What is the most appropriate initial nursing action for Mr. Johnson when he experiences mild, intermittent chest discomfort during physical activity?

B) Encourage him to rest and monitor his symptoms.

A) Administer prescribed nitroglycerin.

B) Encourage him to rest and monitor his symptoms.

C) Call emergency services immediately.

D) Provide oxygen therapy at 2 L/min via nasal cannula.

Mr. Johnson experiences mild chest discomfort primarily during physical activities. Which of the following is the most appropriate initial nursing action?

B) Advise Mr. Johnson to rest and stop the activity when discomfort occurs

A) Instruct Mr. Johnson to take deep breaths to alleviate the discomfort

B) Advise Mr. Johnson to rest and stop the activity when discomfort occurs

C) Encourage Mr. Johnson to continue the activity to improve his cardiac endurance

D) Recommend Mr. Johnson to increase fluid intake to prevent dehydration

What is the primary purpose of prescribing a beta-blocker for a patient with hypertension and stable angina?

C) To decrease blood glucose levels

What is the primary reason for Mr. Johnson's healthcare provider considering the addition of a statin to his medication regimen?

B) To reduce his LDL cholesterol levels

C) To alleviate chest discomfort

D) To increase his HDL cholesterol levels

What is the primary reason for the nurse to instruct Mr. Johnson to rise slowly from a sitting or lying position?

A) To prevent dizziness and reduce the risk of falls

B) To increase his blood pressure immediately

C) To enhance his respiratory rate

What is the primary reason for monitoring Mr. Johnson's blood pressure regularly after adjusting his medication regimen?

A) To ensure his blood pressure remains within the target range

B) To check for signs of dehydration

C) To monitor for potential allergic reactions to the medication

D) To assess his kidney function

Which vital sign finding in Mr. Johnson indicates effective management of his heart condition?

B) Oxygen saturation of 95% on room air

C) Heart rate of 90 beats per minute

D) Respiratory rate of 22 breaths per minute

During a routine check-up, Mr. Johnson reports mild shortness of breath when climbing stairs. Which nursing intervention is most appropriate to further evaluate this new symptom?

B) Perform an electrocardiogram (ECG) to assess cardiac function.

A) Encourage Mr. Johnson to increase his daily walking to improve stamina.

B) Perform an electrocardiogram (ECG) to assess cardiac function.

C) Advise Mr. Johnson to take deep breaths to alleviate the shortness of breath.

D) Recommend Mr. Johnson to rest and avoid any physical activity.

Heart disease - Nursing Case Study

Pathophysiology

• Primary mechanism: Atherosclerosis - This is the buildup of plaque (fat, cholesterol, and other substances) inside the arteries, leading to narrowing and reduced blood flow to the heart, which can cause chest pain or heart attacks.

• Secondary mechanism: Hypertension - High blood pressure causes the heart to work harder to pump blood, leading to thickening of the heart muscle and potential heart failure over time due to the increased workload.

• Key complication: Myocardial Ischemia - Reduced blood flow can lead to a lack of oxygen supply to heart tissues, causing chest pain (angina) and increasing the risk of heart tissue damage or death if untreated.

Patient Profile

Demographics:

54-year-old male, office manager

History:

• Key past medical history: Family history of heart disease, borderline hypertension

• Current medications: Low-dose aspirin, atorvastatin

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Occasional chest discomfort during exertion

• Key symptoms: Mild chest pain, shortness of breath on exertion

• Vital signs: Blood pressure 130/85 mmHg, heart rate 78 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F

Section 1

Initial Assessment Findings:

Upon conducting a thorough nursing assessment, the patient, Mr. Johnson, remains alert and oriented, with no apparent distress. However, he reports mild, intermittent chest discomfort lasting a few minutes, primarily occurring during physical activities such as climbing stairs. He describes the discomfort as a pressure-like sensation, rating it at a 3 out of 10 on the pain scale. The pain typically resolves with rest. His skin is warm and dry, and there are no signs of cyanosis or diaphoresis. Breath sounds are clear bilaterally, and he denies experiencing palpitations or dizziness.

The cardiovascular assessment reveals that his heart sounds are regular, with no murmurs or extra heart sounds. Peripheral pulses are palpable and symmetrical, with a capillary refill time of less than 2 seconds. An electrocardiogram (ECG) performed in the office shows normal sinus rhythm with no acute changes, although some slight ST-segment depression is noted, suggesting possible ischemia during exertion. Based on these findings, Mr. Johnson is educated about the importance of maintaining regular follow-up visits and adhering to his medication regimen to manage his atherosclerosis and hypertension effectively. He is advised to monitor his symptoms and seek immediate medical attention if he experiences more severe or persistent chest pain, as this could indicate a worsening condition requiring prompt intervention.

Section 2

Several weeks following his initial assessment, Mr. Johnson returns for a scheduled follow-up appointment. During this visit, he reports that he has been adhering to his prescribed medication regimen, which includes a low-dose aspirin and a beta-blocker to help manage his hypertension and reduce cardiac workload. He continues to experience mild chest discomfort during exertion but notes that the frequency and intensity of the episodes have decreased. He rates the discomfort now at a 2 out of 10 on the pain scale. He has also incorporated lifestyle modifications, such as a low-sodium diet and regular light exercise, as recommended by his healthcare provider.

