Mr. Smith is experiencing episodes of chest discomfort relieved by rest, consistent with stable angina. Which nursing action is most appropriate to help manage his condition?

B) Educate the patient about the importance of taking prescribed anti-anginal medication.

A) Encourage the patient to engage in high-intensity interval training.

B) Educate the patient about the importance of taking prescribed anti-anginal medication.

C) Advise the patient to avoid all physical activity to prevent chest pain.

D) Recommend that the patient increase dietary sodium intake to manage symptoms.

Which lifestyle modification should the nurse emphasize to Mr. Smith to help manage his stable angina and elevated LDL cholesterol levels?

B) Engage in regular physical activity

What is the primary goal of initiating low-dose statin therapy in Mr. Smith's care plan?

B) To lower LDL cholesterol levels

A) To increase HDL cholesterol levels

B) To lower LDL cholesterol levels

C) To reduce triglyceride levels

D) To alleviate chest discomfort

What lifestyle change is Mr. Smith encouraged to implement to help manage his stable angina and reduce cardiovascular risk?

B) Engage in regular physical activity

A) Increase intake of saturated fats

B) Engage in regular physical activity

What lifestyle modification did Mr. Smith implement to help improve his cardiovascular health?

C) Incorporated more fruits, vegetables, and whole grains

A) Increased intake of saturated fats

B) Reduced physical activity to minimize exertion

C) Incorporated more fruits, vegetables, and whole grains

D) Increased salt consumption to improve blood pressure

What is the primary reason for Mr. Smith to continue his lifestyle modifications and medication regimen?

C) To prevent future occurrences of angina episodes

A) To completely eliminate the need for medication

B) To ensure his LDL cholesterol levels remain stable

C) To prevent future occurrences of angina episodes

D) To reduce his blood pressure to below normal levels

What is the most appropriate nursing intervention for Mr. Smith, considering his occasional mild chest discomfort during intense physical activity?

C) Instruct Mr. Smith to monitor his symptoms and rest if chest discomfort occurs.

A) Encourage Mr. Smith to increase his physical activity to improve cardiac fitness.

B) Advise Mr. Smith to avoid any physical activity to prevent chest discomfort.

C) Instruct Mr. Smith to monitor his symptoms and rest if chest discomfort occurs.

D) Suggest Mr. Smith take an additional dose of his medication when experiencing discomfort.

What is the primary reason for Mr. Smith's healthcare team to encourage him to report any increase in the frequency or intensity of his chest discomfort?

B) To assess the need for potential changes in his medication regimen

A) To ensure timely adjustments to his diet

B) To assess the need for potential changes in his medication regimen

C) To monitor his hydration status

D) To evaluate his sleep quality

When managing a patient like Mr. Smith, who is experiencing increased frequency of stable angina symptoms, which lifestyle modification is most important for the patient to continue practicing?

B) Engaging in moderate-intensity exercise

A) Maintaining a low-sodium diet

B) Engaging in moderate-intensity exercise

What is the primary reason for increasing Mr. Smith's anti-anginal medication dosage?

A) To reduce the frequency of his chest discomfort

B) To manage his blood pressure more effectively

C) To improve his lipid profile

D) To address new findings on his physical examination

angina - Nursing Case Study

Pathophysiology

• Primary mechanism: Angina is primarily caused by reduced blood flow to the heart muscle, often due to narrowed coronary arteries from atherosclerosis. This limits oxygen supply, especially during physical activity or stress, causing chest pain or discomfort.

• Secondary mechanism: Another key factor is coronary artery spasm, which can temporarily reduce blood flow even in the absence of significant blockage, also leading to angina symptoms.

• Key complication: If untreated, these mechanisms can lead to a heart attack (myocardial infarction), as prolonged oxygen deprivation can damage heart tissue.

