Advanced Nursing Practice

Learning points

  • The patient was taken to the hospital with angina symptoms, including crushing chest pain, shortness of breath with exertion, and diaphoretic. Most of the time, angina is accompanied by radiation in the jaw and neck, which the patient has experienced. Angina occurs when the myocardium is ischemic or when there is not enough blood to meet myocardial needs. 
  • When angina occurs, the patient could also appear pale or diaphoretic when the attack occurs. Other symptoms include dyspnoea, tachycardia, nausea and vomiting, dizziness, belching, and palpitations. 
  • Emotional stress, heavy meal, or exertion have been found to provoke angina pain. 
  • Atypical symptoms are often likely to occur among elderly patients or diabetic patients. 
  • The patient, social history, family history, and habits put him at an increased risk of angina, hypertension, obesity, and type 2 diabetes. 
  • The patient has high blood pressure, high blood cholesterol, decreased breathing, and decreased pedal pulses BL with lower leg edema from ankle to mid-calf, and these are further symptoms of the patient’s condition (Ebell, 2004).  

Diagnosis and diagnostic tests

To make a diagnosis, it is essential to obtain a history and evolution of the patient’s chest pain, which has already been done in the case study. Up to 3 percent of patients that are diagnosed with a non-cardiac cause of chest pain could die or suffer from myocardial infarction within 30 days of presenting the symptoms, and patients that have greater age, are male, have diabetes, hyperlipidemia, or heart failure should be watched closely (Musset et al., 2002). The patient should be tested for acute coronary syndrome or coronary artery thrombosis (CAD) using 12-lead ECG, serum markers of myocardial damage and cardiac testing. Pulmonary embolism should be tested using the quantitative enzyme-linked immunosorbent antibody assay (ELISA) d-dimer assay. The pain should be determined whether it is substernal, provoked by stress exertion or relieved by rest. The patient shows all these symptoms and this indicates that it is a typical angina pain. Typical angina pain can be treated using nitroglycerin while long-acting nitrates, beta blockers, and calcium channel blockers could be used for long-term angina management (Cayley, 2005). 

Cardiovascular care for the patient

When a patient reports of crushing chest pain, with shortness of breath, exertion or diaphoresis, it is necessary to assess for tachycardia, dyspnoea and diaphoresis. The presence of these signs and symptoms points out to pulmonary embolism. Suppose the patient has severe substernal pain that radiates to his arm, jaw and neck. In that case, it is important to have the patient lie down and assess for dyspnoea, diaphoresis, nausea, vomiting and apprehension. If these symptoms are present, one can suspect myocardial infarction. If the suspect has life-threatening disorders, one should take the vital signs and obtain an electrocardiogram. A catheter can be inserted to administer fluids, drugs, and oxygen (Wolters Kluwer Health, 2008). To prevent other episodes of angina, the patient will need to change his habits by checking his weight, changing his diet by eating more often, reducing amounts of food and increasing intake of fruits and vegetables, engaging in physical activity, and reducing or quitting tobacco smoking. With a history of Cholecystectomy and having been treated for hypertension and high cholesterol in the past, and stopping medication on his own, the patient will need to change his lifestyle habits to improve his health. 


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