Nursing Case Study: George Orwell's Cardiac Health Management

This case study examines the health condition of Mr. George Orwell, who was admitted to Farquharson Memorial Hospital with chest pain. The assignment provides an overview of Orwell's medical history, including a coronary artery bypass and anterior myocardial infarction, along with lifestyle factors such as smoking, diabetes, and obesity. The primary diagnosis is chest pain, linked to blocked arteries. The case study identifies nursing problems, including managing heart problem symptoms and lifestyle management to prevent readmission. The nursing management section details interventions for symptom management and lifestyle changes, including medication adherence, smoking cessation, and diabetes management. The discharge plan focuses on medication management, lifestyle changes, and support systems to ensure a successful recovery and prevent future cardiac events. The study emphasizes the role of nurses in patient education and care coordination to improve patient outcomes.

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George Orwell Case Study
Student’s Name
University
Date
Course
Instructor

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George Orwell Case Study
Introduction
Mr. George has been transferred to Farquharson Memorial Hospital (FMH) Adelaide to
be investigated with the chest pain condition. The patient has a medical history of heart-related
diseases having undergone a coronary artery bypass five years and suffering from anterior
myocardial infarction six years ago. He is on EtOH daily dose. Apart from this, the patient has
type 2 diabetes, hypercholesterolemia, hypertension, obese and he is also a current smoker who
takes fifteen cigarettes daily. Chest pain requires a proper clinical plan based on identifying
nursing problems and developing a treatment plan to restore the client (Mekaj, Daci & Mekaj
2015, p. 1452). This relates to understanding the condition of the patient and other medical issues
that they have to develop a treatment plan and at the same time a discharge plan to guide the
patient and nurse in managing the condition.
Primary admission diagnosis
From the clinical notes the patient was admitted for chest pain and shortness of breath.
This condition is mostly caused by blocked arteries as a result of fats, cholesterol, and
lipoproteins that form fatty acids which produce extracellular matrix forming atherosclerotic
plaque that narrows the luminal space (Mansour, Reda, Mena, Ghaleb & Elkersh 2016, p. 7).
When the arteries are blocked, blood circulation is reduced making the patients feel squeezing
and uncomfortable pressure that sometimes extends to the shoulder, neck, and jaw. Chest pain is
easily identified and mostly develops due to some physical activity that creates the requirement
for the heart to pump faster than expected.
Usta & Bedel (2017, p. 459) suggest that the onset of chest pain depends on the medical
history of the patient and the challenges that they have been experiencing. The fact that the

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patient experienced anterior myocardial infraction five years ago means that his heart is
vulnerable and can be affected easily. Another issue that can be seen from the case of Orwell is
the fact that he had coronary bypass as a way of reducing the symptoms of heart disease.
According to Li, Kong, Jiang, & Dong (2017, p. 350), this surgery does not cure heart problems
but only reduces the signs and symptoms like chest pain through improved circulation. The fact
that the patient has been on heart problem medications and has used the GT spray four times a
week means that the feeling of chest pain is related to the heart problems that he has had in the
past.
In addition to that lifestyle issues and conditions can exacerbate the signs and symptoms
of heart problems that a patient feels. The fact that Orwell is diabetic the condition presents risk
factors can lead to increased damage of blood vessels which can block the blood vessels thus
creating circulation problems. Further, his lifestyle as seen in the number of cigarettes taken can
be one of the reasons why the symptoms are high. Smoking is a risk factor since it damages the
lining of arteries, which leads to atheroma thus narrowing the arteries (Kamimura, Cain, , Mentz,
White, Fox, Butler & Robertson 2018, p. 2577). The fact that the patient had undergone a
coronary bypass but failed to manage his lifestyle means that this is the genesis of the heart
problems being experienced. Therefore, from the condition of the patient, the main cause of the
problem that has led to the admission of the patient is chest pain which can be caused by many
factors. The patient is on heart disease medication which is used to reduce the symptoms of the
disease (Yasue, Nakagawa, Itoh, Harada, & Mizuno 2014, p. 12). Since the patient is scheduled
for a coronary angiogram the medical team is focused on determining whether the coronary
arteries are blocked.
Nursing problems

