Cardiac assessment and intervention

Introduction

The human body is a complex mechanical system that consists of numerous organs, some of which are crucial for survival, including the lungs, liver and brain. The heart falls under the same category of vital organs as the brain and lungs, primarily because of the role it plays in the body. Some of the heart’s main functions include the distribution of oxygen to the entire body, transportation of nutrients and removal of waste from the system through blood. It is, therefore, essential to ensure it functions correctly, usually by getting regular check-ups that provide for early detection of any faults to its functions. The heart comprises of tissues that are prone to damage if injured and thus requires proper maintenance. Although individuals theoretically are supposed to go for frequent check-ups for early detection of any anomalies in bodily functions, most people only seek medical help when they perceive fault in standard functions or experience pain. This paper explores some case studies with the aim of explaining some of the conditions, processes and procedures that cardiac assessment and intervention involves.

Question 1

Diagnostic process

The first case study involves a situation in which a hospital admits a fifty eight year old man in a ward following an episode of chest pains. In such a case, although abnormalities involving the heart are a common cause of such pain, it is important to conduct an inquiry involving a series of questions before establishing a cause of action. One of the reasons this procedure is necessary is to rule out other causes of such pain, other than cardiac malfunctions. Secondly, the questions enable a medical practitioner narrow down the causes of distress through the symptoms a patient describes.

 One of the questions that aid in the diagnostic process is, asking the patient the particular area that causes distress. Localized pain makes the problem easier to detect as opposed to pain in a general area. For instance, pain in the left side of the chest is more indicative or a heart related problem while pain in the lower right area of the chest is more indicative of gastrointestinal problems.

Another question that greatly aids in the diagnostic process is the type of pain it is (LeMore & Burke, 2004). Although the necessity of the description of his pain may seem trivial to the patient, it helps a doctor or nurse make a proper diagnosis without involving invasive procedures such as surgery. A burning sensation is common with conditions that involve stomach acid like peptic ulcers and gastroesophageal reflux disease. A dull type of chest pain or mild discomfort may indicate conditions or disorders involving other organs close to the heart like hiatal hernia, a condition in which the stomach pushes towards the lower part of the chest after food consumption. Discomfort and mild or dull pain may be the resultant outcome of pressure on the lower chest area. Sharp pain on particular areas of the chest usually indicate localized injuries to those areas, as is the case with a rib fracture, muscle strain or tear.

Asking the patient the length of the period within which he has experienced the pain helps establish the severity of the condition. Sudden sharp pain indicates conditions that require immediate urgent attention such as rib fractures and hypotrophic cardiomyopathy while gradual pain often indicates conditions that a nurse can address more progressively through tests and further inquiry.

The patient’s medical history, especially with diseases or disorders that comprise similar symptoms, is also vital (Petrie, 2013). Conditions such as pulmonary embolism and asthma may bear similar symptoms to an angina or myocardial infarction thus it is necessary to eliminate as many possible causes as possible while isolating the most probable cause of the main.

Other questions that form part of the important inquisition phase include the patient’s occupation or normal every day activities and the patient’s history with drugs and alcohol. It is also necessary to ask whether the patience experiences pain in other areas of his body such as the neck and arms.

Although questions are necessary in establishing the cause of the pain, the nurse or doctor also needs to observe keenly symptoms such as shortness of breath, inflammation of the skin around the distress area and other areas of the body and dizziness.

Some of the medical intervention measures that a doctor or nurse may take at the time of admission of the patient include tests such as breathing and coughing tests for airway obstructions, an x-ray in the case of a suspected rib fracture or an ECG (electrocardiogram) for a detailed heart examination (Fiumara & Goldhaber, 2009). In cases where the pain seems to subside when the patient rests during the inquisition process and does not have any severe symptoms, the nurse may prescribe rest, antibiotics for infections and painkillers in cases of severe pain. Other modes of intervention include surgery and prescription of medical routine check-ups for cases in which the nurse or doctor prescribes medication for the patient to take while at home.

Question 2

Tachycardia

Tachycardia is a condition in which an individual’s heart rate is above normal limits, mainly indicative of hypotension. Hypotension is a descriptive term for a condition in which the blood’s pressure falls below normal limits.

In the second case study, a patient undergoes a 12 lead ECG that indicates ischemic changes in his anterior leads and hypotension associated with tachycardia. A 12 lead ECG (electrocardiogram) is a test that checks the heart’s health through an analysis of the heart’s electrical functions. The heart’s electrical functions are responsible for the frequency and rhythm of its contraction (Kaneko, Cohn & Aranki, 2013). Through an analysis of the electrical emissions and pathways, the ECG is able to measure an individual’s heart rate, the size and position of the heart and lungs and blood pressure. Proper analysis of the tests takes some time, as an individual needs several different tests at different times to provide comparative results necessary for proper diagnosis and prognosis.

The ECG results appear in the form of linear curves that bulge upwards or downwards in a steady manner, with higher peaks during heartbeats. In the case study, the results would indicate more peaks, usually higher than usual and appearing irregular, an indication of irregularly fast heartbeats. Ischemic changes are irregularities in the brain’s metabolism that usually cause irregularities in other body functions such as metabolic rates and energy regulation. Taking several tests enables a doctor or nurses establish the cause and determine an appropriate course of treatment.

