Nursing a Patient with Angina. Patient’s Data.
Nursing a Patient with Angina. Nursing problem one: Impaired Oxygen Supply to Cardiac Muscle
Nursing a Patient with Angina. The patient in the case scenario presents with symptoms suggesting reduced oxygen supply to cardiac muscles. Mrs. Brown in the case scenario presents reports two episodes of chest pain. One of the presenting symptoms of angina pectoris is deep, choking, pressing pain on the chest. After admission into the medical ward, Mrs. Brown complains of shortness of breath after walking around the ward. Angina results from the inadequate oxygen supply to the heart’s muscle cells. The insufficient supply of oxygen to the heart’s contracting muscle cells leads to anaerobic respiration instead of aerobic respiration. The transformation of the mode of energy production is a mechanism to ensure energy production. The heart’s muscles turn to anaerobic respiration since this type of energy production does not require the use of oxygen as raw material. A further insufficient oxygen supply leads to the death of muscle cells.
Notably, the Adenosine Triphosphate (ATP) molecules of energy are broken down to adenosine. Adenosine is known to stimulate the A1 pain receptors on the muscles of the heart. Stimulation of afferent coronary nerve endings results into an impulse that is transmitted to the thalamus of the brain and later to the cortex part of the brain. The chest, the shoulder, and the neck share embryonic innervation. Therefore, the brain interprets the pain stimulus from the heart muscles as originating from the chest (Nakashima, Noguchi, Haruta, Yamamoto, Oshima, Nakao, & Kawasaki, 2016).
Mrs. Brown in the case scenario complains of pain to the chest after walking around the ward. Physical activities require increased energy to the body cells and tissues. The process of energy production requires the use of oxygen. Subsequently, in order to ensure the supply of oxygen that meets the body’s demand, the heart increases its rate and force of contraction. Increased levels of adenosine lead to stimulation of additional A1 pain receptors and thus intensified levels of plain. Mr. Brown rates her pain 9 out of 10 after walking around the ward.
The reduced oxygen supply for cardiac muscles is linked to an elevation in resistance within the arteries. Mrs. Brown has been diagnosed with hypertension. Hypertension is described as a function of resistance and the heart rate. Therefore, the history of hypertension is an indication of raised resistance to the flow of blood. Increased resistance of blood flow within the arteries implies that the heart has to increase the force of contraction. In angina, the heart requires additional energy to overcome arterial blood resistance. Therefore, additional anaerobic respiration is carried out to produce sufficient energy. As a result, more adenosine is produced.Emotional stress contributes to the manifestation of angina symptoms. Emotional stress stimulates the production of adrenaline and noradrenaline, which increase the rate, and the force of contraction of the muscles of the heart. In angina status, the increased rate and force of contraction results into production of adenosine, which in turn stimulates pain receptors in the heart, and the pain is referred to the chest (Mygind, Michelsen, Pena, Frestad, Dose, Aziz, & Hansen, 2016).
Nursing a Patient with Angina. Nursing Interventions.
Administer oxygen via nasal cannula at a rate of 2 liters per minute. The oxygen administration increases the amount of oxygen reaching the lungs for exchange and thus, the concentration of oxygen in arterial blood. The increased amount of oxygen in the blood meets the demand for oxygen for energy production during contraction. Secondly, administer nitroglycerine 0.3mg sublingually. Nitroglycerine releases nitrate that is converted into nitrite oxide, which in turn causes relaxation of the muscles of the walls of blood vessels; thus, the lumen of the vessels widens.
Evaluation Data. The effectiveness of oxygen will be evaluated by the concentration of oxygen in the blood. In adults, the normal oxygen saturation should be 95% or above.
The effectiveness of the administered nitroglycerine is evaluated by assessing the pain experienced by the patient (Sicari, Rigo, Cortigiani, Gherardi, Galderisi, & Picano, 2014).
Nursing a Patient with Angina Nursing Problem Two: Impaired Ability to Perform Activities of Daily Living
Patient’s Data. Mrs. Brown, in the case scenario, experiences chest pain after walking around the ward. Patients experiencing angina have reduced cardiac ability to pump sufficient amounts of blood to all the body tissues, cells, and organs. The heart muscles require energy production in order to pump blood to all parts of the body. In performing the activities of daily living, the individual requires energy. In order to produce energy in the form of ATP, the patient requires the supply of sufficient oxygen through the blood circulation to the skeletal muscles involved in contraction and relaxation during body movement. However, in angina, the heart muscle cells are incapable of contracting due to insufficient energy production. During the execution of activities of daily living, the demand for oxygen increases. In order to meet the increased demand for oxygen, the rate and the force of contraction increase. The force and the rate of contraction of the muscular walls of the heart are factors that determine the manifestation of the symptoms. The muscle cells of the heart perform intensified anaerobic respiration during the performance of activities of daily living. Subsequently, the amount of chemicals produced such as adenosine is increased. The increased amount of adenosine stimulates additional receptors on the heart. Increased stimulation of pain leads to increased intensity of pain conducted and experienced on the chest (Akbas, Yegin, Yilmaz, Altekin, Sabit, & Sanli, 2015).
