Case Study Evaluation
Hospitalized for four days with crushing chest pain, the 52-year old patient is dealing with angina, which is a type of pain in the chest, occurring in cases of reduced blood flow in the heart. This means that the patient’s heart is not getting enough oxygen to function properly. In the majority of cases, patients that experience angina are under high pressure or stress. As to the general treatment of angina, patients are usually encouraged to quit smoking and invest into the treatment of adverse risk factors such as obesity, hypertension, diabetes, and hyperlipidemia (Alaeddini, 2015). The patient’s behavior as evidenced by the case study calls for the immediate treatment and the relief of primary symptoms, as well as the introduction of major healthy lifestyle changes.
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The fact that patient did not seek help immediately and dealt with short breath, increased sweating, and chest pain, is evidence of poor self-care on his part and ignorance of symptoms that can be potentially dangerous. Furthermore, the patient reported suffering from a similar condition for six months, which may suggest the development of stable angina (Angina Pectoris), a disorder associated with predictable patterns of chest pain over a long period of time (Roth, 2015). The primary purpose of angina treatment is relieving the symptoms patient experiences and ensuring the prevention of future symptoms, as well as reducing the patient’s risk of stroke or heart attack, which are immediate consequences. For relieving patients’ symptoms immediately, the administration of Glyceryl Trinitrate may be of great benefit. Beta-blockers or calcium channel blockers can be prescribed in order to prevent recurring angina attacks. The patient should be advised to quit smoking, establish a healthy diet, and invest more time and effort into reducing stress.
It can be stated that the condition exhibited by the patient cannot be called normal development. The disorder arose from a variety of factors that do not coincide with the healthy lifestyle (smoking, sporadic diet, high cholesterol, Android obesity, low physical activity, and increased stress). Therefore, the patient and his family are now challenged by the introduction of new psychological and physiological demands for preventing angina symptoms from occurring or developing into more complicated conditions. After stent placement, the patient is advised to quit smoking, develop a diet and exercise plan suitable for his lifestyle in cooperation with a specialist, and invest both psychologically and physiologically into reducing stress. To achieve optimal disorder management outcomes, the patient and his family must be educated on the importance of treating the underlying conditions, such as high blood cholesterol, high blood pressure, and type 2 diabetes (Mayo Clinic, 2016). Because the patient has a positive family history of heart attacks and accompanying conditions, it is crucial for the household to change the lifestyle to prevent angina from occurring again. If the patient’s wife already has a diabetes-specific diet, it is advised for the patient to follow a similar diet, thus creating positive change in the household.
Key interdisciplinary team personnel needed for achieving positive health outcomes should include a dietician, a certified health and fitness specialist, a cardiologist, and a general practitioner that will monitor the patient’s progress. The interdisciplinary team should work cooperatively towards the common goal of improving the patient’s overall well-being and reducing the risk of angina symptoms. Possible risks and benefits should be taken into consideration for creating a cohesive, holistic health plan, which will cater to the specific needs of the patient as well as his lifestyle and family responsibilities.
Lifestyle is the main barrier to facilitating positive health outcomes for the patient. Because he is the only breadwinner in the family, the pressure to earn money and stay illness-free only contributes to the increased stress, which is one of the main causes of angina. Research has shown that family-related stress and the burden of responsibility negatively influence a person’s overall well-being, at the same time with putting great pressure on the cardiovascular and nervous systems. Another barrier is patient’s disrupted self-efficacy and unwillingness to consult a professional when the symptoms first occurred. When a patient is under intense stress, his levels of positive self-perception decrease and prevent him from persevering through challenges and encouraging him to take better care of his health.
The last barrier is the lack of family and community support since the patient lives with only his wife, with their children moving away. Without the support from either family or the community, the patient can often be left alone with his health problems, which decreases the likelihood of a positive health outcome. To eliminate these barriers, the patient and his wife should be educated about the importance of a healthy lifestyle as well as the possible risks of angina’s development. Reducing the amount of stressful situations such as family conflicts may be of great benefit. It is crucial to advise the immediate family to offer more help and support to elevate the burden of stress. The only facilitator of change is the fact that the patient has experienced a serious decrease in his health, which may cause him to reconsider his outlook on health and life. It is likely that after such an experience, a patient may get an understanding that health should be taken seriously not only for his benefit but his family’s good.
Care Plan Synthesis
The holistic health care plan for eliminating angina and preventing it from occurring in the future implies a range of nursing interventions. First, because the patient experienced the same symptoms over the course of six months, it is crucial to instruct him to immediately notify a medical professional in cases of chest pain occurring. Chest pain and increased cardiac output can influence the emergence of the coronary artery spasm, consequently complicating and prolonging the angina attack. To prevent the symptoms of angina from happening in the future and evolving into a heart attack or stroke, the patient should be strictly advised to inform a medical professional about the first signs of angina. Second, a general practitioner responsible for monitoring the patient’s wellbeing should document the response to medication in order to have full information about the progression of the condition.
as little as 3 hours
Documenting the progress and response to treatment will be beneficial for analyzing the effectiveness of the chosen intervention, and may be indicative of the need for changing the regimen of therapy and lifestyle improvements. Third, if the precipitating event were identified, the patient should be instructed to determine the frequency, duration, location, and the intensity of the chest pain (Matt, 2013). By conducting an identification of these factors, a patient will be able to differentiate the type of the chest pain as well as evaluate the likely development of angina. Fourth, the patient and the health care provider are advised to look for symptoms, commonly associated with angina. Such symptoms may include palpitations, dizziness, nausea, vomiting, dyspnea, as well as desire to micturate. The rationale for this action is associated with the fact that decreased cardiac output can cause a range of ambiguous symptoms and sensations, which may not be identified as primary signs of angina. Fifth, it is important to report the pain in jaw, neck, shoulder, arm, and the left-hand side (Matt, 2013). The rationale for this action refers to the fact that cardiac pain can radiate to other locations, which are served by the same level of the spinal cord.