Although tachycardia may not seem like a likely cause for hypotension, a variation of the condition may ironically cause hypotension. When the body experiences low blood pressure, the heart responds by a rise in the heart rate, increasing the amount of blood pumped that in turn increases the amount of blood in circulation, creating a subsequent rise in pressure. However, during ventricular tachycardia, the increase in heart rate causes the reverse effect leading to a decline in blood pressure. Ventricular tachycardia is a condition whereby the ventricles contract rapidly and irregularly. Due to the rapid contractions, the ventricles fail to fill properly leading to a decrease in the blood pumped and a subsequent decrease in the blood available in the body, hence hypotension (Lin, Lee, et al, 2013).

Medical prescription for the tachycardia depends on various factors, including the cause, severity and frequency of the condition. In essence, the central aim of the medical intervention is to lower and possibly normalize the individual’s heart rate.  In cases where the cause of distress is anxiety or panic attacks, the doctor may prescribe a period of rest coupled with anti-anxiety medication in cases of recurrent attacks. Cardio version is also a temporary solution for conditions that are not life threatening as it normalizes the heart rate through the use of electric shock through the skin to the heart.  The medical practitioner may also apply the use of vagal maneuvers, which are movements that affect the vagus nerve that helps with the regulation of the heartbeat. The movements include exercises such as coughing and applying pressure by holding breath as if passing stool. The doctor may also prescribe some anti-arrhythmic drugs such as Esmolol or beta-blockers that aid in lowering the heart rate (Mulpuru, Pretoriols & Birgersdotter, 2013). The doctor may also recommend that the patient desist from using diuretics in cases where low blood pressure results from dehydration due to their consumption. However, in severe cases, the patient may need to undergo corrective surgery in cases where the use of drugs may not be possible.

Question 3

Ischemic changes

Ischemic changes are alterations or irregularities in healthy brain function that result from a decrease in blood supply to the brain (Majib, Awan, et al, 2004). Low blood supply to the brain causes a decline to the nutrients, hormones and oxygen the brain gets causing symptoms such as dizziness, fatigue, confusion, reduced motor functions and fainting. The changes are usually visible through observation of the patient, although conducting an ECG may enable easier detection in cases where the symptoms are not yet manifest. In cases where low blood pressure occurs for long periods without proper treatment, a patient may stand a high risk of developing complications with such as impaired speech, vision or lose the use of his or her arms and legs, sometimes permanently. Low blood supply to the brain due to low blood pressure causes a drastic decrease to the amount of oxygen and nutrients reaching brain cells, impairing their development. In extreme cases, such deprivation and impairment may eventually cause the brain to degenerate and eventually die, leaving the patient clinically dead.  Ischemic changes are especially dangerous for infants as they bar the growth of the brain, causing permanent physical and sometimes mental disabilities.

Question 4

Risk factors and role of nurses

One of the risk factors associated with the development of cardiovascular diseases is lack of exercise. Exercise plays an important role in improving and maintaining blood circulation in the entire body, preventing problems such as myocardial infarctions and hypotension. The second common risk factor is poor dietary options that lead to problems such as obesity that make the heart prone to conditions such as hypertrophic cardiomyopathy and an angina. Consumption of fatty foods leads to excess fats in the body that is likely to cause blockages and thicken the heart muscle (Lin, Lee, et al, 2013). The third risk factor consists of occupations that prove hazardous to cardiovascular health. People who work in factories involving gaseous products or strenuous activity such as construction work possess a higher risk of contracting cardiovascular diseases or disorders. Fourthly, use of alcohol and drugs increases the risk of a contracting cardiovascular disease due to their characteristic of changing the body’s metabolism including factors such as the heart rate and consequently blood pressure. Age comprises another one of the important risk factors as it affect the body’s ability to repair cellular damage to body organs and makes the heart particularly vulnerable (Sharma, Datta, et al, 2013). Issues such as financial concerns and relationship problems are more prominent in adults than they are with teenagers. Lastly, the presence of other diseases creates a predisposition for cardiac diseases as the diseases leave the body weak.

The main role nurses play in the reduction of cardiovascular diseases in the community is educating community members on the importance and methods of self-care (Kozier, 2007). Giving advice on proper dietary plans and exercise for prevention and management of any existing conditions ensures sustainable reduction in cases of cardiovascular disorders and diseases. Although providing treatment helps in management, self-care is the primary means of reduction in most cases.

Question 5

Angina management

An angina is a blockage of the blood vessels in the heart, causing a reduction in blood and oxygen supply. Glyceryl trinaitrate is a drug commonly applied to the treatment of the disorder as it relaxes and expands blood vessels, causing immediate relief. It also serves a preventive measure during activities that may trigger the condition, such as exercise. Recommendations for lifestyle changes are often part of the intervention aimed at prevention of future episodes. Proper healthy diet low in fat and adequate rest includes part of the lifestyle regime under common recommendation.

 

 

 

 

References

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Kozier, B. (2007). Korzier and Erb’s Fundamentals of nursing (8th ed.) New Jersey:

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LeMore, P. & Burke, K. (2004). Medical-surgical nursing: critical thinking in client care,

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Lin, H., Lee, J., et al (2013). Accumulation of epicardial fat rather than visceral fat is an

independent risk factor for left ventricular diastolic dysfunction in patients under

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Madjib, M., Awan, I., et al (2004). Leucocyte count and coronary heart disease:

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Mulpuru, S. Pretoriols, V. & Birgersdotter, U. (2013). Arrhythmia Management Devices.

AHA Journal, 128.

Parsonage, W., Cullen, L. & Younger, J. (2013). The approach to patients with cardiac

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evidence. Cardiovascular Diabetology, 12 (130).

Sharma, S., Datta, S., et al (2013). The relationship between Elder Risk Assessment

(ERA) scores and cardiac revascularization: A cohort study in Olmsted county,

Minnesota, USA. Dovepress journal, 1209-1215

 

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