Holistic Nursing Care for Ischemic Heart Disease

Introduction

In nursing, the case study analysis acts as evidence-based framework for the nurses to help them understand the way of evaluating and examining complex health issues of the patient so that holistic care can be provided to the individual with improved support (Urbinati et al., 2019). In this study, the case study of James suffering from ischemic heart disease is been focussed. This is because in 2018 it is mentioned that 7% of the population in Scotland was diagnosed with the health issue and it is 8% more prevalent in men than women (7%). Moreover, 26% increased ischemic heart condition or stroke is found among the people who are above 70 years (gov.scot, 2018). In addition, the National Records of Scotland (2018) mentioned that ischemic heart disease led to 6,727 deaths among people in 2017 in the Scotland only (isdscotland.org, 2018). This indicate that the prevalence of the disease and its impact is present at increased level within the Scotland. Thus, discussion regarding this aspect by focussing on James is required to understand way the situation can be managed for similar patients.

In the current case study to be presented, the pathophysiology and nursing priorities for the patient named James who is admitted to the hospital in the coronary catherisation laboratory (Cath Lab) and availed primary Percutaneous Coronary Intervention (PCI) after the process of non-ST segment elevation myocardium infraction (NSTEMI) will be discussed. The nursing prioritises will be mentioned by considering the guidance and policies mentioned by the NHS (National Health Service) Lanarkshire regarding Myocardium Infraction Pathway (MCP).

Case Study

Pathophysiology

The non-ST segment elevation myocardial infarction (NSTEMI) is a nature of heart attack which does not cause any change in the ST-segment elevation in an electrocardiogram report (Tsutsumi and Tsukahara, 2018). In the NSTEMI, a sudden onset of chest pain from the central part of the chest originates to later radiate down the left arm to the jaw causing immense pain. This pain in NSTEMI is mainly perceived due to blockage of blood flow to the heart as a result of occlusion of the coronary artery that eventually leads the myocardium not to be entirely perfused in supporting normal heartbeat out of less blood flow (Smulders et al., 2019). According to Nowbar et al. (2019), the ischemic heart disease is mainly caused by narrowed arteries due to deposition of plaque on their inner lumen which is also known as atherosclerosis. The plaque is mainly composed of fat and cholesterol deposits from the body that eventually narrows the arterial lumen to restrict blood flow to the heart. As argued by Yoo et al. (2020), occlusion in the artery develops when the accumulation of plaque completely blocks the artery resulting in tissue death. In this condition, the troponin enzyme is released which is one of the diagnostic factors considered during blood test to detect heart disease as higher the level of troponin, the more the damage to the heart is been caused to be determined (Manikkan, 2018).

The additional symptoms related to NSTEMI include nausea, dyspnoea, dizziness, sweating and light-headedness (Calderone and Capodanno, 2020). The shortness of breath or dyspnoea is developed due to the inefficiency of the heart muscles to contract that limit oxygenated blood flow to the pulmonary system leading the individual to get less oxygen in the body (Bartolomucci et al., 2017). As argued by Kwok et al. (2017), dyspnoea in ischemic heart disease is developed due to damage to the left ventricle that causes backup of blood in the pulmonary artery. It leads the patient to develop anxiety that affects their respiration as a result of inability to inhale properly. The nauseous feeling is developed in people with NSTEMI as a result of parasympathetic effect on the body (Garadah et al., 2018). However, it is also caused due to the backup of blood in the hepatic vein that causes the spleen and liver to function improperly out of being engorged in the condition (Fatema et al., 2020). Thus, to avoid the symptoms that may lead to fatal condition, the NSTEMI is to be effectively managed with immediate effect in James to ensure his better survival rate and well-being.

Nursing priorities

The nursing priorities are the important skills and knowledge of care to be present among the nurses to help them deliver enhanced quality support to the patients (Huriani, 2019). According to “Prioritise People” of NMC Code (2018) and Section 3 of Nursing 2030 vision, the nurses have the prior duty to provide compassionate and person-centred care to all patients in fulfilling their care needs with quality support and ensure them satisfactory care (gov.scot, 2017; NMC, 2018). Moreover, the Healthcare Quality Strategy for Scotland (2010) also mentions that person-centred care is significant to enhance the quality of care as it led the patients to be in the centre of the care and allow making them take decision for their care while cooperating and coordinating with the nurses (gov.scot, 2010). Thus, following these guidelines and policies, the nurse caring for James ensured they have prior responsibility to arrange person-centred care for him and ensure it is provided in compassionate and empathetic way for fulfilling all his needs and offering him satisfaction from care. The “Practise Effectively” guideline mentioned in the NMC informs that all the nurses are to work according to the best available evidence and communicate clearly with the patients as well as colleagues to deliver enhanced professional care (NMC, 2018). Thus, according to the Code, the nurses while caring for James executed evidence-based care by following best available evidence and accessing assistance from colleagues and patients through effective communication to make decision regarding care.

