Which of the following findings during the initial cardiovascular assessment suggests good peripheral perfusion in the patient?

B) Capillary refill less than 2 seconds

C) Presence of peripheral edema

D) Diminished peripheral pulses

Which of the following is a classic characteristic of stable angina that differentiates it from other types of chest pain?

C) Occurs during physical exertion and is relieved by rest

A) Occurs at rest and is relieved by nitroglycerin

B) Is sharp and worsens with deep breathing

C) Occurs during physical exertion and is relieved by rest

D) Is constant and does not change with activity

Which of the following actions is most appropriate for the nurse to take in managing a patient with stable angina based on the provided diagnostic results?

C) Reinforce the importance of lifestyle modifications and adherence to prescribed medications.

A) Encourage the patient to stop taking antihypertensive medication to avoid hypotension.

B) Advise the patient to engage in vigorous exercise to improve cardiovascular health.

C) Reinforce the importance of lifestyle modifications and adherence to prescribed medications.

D) Schedule immediate emergency intervention due to the risk of myocardial infarction.

Which of the following actions is most appropriate for the nurse to take when a patient with stable angina reports new or worsening symptoms?

C) Encourage the patient to immediately seek medical attention.

A) Instruct the patient to increase their antihypertensive medication dosage.

B) Advise the patient to rest and monitor symptoms for 24 hours.

C) Encourage the patient to immediately seek medical attention.

D) Suggest the patient to wait until the follow-up appointment with the cardiologist.

What is the primary reason the nurse emphasizes lifestyle modifications for a patient with stable angina?

B) To help manage symptoms and reduce the risk of future cardiac events

A) To eliminate the need for medication

B) To help manage symptoms and reduce the risk of future cardiac events

C) To diagnose the underlying cause of chest pain

D) To increase the patient's physical strength significantly

What is the primary goal of lifestyle modifications in the management of stable angina?

B) To reduce the frequency and severity of chest pain episodes

A) To completely eliminate the occurrence of chest pain

B) To reduce the frequency and severity of chest pain episodes

C) To increase the patient's medication dosage

D) To prevent the need for surgical intervention

What is the primary purpose of adding a beta-blocker to the patient's medication regimen in the management of stable angina?

B) To reduce myocardial oxygen demand during physical activity

A) To increase heart rate and improve blood circulation

B) To reduce myocardial oxygen demand during physical activity

C) To enhance the absorption of other cardiovascular medications

D) To eliminate the need for lifestyle modifications

During a follow-up visit, a patient with stable angina is prescribed a low-dose beta-blocker to help manage exertional chest pain. What is the primary action of beta-blockers in the management of angina?

B) Decrease myocardial oxygen demand

A) Increase coronary blood flow

B) Decrease myocardial oxygen demand

C) Dilate peripheral blood vessels

What is the primary reason for the nurse to reinforce medication adherence in this patient?

B) To ensure the patient's blood pressure remains within target ranges

A) To prevent the patient from experiencing side effects

B) To ensure the patient's blood pressure remains within target ranges

C) To enhance the patient's intake of sodium

D) To allow the patient to avoid follow-up appointments

After reviewing the patient's progress post-medication adjustment, which aspect of the assessment indicates the most positive response to the beta-blocker therapy?

C) Decrease in frequency and intensity of chest pain episodes

A) Stable blood pressure of 120/75 mmHg

B) Heart rate of 68 beats per minute

C) Decrease in frequency and intensity of chest pain episodes

D) Unchanged weight with adherence to dietary recommendations

chest pain - Nursing Case Study

Pathophysiology

• Primary mechanism: Reduced blood flow to heart muscle due to narrowed or blocked coronary arteries, often from atherosclerosis, causes ischemia, leading to chest pain (angina).

• Secondary mechanism: Inflammation of the heart lining (pericarditis) can irritate nerves and tissues, resulting in sharp chest pain that worsens with breathing or lying down.

