Question

Patient M is a white woman, 75 years of age, who presented to her local emergency room with sudden complaints of chest pain. She described the pain as a severe substernal burning sensation that radiated across the chest to her shoulders bilaterally and then to the neck and jaw region. Although not brought on by exertion, the chest pain was associated with dyspnea, pallor, diaphoresis, nausea, and epigastric discomfort. Patient M had taken one nitroglycerin tablet with partial relief. When the chest pain recurred 10 to 15 minutes later, her family dialed 911 and the local emergency medical service responded. Once transported to the emergency room, her pain persisted. She received two additional doses of nitroglycerin and was placed on 2 L of oxygen per nasal cannula.

Following stabilization, she was admitted to a telemetry floor for further observation and medical management. Nursing assessment revealed the following cardiovascular risk factors: 50-pack-year history of cigarette smoking, hypertension, and mild-to-moderate obesity. As part of the medical workup, Patient M was scheduled for a cardiac catheterization the following day. The cardiac catheterization revealed an 80% blockage of the right coronary artery and the cardiologist recommended Patient M consider a PCI to open the coronary artery blockage.

The following day, Patient M underwent a PCI to the right coronary artery. The procedure was progressing uneventfully until she had an episode of bradycardia; her heart rate dropped to 38 beats per minute. The patient received a 0.5 mg dose of IV atropine, which was repeated in 10 minutes. Other than this episode, Patient M did not experience any other postprocedure complications, such as hypotension, or other technical-related problems.

The day after the PCI, Patient M was receiving her discharge instructions from her nurse when she began noticing a return of the dull epigastric pain. The pain did not appear to be related to her food intake because she was progressing on her diet. Later that day, as the pain persisted, Patient M had an ultrasound of her abdomen, which showed multiple walnut-sized gallstones. The gastroenterologist referred her to a general surgeon who recommended that she undergo a cholecystectomy for further relief of her gastrointestinal symptoms. The surgeon advised her of the risks and benefits of laparoscopic versus traditional surgery, and Patient M opted for the laparoscopic procedure. Four small incisions were made in her abdomen, and the cholecystectomy was performed without any complications. Three days postoperatively, she complained again of moderate-to-severe epigastric pain and became jaundiced.

An endoscopic retrograde cholangiopancreatography revealed retained stones in the common bile duct, which were removed. Patient M subsequently recovered and was discharged home after a total of nine days in the hospital.

In analyzing this case study, consider the following questions:

1. What coronary risk factors are present? What risk factors are negative?

2. Is the patient's chest pain syndrome typical or atypical for women? Why or why not?

3. What tests would you anticipate to be in the diagnostic workup of women experiencing angina?

4. What nursing diagnoses would be appropriate for this patient during hospitalization? What special implications do these diagnoses have in women?

5. What nursing intervention would you include for this patient?

6. List 3 nursing diagnosis that would be appropriate for this patient during hospitalization. What special implication do these diagnosis have in women?

7. Upon discharge of this patient list 5 aspects of patient education that should be included. Please also provide rational for each.

8. Please look up the following medications and list the drug class, desired effect of medication, side effects of medication and any patient education that should be provided with each. LISINOPRIL and NITROGLYCERIN TABLET.

Answer 1

1.What coronary risk factors are present? What risk factors are negative?

• 50-pack-year history of cigarette smoking
• hypertension
• mild-to-moderate obesity
• increased age (M is 75 Years)
• white have more risk

The negative risk factors in the patient is that she is a female. males often tend to have high risk compared to women.

2. Is the patient's chest pain syndrome typical or atypical for women? Why or why not?

The chest pain syndrome can be atypical for women. though the most common presentation is chest pain, atypical presentations are more in women than men.

The reason is that the heart disease in men often occurs due to obstruction in coronary arteries, but in women the most cases of heart disease occurs due to microvascular blockage.

3. What tests would you anticipate to be in the diagnostic workup of women experiencing angina?

a. Electro cardiogram

b. Stress test

c. Echo cardiogram

d.Blood tests for cardiac enzymes

e. CT scan

f. Cardiac MRI

g. Coronary angiography

4. What nursing diagnoses would be appropriate for this patient during hospitalization? What special implications do these diagnoses have in women?

• Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms.
• Death anxiety related to cardiac symptoms.
• Deficient knowledge about the underlying disease and methods for avoiding complication
• Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.

The woman may experience same symptoms as men for chest pain. Death related anxiety will be more for women, as they are more concerned about their family. The women are emotionally more addicted than men and they react frantically to the situation.

Women tend to ignore their illness, which leads to early non management of symptoms and also leads to complication.

A common lack of knowledge is due to the commo belief among women that, women are not prone to CAD. The statistics show CAD as a major cause of death among women too.