The Situation Background Assessment and Recommendation (SBAR) is a technique used for developing communication between the healthcare team members to develop situational and background health information of the patients (Shahid and Thomas, 2018). This is important because SBAR leads to understand prior health history of the patients and allows to avoid barrier in communication with the different health disciplines who have already cared for the patient (Ting et al., 2017). Thus, during handover of James at the Cath Lab, the student nurses performed SBAR for him to get detailed information of his health condition till the handover from different member of the healthcare team. Moreover, SBAR is used for James because it is one of the recommended handover methods mentioned to be followed by the NHS Education for Scotland (2019). This is because NHS mentions that SBAR during handover helps to determine the correct and limit of the patient's details and assist in structuring a well-developed care plan in a critical way (pharmacyregulation.org, 2019). It is also to be followed as NES (2019) mentions that clear and concise health documentation of the patient during handover assists in practising effectively and ensuring greater safety to the patient that fulfils "Preserve Safety" guideline of the NMC Code (NMC, 2018).

The Royal College of Nursing (RCN) (2017) mentions that admission documentation of the patient is to be completed as early as possible and immediately after the PCI process as it is one of the prior parts of nursing care regarding cardiac monitoring. This is because the admission report is connected with presenting information about the cardiac monitoring used, if any arrhythmias have occurred and if the patient is been thoroughly monitored by following the section 4 principles of SIGN (2016) (gov.scot, 2016). The presence of this baseline information regarding James would help to provide effective early intervention and ensure his better monitoring as any doubts regarding her health can be resolved through analysis of the already developed reports. According to section 2 of SIGN 139 (2014), the patient is to be monitored initially for fifteen minutes and based on the escalating situation the time is to be further increased and during monitoring proper documentation of all health aspects are to be made each time (gov.scot, 2014). Thus, according to the guidance, effective cardiac monitoring of James for the first fifteen minutes was done and all data are recorded after which the monitoring time was gradually increased based on his situation.

The cardiac monitoring is mainly mentioned to be executed by clinical nurses trained in the approach (Tsivgoulis et al., 2019). However, in most cases, it is seen that the monitoring is left to be executed by the clinical support staffs who have no prior knowledge or training regarding the cardiac monitoring process leading them to fail to determine early warning signs in patients to avoid their worsening of health (Funk et al., 2017). However, in the case of James, it was seen that clinical nurses were present to monitor his health to ensure safe cardiac monitoring and effective detection of any early warning signs regarding his health condition after handover to the Cath Lab. The National Early Warning Signs (NEWS) chart was used to record warning signs regarding James and the patient admission record was maintained and documented as par the health records policy mentioned by NHS Lanarkshire (NHS, 2019).

The NMC mentions that nurses have the Duty of Candour according to which they are remain open and honest to the patient and their families regarding health condition and any wrong care been mistakenly provided to the patient (NMC, 2019). In order to execute the duty, James on returning from the PCI procedure that was unexpected to him, the nurses mentioned him in detail about his current condition and assured during his stay in the hospital to be good. James was able to understand and was aware of his condition along with was able to determine what may happen next in care or to his health. The risk assessment of patient is essential to determine the vulnerabilities towards their health to be avoided to ensure their safety and quality care delivery (Flores Kim et al., 2018). In many cases, certain allergy towards medication can be seen in patients which deteriorates their health (Shenoy et al., 2019). Thus, in case of James, the allergy status was documented which revealed that he has allergy with penicillin and the student nurse made the fact aware to the practitioners. The nurse executed the duty by acting according to NICE (2016) guidelines. James was also tagged with a visible band to indicate that he has allergy.

The presence of chest discomfort is common in PCI and MI, but it is determined to be reduced after the affected artery is treated (Krishnan et al., 2019). However, in case of James, it was seen that he was still reporting of continued chest pain similar to the one that he previously faced that prompted his admission to the hospital. In this context, the National Early Warning Score (NEWS) is implemented to determine the level of clinical deterioration of the health of the patient (D’Auria and Ramani, 2018). James scored 2 in NEWS chart which indicated that his condition is vulnerable and needs immediate care. In this relation, an electrocardiogram (ECG) was performed for James to detect if the pain is due to cardiac reason or other as all pain in the chest is not related to heart. This is because if the pain related to cardiac then anomaly in the electric impulse would be detected and accordingly the physician can determine the nature of cardiac pain caused to the patient (Chen et al., 2020). The observation of ECG of James leads the physician determine he is suffering from pericarditis pain and prescribed normal pain medication to be provided to ease the condition. The pericarditis pain after PCI is normal as the patient remains under shock and feel discomfort of the procedure being done that leads them to develop anxiety and chest pain (Korjian and Gibson, 2020).

Conclusion

The above case study discussion mentions that James who had to suffer NSTEMI is been provided primary PCI to help him recover from the condition. The pathophysiology of the condition mentions that lack of enough reach of oxygenated blood to be pulmonary arteries leads to dyspnoea as addition symptom of NSTEMI. Moreover, chest pain in NSTEMI mainly occurs due to incapability of effective heart muscle movement out of low flow of blood to the heart due to narrowed arteries. The Scottish Government mentions that ischemic heart disease is a major health issue in the country and effective preventive actions are required. In case of James, the use of different guidelines like the NMC, SIGN (2016) and other are considered so that ensured quality care been delivered to the individual. Moreover, it was seen that enhanced skill and knolwdege of the students nurses along with clinical nurses helped to provide high quality care to James with less to no error. The person-centred care is considered to be important and safe care to James is been provided by following care principles and executing risk assessment.

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