• Key complication: Prolonged ischemia can lead to myocardial infarction (heart attack), causing tissue damage and potentially life-threatening heart function impairment.

Patient Profile

Demographics:

52-year-old male, accountant

History:

• Key past medical history: Mild hypertension

• Current medications: Lisinopril 10 mg once daily

• Allergies: None

Current Presentation:

• Chief complaint: Mild chest pain

• Key symptoms: Discomfort in the chest lasting a few minutes, no radiation, associated with exertion, relieved by rest

• Vital signs: Blood pressure 128/82 mmHg, heart rate 74 bpm, respiratory rate 16 breaths per minute, temperature 98.6°F, oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon admission to the outpatient clinic, the nurse conducts a focused assessment of the patient’s cardiovascular status. The patient describes his chest pain as a mild, pressure-like sensation occurring during physical exertion, such as walking up stairs, and subsiding with rest. He rates the pain as a 3 out of 10 in intensity. The nurse notes that the patient's skin is warm and dry, and he is alert and oriented to person, place, and time. There are no signs of acute distress, and his speech is clear and coherent.

A thorough cardiovascular assessment reveals normal heart sounds with no murmurs, rubs, or gallops. Peripheral pulses are palpable and symmetric bilaterally, and capillary refill is less than 2 seconds, indicating good peripheral perfusion. The nurse also observes that the patient has no jugular venous distention or peripheral edema, which are important findings that help rule out heart failure as a complicating factor. The patient’s breath sounds are clear upon auscultation, and there is no evidence of respiratory distress.

Based on these findings, the nurse anticipates the need for further diagnostic testing to confirm the underlying cause of the chest pain. An electrocardiogram (ECG) is ordered to assess for any ischemic changes or cardiac rhythm abnormalities. Additionally, laboratory tests, including cardiac enzymes such as troponin, are planned to evaluate for any myocardial damage. The nurse educates the patient about the potential need for lifestyle modifications and adherence to his antihypertensive medication to manage his mild hypertension and reduce the risk of future cardiac events. This comprehensive initial assessment and patient education provide a foundation for the next steps in the patient's care journey.

Section 2

New Diagnostic Results:

Following the initial assessment, the results from the electrocardiogram (ECG) and laboratory tests become available. The ECG shows no significant ST-segment changes or arrhythmias, suggesting an absence of acute ischemia or conduction abnormalities at this time. The cardiac enzyme panel, including troponin levels, returns within normal limits, further indicating that there is no acute myocardial infarction. These findings are reassuring and suggest that the patient's chest pain may be related to stable angina rather than an acute coronary syndrome.

Despite the normal diagnostic results, the nurse continues to monitor the patient's vital signs closely. The patient's blood pressure is observed to be slightly elevated at 142/88 mmHg, with a heart rate of 78 beats per minute. His respiratory rate remains at 16 breaths per minute with an oxygen saturation of 98% on room air. The nurse reinforces the importance of adhering to the prescribed antihypertensive medication and discusses with the patient lifestyle modifications, such as dietary changes and a graduated exercise program, to optimize cardiovascular health and prevent future episodes of chest pain.

The nurse schedules a follow-up appointment for the patient with a cardiologist for further evaluation and management of his stable angina. In the meantime, the patient is advised to monitor his symptoms and to seek immediate medical attention should the chest pain increase in intensity or frequency, or if any new symptoms such as shortness of breath or dizziness develop. This plan helps ensure that the patient remains stable and effectively manages his condition while awaiting specialist consultation.

Section 3

A few days after the initial assessment, the patient returns to the clinic reporting mild, intermittent chest pain that occurs during exertion but resolves with rest. This change in the patient's status prompts the nurse to conduct a thorough reassessment. The patient's vital signs remain relatively stable, with a blood pressure of 140/86 mmHg and a heart rate of 80 beats per minute. The patient denies experiencing any new symptoms such as dizziness or shortness of breath, and his oxygen saturation is steady at 98% on room air. However, the patient expresses concern about the recurrence of chest pain, prompting the nurse to review the patient's current management plan and adherence to lifestyle modifications.