New diagnostic results include a repeat ECG and a lipid panel. The ECG again shows normal sinus rhythm, with no new changes from the previous tracing. The ST-segment depression remains present but unchanged, consistent with stable exertional angina. His lipid panel reveals that his total cholesterol is slightly elevated at 210 mg/dL, with an LDL cholesterol level of 130 mg/dL, which is above the target range for a patient with heart disease. HDL cholesterol is within normal limits, and triglycerides are slightly elevated. Based on these findings, Mr. Johnson's healthcare provider discusses the potential benefits of adding a statin medication to his regimen to help manage his cholesterol levels and further reduce his risk of cardiac events.

These developments provide a foundation for Mr. Johnson's continued management and monitoring. The nursing team emphasizes the importance of continuing lifestyle changes and medication adherence, as well as recognizing any new or worsening symptoms. Mr. Johnson is encouraged to maintain regular follow-up appointments to monitor his condition and adjust his treatment plan as necessary. This proactive approach aims to prevent the progression of his heart disease and minimize the risk of complications.

Section 3

In the following weeks, Mr. Johnson continues with his prescribed regimen and lifestyle modifications. During a routine check-in call from the nursing team, he reports feeling generally well, though he has noticed a slight increase in fatigue and occasional dizziness, particularly when standing up quickly. These symptoms prompt a visit to the clinic for further assessment. Upon arrival, Mr. Johnson's vital signs are taken, showing a blood pressure of 118/76 mmHg, which is lower than his previous readings. His heart rate is stable at 68 beats per minute, and his respiratory rate is 16 breaths per minute. Oxygen saturation is 97% on room air.

The nursing team conducts a thorough assessment, considering potential causes for Mr. Johnson's new symptoms. His medication list is reviewed, and it is noted that the recent introduction of a statin, in addition to his beta-blocker, might be contributing to his fatigue. The possibility of orthostatic hypotension due to the combination of medications is also considered. The nurse performs an orthostatic blood pressure measurement, which reveals a drop of 12 mmHg in systolic pressure when Mr. Johnson moves from a seated to a standing position, supporting this hypothesis.

Based on these findings, the nurse collaborates with Mr. Johnson's healthcare provider to adjust his medication plan. The beta-blocker dosage is slightly reduced to address the orthostatic hypotension, and Mr. Johnson is advised to rise slowly from sitting or lying positions to mitigate dizziness. Education is provided on recognizing signs of hypotension and ensuring adequate hydration. Mr. Johnson is encouraged to monitor his symptoms closely and contact the clinic if they persist or worsen. This adjustment is intended to enhance his comfort and safety while maintaining effective management of his heart disease, reflecting the importance of individualized care in chronic disease management.

Section 4

In the following weeks, Mr. Johnson adheres diligently to the newly adjusted medication regimen and lifestyle recommendations. During a follow-up appointment at the clinic, the nursing team evaluates his response to the recent interventions. Mr. Johnson reports a noticeable decrease in dizziness, especially when transitioning from sitting to standing. His energy levels have improved, although he still experiences mild fatigue in the late afternoon. This improvement is encouraging, indicating a positive response to the adjustments made.

Vital signs are assessed, showing a blood pressure of 122/78 mmHg and a heart rate of 70 beats per minute. Both readings are stable and within the target range, suggesting effective control of his heart disease without significant adverse effects from the medication. A repeat orthostatic blood pressure measurement shows a minimal drop of 5 mmHg in systolic pressure, confirming that the reduction in beta-blocker dosage has effectively managed the orthostatic hypotension. Mr. Johnson's oxygen saturation remains steady at 98% on room air, and his respiratory rate is 16 breaths per minute.

The nursing team also reviews Mr. Johnson's recent blood work, which reveals that his lipid profile has improved, with a slight reduction in LDL cholesterol levels, likely due to the introduction of the statin. These findings point to successful management of his cardiovascular risk factors. As Mr. Johnson continues on this path, the nursing team emphasizes the importance of ongoing monitoring and encourages regular follow-up visits to maintain stable health status and prevent potential complications. They reiterate the significance of lifestyle modifications, such as a heart-healthy diet and regular exercise, as integral components of his treatment plan.

Section 5

Two months after the last follow-up, Mr. Johnson returns to the clinic for a routine check-up. He is pleased to report that he has been adhering to his prescribed heart-healthy diet and walking for at least 30 minutes daily, as recommended. Upon initial assessment, Mr. Johnson's vital signs remain stable with a blood pressure of 118/76 mmHg, a heart rate of 68 beats per minute, and oxygen saturation holding steady at 98% on room air. He mentions feeling more energetic throughout the day, though he occasionally experiences mild shortness of breath when climbing stairs, a new symptom that prompts further investigation.

The nursing team conducts a thorough physical examination, noting clear lung sounds and no signs of peripheral edema. Despite the mild shortness of breath, Mr. Johnson's respiratory rate remains normal at 16 breaths per minute, providing some reassurance. However, in light of the new symptom, the team decides to perform an electrocardiogram (ECG) and schedule a stress test to evaluate his cardiac function under exertion. The ECG reveals no significant changes compared to previous results, but the decision to proceed with further testing is confirmed to rule out any progression of heart disease.

As the nursing team discusses these findings with Mr. Johnson, they emphasize the importance of continuing his current medication regimen and lifestyle habits while awaiting the results of the stress test. They encourage him to monitor his symptoms closely and report any worsening or new developments. This proactive approach is intended to maintain his current stability and address any potential complications early, ensuring a comprehensive and continuous management plan for his heart health.