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Managing of the heart problem symptoms
Orwell has a heart problem and has been on different medication doses to control his
situation. The reason why he was admitted is the feeling of chest pain and breathlessness during
exertion. Young & Melander (2013, p. 4) suggest that chest pain is a common symptom for heart
problem patients since it arises from the inability of the heart to function normally. This
condition arises from blocked arteries that create difficulties in blood circulation which leads to
tightness, squeezing or crushing pain. Chow, Chan, Ho & Chun (2017) suggests that patient
lifestyle is one of the major reasons for chest pain or the possibility of breathlessness. As seen in
the case of the patient, he is diabetic and smokes fifteen cigarettes daily which all lead to
atheroma that increases heart problems. Further, the patient seems to have difficulty maintaining
the required dose since he forgets taking the medication and complains of the effects of fluid
medications. Lemone, Burke, Bauldoff, Gubrud-Howe, Levett-Jones, Hales, Berry, Carville &
Reid-Searl (2016, p. 19) suggests that the role of patient cenyered care is to design a care plan
that reflects the needs of the patient. This means that a care plan is supposed to be developed to
assist Orwell overocome the risks associated with heart failure.
The second medical problem is lifestyle management to avoid readmission.
According to the American Heart Association (2019, pp. 4), one major problem in heart-
related patients is the lack of commitment to healthy lifestyles. In most cases, heart problem
patients are supposed to lead a strict lifestyle that adheres to the condition management plan that
is given in the hospital. From the patient notes, Orwell is diabetic and smokes 15 cigarettes daily
which could be one of the reasons why he is prone to the symptoms of the condition. Fleg (2016,
p. 5) argues that having diabetes means that there is the likelihood to develop a heart disease
since high glucose damages the blood vessels which can lead other fatal causes.

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Further, Tan, Jiang, Huang, Zhang, Chen, Xie & Cai (2017, p. 5) suggests that diabetic
people who smoke, have high blood pressure, are obese and have a history of heart related
complications are at higher risk. Smoking narrows blood vessels which creates blood flow
difficulties. High blood pressure makes the heart to strain by pumping hard which can damage
blood vessels increasing the chance of a heart attack or stroke (Burman, Zakariassen, &
Hunskaar 2014, p. 6). Obesity reduces the ability to manage diabetes thus increasing the risks of
health problems that relate to heart disease. This shows that Orwell has to be assisted on how to
manage his lifestyle to avoid readmission or the likelihood of developing chest pain or a heart
attack.
Nursing management
Nursing problem 1: Managing of the heart problem symptoms
In managing the chest pain, Burman, Zakariassen, & Hunskaar (2014, p. 6) suggest that it
is important to understand the nature of the problem that the patient is having before developing
a care plan for the same. From the history of the patient, he had a coronary bypass five years ago
which has led to the need for the coronary angiogram to be done so that the source of
breathlessness and chest pain can be determined. Chest pain is diagnosed through history
evaluation and physical examination to distinguish between cardiac and non-cardiac causes
(Herren & Mackway-Jones 2010, p. 7). Physical examination entails asking the patient clinical
questions to assess the causes of the problem and so that they can inform the care plan that will
be developed. In a complex situation, a coronary angiogram can be done to determine the exact
nature of the condition since physical examination may be inadequate.
Treatment of chest pain should be based on the underlying causes that have been gathered
through physical examination. In this case, Orwell is suffering from cardiac chest pain with

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invasive medications (Pascale, Petrucci, Dragani, Habib, Zaccardi, Pagliaccia, & Patrono 2012,
p. 3598). The first medication that is commonly given is aspirin which is an anti-inflammatory
drug used to prevent clotting and making the blood thinner. Atorvastatin is also prescribed to
lower the cholesterol level in the body so that the possibility of stroke can be reduced. The rest of
the drugs metoprolol, candesartan and spironolactone are all used to increase blood circulation.
According to Berman, Snyder, Levett-Jones, Dwyer, Hales, Harvey, & Stanley (2018, p.
23) nurses need to be empowered so that they can empower patients uisng evidence based
approaches. The role of the nurse in the medication process is to ensure that the patient takes the
medication as indicated. The role of the registered nurse in medication administration is to
ensure that the patient takes the medication properly so that the therapy can work (Grech, 2013,
p. 4). Drug therapy in chest pain patients is to reduce the symptoms of the disease and ensure that
the patient heals properly. Since Orwell has been having difficulties in taking his medication,
then the registered nurse needs to ensure that he takes the medication as prescribed. Chest
heaviness can only be treated through medication therapy that allows the patient to respond.
Nursing problem 2: lifestyle management to avoid readmission.
The next nursing problem for the patient is the need to assist Orwell in the management
of his lifestyle to prevent chest pain and other related problems. Estes, Calleja, Theobald, &
Harvey (2016, p. 34) states that different patient evaluation approaches can be used to asses the
lifestyle of the patient. This can be assessed using the Health Risk Appraisal (HRA) which is
used to assess the strengths and weaknesses of the healthy behaviors that he leads. By assessing
the lifestyle of the patient, it makes it easy to develop a nursing care plan that can be used on the
patient. Further, Costa-Tutusaus & Guerra-Balic (2016, p. 5) adds that patient with heart-related