Mrs. Brown weighs 120 kilograms. Increased body weight has been linked to elevations in the number of body lipids. Excess body fat is deposited in several body organs, including the walls of the blood vessels. Deposition of the lipids on the walls of blood vessels leads to a reduction in the size of the lumen of the blood vessels. Also, the ability of coronary blood vessels to dilate is reduced. Research has found out that lesion of lipid depositions account for 50 % of the causes of death to cells of the muscular walls of the heart. During increased oxygen demand, for instance, in cases of intensified activities of daily living, the body initiates mechanisms to produce a physiological increase in the amount of blood reaching cardiac muscles. Relaxation of the muscles of the walls of the small blood vessels supplying blood to heart muscles results into an increased blood flow. However, in cases of arteriosclerosis, the walls of blood vessels do not relax to cause dilatation as an adaptive mechanism. In such cases, the patient cannot perform the activities of daily living. Additionally, the lesions of fats within the lumen of the blood vessels block sufficient blood supply to the heart. Lesions are common in patients with increased body weight and deposition of fat on the walls of the vessel (Michalek, Neuzil, Stritesky, & Johnston, 2014).
(Nursing a Patient with Angina). Mrs. Brown states that she has experienced shortness of breath. Ventilation determines the amount of oxygen that reaches the lungs and therefore the amount that diffuses into the blood system. Subsequently, ventilation and gaseous exchange affect the oxygen concentration in the blood. Angina is primarily a manifestation of lack of enough oxygen supply to the heart’s muscles. Shortness of breath reduces the amount of oxygen reaching the lungs for diffusion into the blood. The deficiency of oxygen is further worsened by the lack of enough concentration of oxygen in the blood. Shortness of breath leads to an insufficient amount of oxygen available for the production of energy during muscle movement in performing the activities of daily living. Therefore, the shortness of breath experienced by the patient contributes to the exacerbation of the symptoms. The pain experienced by the patient is a limitation to the performance ADLs. Patients diagnosed with angina experience referred pain. Mrs. Brown reports that she experienced two episodes of chest pain. Further, while in the medical ward, Mrs. Brown complains pain in the chest after walking around the ward (Bahtiyar, Gutterman, & Lebovitz, 2016).
(Nursing a Patient with Angina) Nursing Interventions: Advise the patient to maintain bed rest in Semi-Fowler’s position. Reducing physical activities reduces the demand for oxygen by the body. In order to carry out physical activities, the body requires energy. The process of producing energy through cellular respiration requires the use of oxygen. In angina, the muscle cells of the heart do not receive enough amounts of oxygen to carry out the metabolic activities responsible for energy production. In the case scenario presented, the patient is at risk of developing an arteriosclerotic lesion. Therefore, in order to compensate for the inability of the body’s mechanism to increase the oxygen supply, reduction of the number of energy demand is necessary. Semi-Fowler’s position increases the patency of the airway. Patency of the airway increases the rate of airflow to the lungs. Mrs. Brown, the case scenario, experiences shortness of breath. Shortness of breath causes a reduction in the amount of blood reaching the lungs. The reduced amount of oxygen reaching the lungs reduces the ultimate amount of oxygen available for energy production (Mygind et al., 2016).
Education to the patient and the family is also an intervention to increase the performance of activities of daily living. The patient and the family are educated on the need to reduce the number of physical activities. In the case scenario presented, the patient will be educated on maintaining a bed rest at home. The patient and the family should be assisted in performing activities of daily living. Assistance in performing ADLs ensures reduced the need for high amounts of oxygen and in attaining self-care (Bahtiyar et al., 2016).
(Nursing a Patient with Angina) Evaluation Data. The effectiveness of bed rest in Semi-Fowler’s position will be evaluated through assessment of the intensity and nature of the pain on the chest. The subjective data collection will involve asking the patient on the occurrence of pain and a description of the nature of pain. The effectiveness of patient education will be assessed by asking the patient to state the activities where she may need assistance (Sicari et al., 2014).
(Nursing a Patient with Angina) In conclusion, the patient presents with chest pain that indicates an underlying cardiac condition. The heart’s oxygen supply is compromised and does not meet the body’s oxygen demand. The patient’s emotional stress and history of hypertension are risk factors to the presenting condition. Insufficient supply of oxygen to the heart and the inability to perform ADLs are two main problems facing the patient. Generally, interventions involve reducing the demand for oxygen and improving oxygen supply.
Nursing a Patient with Angina. References
Akbas, M., Yegin, A., Yilmaz, H., Altekin, R. E., Sabit, M. J., & Sanli, S. (2015). Unstable angina pectoris and spinal cord stimulation. Anaesth Pain & Intensive Care, 19(3), 383-385.
Bahtiyar, G., Gutterman, D., & Lebovitz, H. (2016). Heart failure: a major cardiovascular complication of diabetes mellitus. Current diabetes reports, 16(11), 116.
Michalek, P., Neuzil, P., Stritesky, M., & Johnston, P. (2014). Interventional treatment of pain in refractory angina. A review. Biomedical Papers of the Medical Faculty of Palacky University in Olomouc, 158(4).
Mygind, N. D., Michelsen, M. M., Pena, A., Frestad, D., Dose, N., Aziz, A., … & Hansen, H. S. (2016). Coronary microvascular function and cardiovascular risk factors in women with angina pectoris and no obstructive coronary artery disease: the iPOWER study. Journal of the American Heart Association, 5(3), e003064.
Nakashima, T., Noguchi, T., Haruta, S., Yamamoto, Y., Oshima, S., Nakao, K., … & Kawasaki, T. (2016). Prognostic impact of spontaneous coronary artery dissection in young female patients with acute myocardial infarction: a report from the Angina Pectoris–Myocardial Infarction Multicenter Investigators in Japan. International journal of cardiology, 207, 341-348.
Sicari, R., Rigo, F., Cortigiani, L., Gherardi, S., Galderisi, M., & Picano, E. (2014). Additive prognostic value of coronary flow reserve in patients with chest pain syndrome and normal or near-normal coronary arteries. The American journal of cardiology, 103(5), 626-631.