The Nursing Process Discussion
Semachew (2018) defines the nursing process as step-by-step approach to provide care by conducting assessments, making diagnoses, creating care plans, implementing and conducting evaluations. This paper discusses the nursing process of a 48-year-old married male patient who presented with mild chest pain, chronic fatigue, indigestion after eating, frequent eructation, and flatulence. It describes the additional subjective and objective data to obtain as part of the assessment, the diagnostic tests to order, nursing and medical diagnoses, legal and ethical considerations, and the patient’s plan of care. The author will also discuss the Healthy People 2020 objectives to consider and additional patient education to help the client make informed decisions. The Nursing Process Discussion
Subjective data refers to the signs and symptoms reported and described by a patient that may or may not be visible to a healthcare provider. The patient complains of fatigue and mild chest pain that is relieved from taking a break from work. The patient should state the exact site of the chest pain, whether it has a sudden or gradual onset, the character of the pain, where it radiates, the symptoms it is associated with, if there is a specific time or position that the pain begins, and if it has exacerbations. Besides, the patient should rate the severity of the pain on a pain scale of 1-10.
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He also complains of frequent eructation, flatulence, and indigestion after eating. The client should provide more information on the type of food that causes the gastrointestinal (GIT) disturbance, which could be happening after all meals or a specific class of the food. He should state the duration that he the aforementioned symptoms, and whether it is associated with symptoms such as diarrhea or vomiting. On the GIT, the client should mention any allergies related to food and medical products. In most cases, patients tend to manage symptoms using self-prescribed drugs bought either over the counter or from a previous incomplete dose. The client should provide information on any medical products that he may have used to manage the symptoms before coming to the hospital
Objective data is obtained from observation, diagnosing testing, lab test, and physical examination. The nurse should conduct a review of systems to obtain additional information that will help to make definite baseline data as well as make a diagnosis. The review entails the assessment of aspects like color, integrity sounds produced, and if the organs are palpable among others. The nurse should assess the skin integrity, itchiness, and changes on the nails. After the skin, the nurse should also evaluate the organs in the head that is the eye, mouth, nose, and ears for abnormal finds like color changes for the eye, secretions, and possible swelling. Evolution on the neck includes distended veins or stiffness.
Objective data around the chest region contains both the circulatory and the respiratory systems. Since one of the clients complains as chest pain, the nurse should collect more data through that will be used in making a diagnosis. Other than observing breathing patterns, the nurse should percuss, palpate, and auscultate the chest region to collect the sounds produced by the client’s chest during the various procedures. The review on the GIT includes the presence of bowel movements, constipation, distended stomach, vomiting, diarrhea, and food intolerance. In the urinary system the nurse should assess for urine incontinency, palpable bladder, swelling on the testicles, rashes, or ulcers on the penis and the volume of the urine produced. On the peripheral vascular, the nurse should assess for varicose veins, leg claps, and clots in the veins.
The muscular-skeletal system areas of interest should be pain, broken limbs, stiffness, decreased joint movement and swelling. Another aspect of objective data obtained from the review of systems is the neurologic status of the client. The review will assess if the client has tremors, paralysis, seizures, weakness, numbness, loss of consciousness, and muscle spasms. For the hematologic aspect, the nurse should assess for anemia, easy bleeding on bruising, and past blood transfusion during cholecystectomy and vasectomy procedures that he underwent in the past. The endocrine system is also essential where the caregiver obtains data like excessive sweating, frequent urination, excessive thirst, increased appetite, and thyroid troubles. The mental status of the client is also essential where the health provider evaluates for signs of depression, insomnia, memory loss, anxiety, or previous psychiatric treatment.The Nursing Process Discussion
Appropriate National Guidelines
According to the hypertension guidelines provided by the American College of Cardiology (ACC) and American Heart Association (AHA) ACC/AHA, the client’s blood pressure (148/88) indicates that he has hypertension stage two and a BMI of 32.82 signifies obesity (Whelton et al., 2018). Besides, the patient’s lab results indicate that he has borderline high levels of total cholesterol (TC) at 230, Low-Density Lipoproteins (LDL) at 180 is high, and High-Density Lipoproteins (HDL) at 32 is potentially low.
LDL is bad cholesterol and it places the patient at high risk of accumulation and blockage of cholesterol in the arteries. In comparison, HDL is the good cholesterol that safeguards against heart diseases. Thus, it should be higher (Whelton et al., 2018). ACC/AHA advises that HDL levels below 40mg/dL are low and a potential risk factor for developing cardiovascular disease. To add on, based on the guidelines provided by the American Diabetes Association (ADA), the patient’s blood glucose of 178 indicates that he is in the prediabetes range. This information should prompt the nurse to initiate the management of hypertension and dyslipidemia.
CT-scan of the Chest-to rule out other causes of chest pain such as pneumonia, blood clots on lung blood vessels, or aortic disease.
CT angiography- since the patient’s lab results reveal that he had elevated blood cholesterol levels, a CT angiography is important to evaluate the likelihood of narrowing of the heart blood vessels due to plaque.