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conditions need to be assessed so that the condition that they have can be assessed to determine
the risk factors that the care plan needs to be based on.
A nursing intervention that will be applied here is lifestyle change education to assist him
to learn how to manage the risk factors. This includes the need to assist him to quit smoking,
develop a medication-taking plan, address obesity and manage diabetes so that the risks
associated with the condition are lowered. Anderson, Brown, Clark, Dalal, Rossau, Bridges &
Taylor (2017, p. 23) adds that in coronary heart failure patients, patient education is important in
ensuring that the risk factors are reduced.
From the standard of clinical nursing practice, patient education is the primary
responsibility of the nurse used to promote health and disease prevention. This includes teaching
the patient about his condition, risk factors, treatment, and prevention (Cliff 2014, p. 5). Since
Orwell has been leading an unhealthy lifestyle, the registered nurse needs to develop an
individualized lifestyle process that he will follow. This entails taking medication appropriately,
changing the risky lifestyle and observing a daily required routine to avoid risk factors that lead
to readmission.
Discharge planning
The discharge plan is based on the identified health problems which entail focusing on the role of
the patient and multidisciplinary team. Cliff (2014, p. 5) adds that the role of a discharge plan is
to create an individualised care that reflects the clinical requirements of the patient.
Activity 1: Proper intake of medication
The nurse needs to develop a medication plan with the patient to ensure that he is able them
accordingly. This will include working with the schedule of the patient and linking him with the
family to improve accountability.

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Activity 2: Healthy lifestyle and lifestyle change
The patient needs to be linked with a cardiovascular program within his locality to gain moral
support in adjusting to the new lifestyle (Cliff 2014, p. 5).
Proper management of diet to put diabetes and obesity in check by linking him with a dietician.
Development of a smoking plan and linking the patient to a psychosocial counselor to assist him
in quitting. The nurse needs to link with the son to ensure that he is given the support needed to
adjust the lifestyle change.
Activity 3: exercise
The nurse needs to work with the patient and link him to TV yoga program where he can practice
and put his health in check. The patient needs to work with the son so that he can follow up with
the patient in understanding the progress made. Exercise needs to be done for at least thirty
minutes 3-4 times per week.
Activity 4: monitoring of signs and symptoms
The patient needs to understand heart attack warning. These include chest discomfort or pain in
one or both arms, back, neck, jaw or stomach, Shortness of breath, breaking out in cold sweat,
nausea, or light‐headedness.
The patient also needs to know when to call a doctor or seek medical assistance when the
following signs are present.
Shortness of breath or have more difficulty breathing Swelling of your feet, ankles, hands or
abdomen.
Feeling tired with normal activity or experiencing dizziness or fainting Trouble sleeping or
waking up feeling short of breath or coughing
Chest pain or pressure

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Weight gain of 3‐5 pounds over2‐3 days
Inability to take medications or follow the treatment plan
Conclusion
From the case study, it is evident that poor management of the health condition is the reason why
Orwell is having a problem. Patients with cardiovascular problems live on medication that is
supposed to be taken daily. Managing heart related conditions is the best way to lead life and
avoid readmission. This implies that patient education is important in achieving lifestyle change
and medication management to avoid the risk factors of the condition. Thus effort needs to be
made in the discharge plan to ensure that the patient is empowered to take care of himself by
understanding the warning signs of the episodes, how to respond to them and leading a healthy
lifestyle by avoiding the risk factors.

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