Patient Profile

Demographics:

55-year-old male, accountant

History:

• Key past medical history: Hypertension diagnosed 5 years ago

• Current medications: Amlodipine 5 mg once daily

• Allergies: None

Current Presentation:

• Chief complaint: Chest discomfort during exertion

• Key symptoms: Mild chest pain lasting a few minutes, relieved by rest, no radiation of pain

• Vital signs: Blood Pressure 130/85 mmHg, Heart Rate 78 bpm, Respiratory Rate 16 breaths per minute, Temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon initial assessment, the patient, Mr. Smith, presents with mild chest discomfort that he describes as a tightness occurring during physical exertion, such as climbing stairs or walking briskly. The discomfort is consistently relieved by resting for a few minutes. Mr. Smith denies any radiation of pain to the arms, neck, or jaw, and there is no associated nausea or diaphoresis. He reports that these episodes have been occurring more frequently over the past month, prompting his visit to the healthcare facility.

A targeted cardiac assessment reveals normal heart sounds with no murmurs or gallops noted. The lungs are clear to auscultation bilaterally, and peripheral pulses are strong and symmetrical. An electrocardiogram (ECG) performed at rest shows normal sinus rhythm with no ST-segment changes, which is typical in stable angina when the patient is not experiencing symptoms. Mr. Smith’s lipid profile, obtained from recent labs, shows elevated LDL cholesterol levels at 150 mg/dL, above the recommended level of less than 100 mg/dL for patients with a history of hypertension. His HDL cholesterol is within normal limits at 55 mg/dL.

These findings suggest that Mr. Smith’s episodes of chest discomfort are consistent with stable angina, likely exacerbated by exertion. The elevated LDL levels indicate a need for lifestyle modification and potential medication adjustment to manage his cardiovascular risk factors. The nursing team will focus on patient education regarding lifestyle changes, such as diet and exercise, and discuss the importance of medication adherence to prevent progression to more severe cardiac events. The next steps will involve a referral for a stress test to further evaluate Mr. Smith's cardiac function under controlled exertion.

Section 2

Following the initial assessment and subsequent referral, Mr. Smith underwent a stress test to assess his cardiac function during physical exertion. The test was conducted without complications. During the test, Mr. Smith experienced mild chest discomfort at a moderate level of exertion, consistent with his reports of symptoms during daily activities. The exercise was halted, and the discomfort subsided within a few minutes of rest, reinforcing the diagnosis of stable angina. The stress test results showed no significant ST-segment changes, and his heart rate and blood pressure responses were within normal limits for his age and health condition.

In light of these findings, the healthcare team focused on addressing Mr. Smith’s elevated LDL cholesterol to reduce his cardiovascular risk. Mr. Smith expressed readiness to make dietary changes and engage in regular physical activity, such as walking for 30 minutes at least five times a week, to help manage his condition. He was educated on the importance of a heart-healthy diet, emphasizing the reduction of saturated fats and the inclusion of more fruits, vegetables, and whole grains. Additionally, the physician initiated a low-dose statin therapy to assist in lowering his LDL cholesterol levels, and Mr. Smith was instructed to have a follow-up lipid profile in three months to monitor progress.

Mr. Smith was also provided with guidance on recognizing potential warning signs of worsening angina or possible myocardial infarction, such as increased frequency or severity of chest pain, pain not relieved by rest, or the onset of pain at rest. He was advised to seek immediate medical attention should any of these symptoms occur. The nursing team ensured that Mr. Smith understood his medication regimen, including potential side effects, and emphasized the importance of adherence to prevent the progression of his condition. Mr. Smith left the healthcare facility feeling informed and empowered to manage his health, with plans for a follow-up appointment in one month to assess his response to the interventions and adjust his care plan as needed.

Section 3

In the weeks following his initial intervention plan, Mr. Smith diligently adhered to his prescribed lifestyle changes and medication regimen. At his one-month follow-up appointment, he reported feeling more energetic and noted a decrease in the frequency of his angina episodes. He had been walking for 30 minutes five times a week and made significant dietary adjustments, incorporating more fruits, vegetables, and whole grains while reducing his intake of saturated fats. These changes were reflected in his recent laboratory results, which showed a modest reduction in his LDL cholesterol levels from 160 mg/dL to 140 mg/dL. His total cholesterol had also decreased, indicating a positive response to the low-dose statin therapy and lifestyle modifications.