It is crucial to mention that a healthy diet plan will become a basis for other positive lifestyle changes. By following easy steps that provide a change in the diet routine, the patient will be able to reduce excess weight and improve the overall condition. First, it is advised to control the portion size as well as the type of consumed products. Vegetables such as leafy greens and deeply colored vegetables are filled with nutrients that benefit the condition of the heart. Second, because the patient is used to consume a high-fat diet made up from fast food, it is important to choose low-fat or nonfat dairy options, which are very high in potassium, an element that reduces the risk of stroke. Third, Omega-3 fatty acids found in many types of fish can benefit the heart greatly. According to Health Communities (2011), omega-3s can potentially lower the level of triglycerides in the blood, therefore decreasing the occurrence of abnormal heart rhythms. Therefore, a diet rich in omega-3s can have a great impact on the patient’s overall well-being.
Apart from a cohesive diet rich in healthy food options, the patient is advised to consult a fitness specialist about an exercise routine he should introduce into his daily life. It is known that stress can be decreased through exercise; therefore, however, complicated it may seem, the patient must make healthy choices and exercise more. According to the American College of Sports Medicine (2010), regular exercises are crucial for patients with stable angina because of the beneficial impact on reducing high blood pressure, elevating the symptoms of diabetes, reducing cholesterol levels, and improving the overall psychological and physiological well-being. Particularly, scientists distinguish everyday aerobic exercises such as climbing stairs and carrying weights for increasing the flow of oxygen in the blood even when the patient is at rest. First, the patient is advised to consult a healthcare provider before the introduction of any exercise routine to make sure that all of the possible risks are eliminated. Second, the patient should remember than an exercise routine is designed to improve his cardiovascular fitness and increase the strength of muscles, not to drastically lose weight and put the body under stress. Third, it is advised to stop any exercising in a case of angina’s reoccurrence and contact a health facility immediately. Fourth, the patient should perform long cool-downs and warm-ups, which can significantly reduce the risk of angina or any other complications.
The patient should be advised to avoid situations that can influence the appearance of angina episodes to reduce the incidence of heart-related diseases. Furthermore, it is crucial to discuss how the sources of stress can be identified and eliminated. According to the article written by Boyles (2010), men and women in stressful family relationships and situations are much more prone to develop heart-related problems, including the increased risk of angina occurrence. Having to worry about family-related problems, as with the patient of the case study, is associated with the 3.5-fold increase in angina risk, as mentioned by Boyles (2010). Therefore, apart from adopting a healthy diet, quitting smoking, and taking up exercising, the patient is advised to take some time for relaxation or seeking mental health with a specialist, which may develop a cohesive treatment plan to elevate the burden of stress. The greatest challenge for the patient will be admitted that extra attention should be given to the stress-reducing activities because of his low self-efficacy and the fear of not being able to provide for his wife. It is a goal of a holistic care plan to make sure that the patient accepts the need for help and complies with the interventions strategies.
The patients’ social and cultural background is not the best environment for facilitating effective lifestyle changes. The patient is under pressure to provide for his wife who suffers from uncontrolled type 2 diabetes. Living from paycheck to paycheck, without being able to afford a vacation, the patient experiences increased levels of stress. Therefore, it will be very hard for the patient to implement healthy lifestyle changes because of the high pressure on him as a provider for his wife and her caretaker.
It is important to mention that the key issue identified from the case study is the stressful life of the patient, who does not have enough time and resources to improve his health because of the great responsibilities put on him. Bad habits such as smoking, the lack of physical activity, and decreased attention to the symptoms of angina do not facilitate beneficial changes in his lifestyle. The approach towards angina management should be focused predominantly on introducing healthy habits, abandoning harmful ones, and reducing the pressure and instances of stress. Follow-ups and examinations are crucial for monitoring the progress and evaluating the effectiveness of the administered interventions.
To conclude the analysis of the case study, the patient can be loosely referred to as ‘a perfect example’ of people suffering from angina as well as accompanying conditions. The lack of coherent self-care, the ability to consult a healthcare provider when the first symptoms occurred suggests that the patient is under increased stress associated with work and family relations, leaving no time for himself. It is important to communicate to the patient that healthy lifestyle choices will change his health dramatically, offering him more time to spend with his wife. Key advice includes smoking cessation, healthy omega-3 enriched diet, consultations with a mental health professional, and the reduction of stressful situations. By referring to this case study as an example, nursing practitioners and other specialists in the sphere of healthcare will be able to identify main causes of angina, how patients deal with it without referring to a healthcare facility, as well as what changes and interventions can be useful for elevating the burden of the disease and improving the patient’s well-being.
Alaeddini, J. (2015). Angina pectoris. Web.
Boyles, S. (2010). Family stress linked to angina pain. Web.
Health Communities. (2011). Angina: Heart healthy diet tips. Web.
Matt, V. (2013). 4 Angina pectoris (Coronary Artery Disease) nursing care plans. Web.
Mayo Clinic. (2016). Angina treatment: Stents, drugs, lifestyle changes – What’s best? Web.
Roth, E. (2015). Stable angina. Web.