The nurse takes this opportunity to emphasize the importance of the patient's adherence to lifestyle changes, particularly diet and exercise, to help manage his stable angina. She provides additional educational resources and discusses strategies to incorporate heart-healthy foods into his diet, such as increasing intake of fruits, vegetables, and whole grains. She also reiterates the importance of gradually increasing physical activity levels, encouraging the patient to start with short, daily walks and gradually increase the duration and intensity as tolerated. The nurse reassures the patient that these lifestyle changes, along with adherence to prescribed medications, can help manage his symptoms and reduce the risk of future cardiac events.

To address the patient's ongoing concerns, the nurse arranges for an expedited follow-up appointment with the cardiologist to reassess his treatment plan and determine if any adjustments are needed. She advises the patient to maintain a symptom diary, noting the frequency and triggers of his chest pain, and to bring this information to the cardiologist appointment. This approach not only empowers the patient to actively participate in his care but also provides the healthcare team with valuable information to fine-tune his management plan.

Section 4

A week later, the patient returns for his follow-up appointment with the cardiologist. During this visit, new diagnostic tests are conducted, including an electrocardiogram (ECG) and a stress test. The ECG results reveal minor nonspecific changes, but no acute ischemic changes are observed, providing some reassurance regarding the stability of the patient’s condition. During the stress test, the patient experiences mild chest discomfort at a moderate level of exertion, which subsides quickly with rest. These findings suggest that while the patient’s angina is stable, there is room for optimizing his current treatment regimen.

In response to these results, the cardiologist decides to adjust the patient’s medication plan, adding a low-dose beta-blocker to help reduce the frequency and severity of exertional chest pain. This addition aims to improve the patient’s exercise tolerance by decreasing myocardial oxygen demand during physical activity. The cardiologist also emphasizes the importance of continuing with lifestyle modifications, highlighting the positive impact these changes can have on heart health and overall well-being.

The nurse takes this opportunity to review the patient's recent symptom diary, noting that while episodes of chest pain are less frequent, they still occur during more strenuous activities. She reinforces the significance of adhering to the new medication regimen and encourages the patient to continue monitoring his symptoms closely. The nurse also schedules a follow-up appointment in one month to evaluate the patient’s response to the medication adjustment and to reassess his progress with lifestyle changes. This follow-up is crucial to ensure that the patient's angina remains stable and that he is supported in managing his condition effectively.

Section 5

Response to Interventions

A month after the medication adjustment, the patient returns for his follow-up appointment. The nurse conducts a thorough assessment, noting that the patient reports a significant decrease in the frequency and intensity of chest pain episodes. He mentions feeling more confident engaging in daily activities and mild exercise, which he had previously avoided due to discomfort. The patient states that he has been taking the prescribed beta-blocker regularly, as instructed, and has noticed a marked improvement in his overall stamina and energy levels.

Vital signs are stable, with a blood pressure reading of 120/75 mmHg and a heart rate of 68 beats per minute, both within target ranges. The patient’s weight is unchanged, and he reports adherence to dietary recommendations, including reduced sodium intake and increased consumption of fruits and vegetables. The patient also highlights maintaining regular physical activity, primarily through walking and light aerobic exercises, as recommended by the cardiologist.

The nurse reviews the patient’s symptom diary, which reveals only two mild episodes of chest discomfort over the past month, both resolving quickly with rest. Encouraged by these positive outcomes, the nurse reinforces the importance of continued medication adherence and regular follow-up appointments. She also discusses strategies for gradually increasing physical activity while monitoring for symptoms, emphasizing the role of lifestyle changes in sustaining heart health. The patient is scheduled for another follow-up in three months to continue monitoring his progress and to ensure the stability of his condition.