During the examination, Mr. Smith's vital signs were stable; his blood pressure was measured at 128/78 mmHg, and his heart rate was 72 beats per minute, which were both within normal limits for his age. A physical examination revealed no new findings, and he reported no episodes of chest pain at rest or increased pain during exertion. The nursing team was pleased with his progress and encouraged him to continue with his current regimen. They reinforced the importance of ongoing monitoring and adherence to his treatment plan, reminding him of the upcoming lipid profile test in two months to further evaluate the effectiveness of his interventions.

While Mr. Smith's current status was stable, the healthcare team emphasized vigilance in recognizing any potential warning signs of complications. They discussed the importance of maintaining regular follow-ups and being proactive in managing his condition. The next steps in his care plan included a continued focus on lifestyle modifications, ongoing assessment of his response to statin therapy, and ensuring open communication with the healthcare team to promptly address any concerns. Mr. Smith left the appointment feeling reassured and motivated to continue his journey towards improved cardiovascular health.

Section 4

Two months later, Mr. Smith returned for his scheduled follow-up appointment. At this visit, he reported experiencing some occasional mild chest discomfort, particularly during more intense physical activities like brisk walking uphill. However, he noted that the discomfort subsided with rest and had not been as frequent or as intense as before his treatment began. Overall, Mr. Smith felt that his energy levels remained improved, and he was able to engage in daily activities with greater ease.

The nursing team conducted a thorough assessment, noting that his vital signs remained stable. His blood pressure was recorded at 126/76 mmHg, and his heart rate was 70 beats per minute. During the physical examination, there were no new findings. Mr. Smith’s lipid profile results were reviewed, showing further improvement with an LDL cholesterol level now at 130 mg/dL and total cholesterol continuing to decline. These results suggested a positive response to the ongoing statin therapy and lifestyle changes.

Despite these improvements, the healthcare team discussed the importance of continuing to monitor Mr. Smith’s symptoms and adjusting his management plan as needed. They encouraged him to be mindful of any increase in the frequency or intensity of his chest discomfort and to report these changes promptly. The team highlighted the significance of adhering to his exercise regimen while avoiding overexertion. They also discussed potential adjustments to his medication dosage if needed, to better control his symptoms. Mr. Smith left the appointment with a reinforced understanding of his condition and a commitment to maintaining his proactive approach to managing his cardiovascular health.

Section 5

Two weeks after his follow-up appointment, Mr. Smith contacted his healthcare provider with concerns about experiencing mild chest discomfort more frequently, even during less strenuous activities such as walking on flat surfaces. Despite these episodes remaining mild and subsiding with rest, he felt that they were occurring more often than before. Mr. Smith had been diligent with his medication regimen and lifestyle modifications, but these changes in his symptoms prompted him to seek further evaluation.

Upon examination, the nursing team found that Mr. Smith's vital signs remained stable, with a blood pressure of 124/78 mmHg and a heart rate of 72 beats per minute. There were no new findings during the physical examination. To further investigate, an electrocardiogram (ECG) was performed, which revealed no acute changes but did show some nonspecific ST-segment changes suggestive of stable angina. Additionally, his latest lipid profile showed continued improvement, with an LDL cholesterol level of 125 mg/dL, supporting the effectiveness of his ongoing statin therapy.

In response to these findings, the healthcare team decided to adjust Mr. Smith's management plan to address his increased frequency of chest discomfort. They recommended a slight increase in his anti-anginal medication dosage, aiming to provide better symptom control. The team also emphasized the importance of Mr. Smith maintaining regular follow-up appointments to closely monitor his condition. Mr. Smith was advised to continue practicing moderate-intensity exercises, ensuring he avoided any activities that might provoke symptoms, and to keep track of any changes in his symptoms. With these new strategies in place, Mr. Smith felt reassured and motivated to continue working collaboratively with his healthcare team to manage his condition effectively.