supply in the heart.

Aspirin
Aspirin gets absorbed through the
cell membrane, under acidic
conditions of the stomach.
Increased surface area of small
intestine and greater pH helps
aspirin to get absorbed, while the
rest gets ionized (Vane, 2014).
The acetyl group covalently attaches
to a residue of serine, located near
active site of COX enzyme, thereby
producing inhibitory effect on
aggregation of platelets.

Morphine
This drug is commonly administered
for pain management at the time of
myocardial infarction.
The action of the drug on receptors
located in CNS facilitates relieving
pain and analgesia.
Morphine is taken sublingually,
orally, subcutaneously, epidurally or
intravenously . The drug is
metabolized into Morphine 6
gluconoride (M6G) and Morphine 3
gluconoride (M3G) (Tzvetkov et al.,
2013).

Heparin
In the words of De Caterina et al.
(2013) heparin sulphate is an
anticoagulant that is typically
used for averting deep vein
thrombosis, pulmonary embolism,
and arterial thromboembolism.
It is also used for the treatment of
heart attack and unstable angina.
Ternary complex between AT,
thrombin, and heparin results in
thrombin inacivation.

Fentanyl
Fentanyl provides impacts that
are typical of opioid drugs
through activation of varied
kinds of opioid receptors.
20–50mcg/kg is the moderate
dose for fentanyl administration
via intravenous route.
High lipophilicity leads to its
strong potency, when compared
to morphine that allows it to
penetrate the central nervous
system (Barratt et al., 2014).

Nursing management
Apart from the prescribed
medications, beta blockers must be
administered to manage the
abnormality is in heart rhythm and
second heart attack.
They are competitive antagonists
block receptor sites, specific for
endogenous catecholamine, and are
effective for hypertension and stroke
prevention (Andersson et al., 2014).
They will also influence renin
angiotensin system, and decrease
secretion of renin.

Nursing management
Verapamil drugs are class-IV antiarrhythmic
agents and will block voltage dependent
calcium channels.
It will reduce impulse conduction through AV
node, thus protecting ventricles from
tachyarrhythmias (Tarkin & Kaski, 2013).
‘PQRST’ pain assessment is needed.
Coronary vasodilator administration and
physical therapy are crucial for the patient.

Educate patient
Some adverse effects of aspirin are mild
diabetes, peptic ulcer, gastrointestinal
bleeding, gastric mucosal erosion, increased
risk for stomach bleeding, and temporary
tinnitus in the ears (Baron et al., 2013).
Reye’s syndrome and allergic reactions in
skin are other adverse impacts
Opioid use might cause depression, loss of
appetite, increased fall risk, dependence, and
immunodeficiency (Zeppetella & Davies,
2013).

Educate patient
Overdose of fentanyl would lead to sweating,
constipation, sweating, nausea, confusion,
and somnolence (Kuip, Zandvliet, Koolen,
Mathijssen & van der Rijt, 2017).
The medication must be discontinued if
allergic reactions are seen.
Overdose of fentanyl must be prevented to
manage unexpected respiratory depression.
Educating the patient and family on adverse
implications would prove imperative.

References
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Barratt, D. T., Bandak, B., Klepstad, P., Dale, O., Kaasa, S., Christrup, L. L., ... & Somogyi, A. A. (2014). Genetic, pathological and
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