ECG- will record the electrical activity of the heart and help to detect the likelihood of abnormalities such as ischemia or arrhythmias (Whelton et al., 2018).
Cardiologist- objective and subjective data reveal that he has a high cardiovascular risk. Obese and hypertensive patients with dyslipidemia who experience stable angina are likely to experience MI (Whelton et al., 2018). Thus, it will be necessary to consult with a cardiologist to initiate management to prevent a likelihood of MI and associated complications.
Diabetes Educator– Since the patient is also within the prediabetes range, the nurse should also consult with a diabetes educator to educate the patient about the prevention of diabetes through lifestyle modification.
Clinical Nutritionist- the ACC/AHA guidelines recommend a DASH diet as part of the management of patients with hypertension (Whelton et al., 2018). Consulting with a clinical nutritionist will provide greater insights on the most appropriate foods to consider for both dyslipidemia and hyperlipidemia. The Nursing Process Discussion
Medical and Nursing Diagnosis
The medical diagnosis of the client is coronary artery disease that occurs when the cardiac arteries narrow or is blocked, causing the blood supply to the heart muscles. The condition presents with increased blood pressure, activity intolerance, and chest pains (Koganti et al., 2017). Nursing diagnosis includes acute pain related to limited oxygen supply to the heart muscles evidenced by patient verbalization. The client is also at risk of anxiety related to the crisis where he does not know the outcome of the current health status.
The nurse should obtain informed consent from the client for a possible heart procedure to correct the condition. When providing care, the healthcare providers should ensure the patient receives the right of autonomy and surrogate decision-makers should the managing team resolve conducting a heart surgery as the best treatment therapy for the client.
Coronary artery disease is best managed by percutaneous coronary revascularization to increase blood flow on heart arteries (Head et al., 2 018). The patient should also be given drug therapy to control cholesterol levels in the body causing blockage of the arteries. The physician should prescribe angiotensin-converting enzyme (ACE) inhibitors and angiotensin II receptor to control the patient’s blood pressure levels (Doyle et al., 2019). The nurse should constantly take vital signs and more so the blood pressure since he is at risk of hypertension. High blood pressure is likely to cause kidney failure, therefore, the nurse should monitor fluid intake and output to evaluate renal function. The nurse should also administer analgesics to control pain and restlessness on the patient.
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Healthy People 2020 Objectives to Consider
The management of this patient requires the consideration of Healthy People 2020 objective HDS-10.1 and objective NWS-9. Objective HSD-10.1 aims at increasing the proportion of adults with hypertension who meet the recommended guidelines for BMI while objective NWS-9 purposes to reduce the proportion of adults who are obese while objective HDS-10.1 (Healthy People, 2020). The Nursing Process Discussion
Circle of Care and Teaching
The circle of care helps to ensure care continuity, familial, and social support. The wife should be involved in the circle of care as she can provide valuable information about his functioning while at home as well as ensure that he complies with treatment. The family should receive additional teaching about coronary artery disease, hypertension, and obesity. Doyle et al (2019) acknowledge patient education as an important aspect in the nursing process that promotes patient-centric care and increases compliance to management, Education should include vital information on dietary modifications to prevent complications, including the need to reduce salt intake, tobacco smoking, and alcohol consumption. Education should particularly focus on the impact of lifestyle activities such as exercise in reducing blood pressure, preventing diabetes, and reducing the amount of bad cholesterol in the body. References
Doyle, F., Freedland, K., Carney, R., De Jonge, P., Dickens, C., Pedersen, S., & Dempster, M. (2019). Network meta-analysis of randomized trials of pharmacological, psychotherapeutic, exercise, and collaborative care interventions for depressive symptoms in patients with coronary artery disease: a hybrid systematic review of systematic reviews protocol. Systematic reviews, 8(1), 71.
Head, S. J., Milojevic, M., Daemen, J., Ahn, J. M., Boersma, E., Christiansen, E. H., & Hlatky, M. A. (2018). Stroke rates following surgical versus percutaneous coronary revascularization. Journal of the American College of Cardiology, 72(4), 386-398.
Healthy People (2020). Heart Disease and Stroke. Retrieved September 2, 2020, from https://www.healthypeople.gov/2020/topics-objectives/topic/heart-disease-and-stroke/objectives
Koganti, S., Eleftheriou, D., Brogan, P. A., Kotecha, T., Hong, Y., & Rakhit, R. D. (2017). Microparticles and their role in coronary artery disease. International journal of cardiology, 230, 339-345
Semachew A. (2018). Implementation of the nursing process in clinical settings: the case of three governmental hospitals in Ethiopia, 2017. BMC research notes, 11(1), 173. https://doi.org/10.1186/s13104-018-3275-z
Whelton, P. K., Carey, R. M., Aronow, W. S., Casey, D. E., Collins, K. J., Himmelfarb, C. D., … & MacLaughlin, E. J. (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the prevention, detection, evaluation, and management of high blood pressure in adults: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Journal of the American College of Cardiology, 71(19), e127-e248. The Nursing Process Discussion