Coronary Heart Disease: A Patient Care Plan

Introduction

Selected Case Description

Coronary heart disease is a widely diagnosed physiological impairment that adversely impacts human well-being healthy functioning and often leads to increased mortality. One of the historical figures who suffered from coronary heart disease was President William Howard Taft. The cause of his death was a heart attack on March 8, 1930, in Washington, DC. Taft was the 27^th President of the United States from 1909 till 1913; after his presidency, Taft was appointed to the position of Chief Justice in the Supreme Court; he died in 1930 (Fallon, 2019). This disease is particularly dependent on lifestyle choices, especially unhealthy diet, substance use, and limited movement (Severino et al., 2020). The illness is a prevailing heart problem that requires adequate prevention and treatment methods advancement.

Normal Physiological Functioning

The healthy functioning of the heart is based on the non-disrupted work of the organ when pumping blood to all body systems. Under normal circumstances in a healthy individual, the blood is transmitted to the heart through coronary arteries, which provide nutrients and oxygen to body organs (Severino et al., 2020). In a healthy individual, the coronary arteries are clear without any formations that obstruct blood flow to the heart. In such a manner, the delivery of blood with oxygen and nutrients to the whole body is timely and undisrupted, which guarantees the healthy functioning of the entire physiological system.

Pathophysiology

Coronary heart disease is an impairment in the functioning of arteries that obstructs the delivery of oxygen to the heart. It occurs under the influence of plaques in the coronary arteries. The disease is caused by “the presence of an obstructive atherosclerotic plaque, which causes a blood flow reduction to the myocardium” (Severino et al., 2020, p. 2). The build-up of plaque on the inside of arteries that makes them narrower and more difficult for blood to pass is called atherosclerosis, which is a factor contributing to coronary heart disease (Severino et al., 2020, p. 2). Atherosclerosis further results in myocardial ischemia, which might result in a heart attack and may lead to disability or death.

Clinical Manifestations

The clinical manifestations of coronary heart disease include symptoms and signs that might signalize the problem. Firstly, the signs that might indicate coronary heart disease in a patient include dizziness, cold sweat, pain in the neck, shortness of breath, difficulty sleeping, and weakness (“Coronary heart disease,” n. d.). Secondly, chest pain is a common sign of heart problems in general and coronary heart disease in particular. However, women are “less likely than men to experience chest pain” but more often experience fatigue, nausea, pressure in the chest, and stomach pain (“Coronary heart disease,” n. d., para. 5). These signs and symptoms might vary from patient to patient and be manifested more or less severely.

Influence on Body Systems

Since coronary heart disease disrupts the heart, this impairment affects other vital body systems. Firstly, it might disrupt the functioning of the cardiovascular system due to possible complications. They include “acute coronary syndrome, including angina or heart attack, arrhythmia, heart failure, cardiogenic shock, and sudden cardiac arrest” (“Coronary heart disease,” n. d., para. 5). With the obstructed blood flow to the heart, the blood supply to the digestive, respiratory, muscular systems, and brain is insufficient. That is why these systems might not function properly. Moreover, coronary heart disease adversely impacts the nervous system by disrupting its balanced functioning, which deteriorates heart function in the future. Thus, coronary heart disease is a severe health problem that might disturb the normal physiological work of the whole body or its particular systems.

History

Historical Variations

Coronary heart disease, or coronary artery disease, or ischemic heart disease are all the names of the prevalent heart issue that has been identified in the selected case. Although it has been experienced by people since ancient times, its discovery with proper clinical manifestations articulated is dated by the 19^th century with the invention of the coronary arteriography (Hajar, 2017). This disease is often faced by many people representing a variety of professions, cultural and lifestyle backgrounds, family histories, and psychological circumstances.

In particular, among some famous people who have suffered from coronary heart disease are American journalist and TV presenter Larry King, a renowned TV show host David Letterman, and an actress Elizabeth Taylor (Porter, 2017). Moreover, some politicians have had heart disease, including former US President Bill Clinton and former Vice President Dick Cheney (Porter, 2017). The variations of the disease in these cases included a different number of heart attacks in individuals, a variety of causes, ranging from heavy smoking to family history, and differences in treatment outcomes. Thus, the historical variations of the selected case indicate that the disease is highly prevalent in the United States and has multiple risk factors and manifestations.

Psychological Stressors and Mechanisms Impacting the Disease

Psychological stressors are perceived to be a significant risk factor causing the onset and development of coronary heart disease. Research shows that excessive and continuous exposure to stress increases cortisol levels and further causes the growth of cholesterol levels with ultimate artery plaque-forming (Beer et al., 2020). In addition, anxiety, depression, and post-traumatic stress disorder are considered significant psychological factors contributing to coronary heart disease (Beer et al., 2020; Fallon, 2019). Moreover, sleep deprivation and low quality are found to have an impact on coronary artery disease. In particular, “poor sleep causes changes in circulating levels of leptin and ghrelin, which can facilitate the development of obesity and impair glycemic control,” ultimately leading to artery plaques and the development of heart disease (Lao et al., 2018, p. 116). Thus, psychological factors have a high level of influence on the onset of ischemic heart disease in different patient groups.

As for the adaptive psychological mechanisms attributed to coronary heart disease, they include patients’ adjustment to the manifestations of the illness and change in lifestyle to minimize the symptoms and treat the condition. In particular, improvement of sleep, minimization of stress, anxiety, and unhealthy food, increased mindfulness in diet and physical activity contribute to adaptation to coronary heart disease (Beer et al., 2020; “Coronary heart disease,” n. d.; Lao et al., 2018). Through such mechanisms and actions, patients are capable of adjusting their perception of their condition and facilitating their lifestyles in a way that allows them to improve their state of health.

Historical Impact of Patient Care Technology

The case of President William Howard Taft demonstrates a significant impact of the historic setting on the patient’s health outcomes. Indeed, since Taft suffered from coronary heart disease in the 1920s, the diagnosis and treatment of the disease were insufficient compared to modern technologies (Fallon, 2019). The formulation of the causes of the disease, such as “hard work” or “overworking,” implies the lack of an in-depth analysis of the causes of the disease and its proper treatment (Fallon, 2019, p. 585). Over time, the development of patient care technologies significantly improved due to the use of computer-based tools and arteriography diagnosis (Hajar, 2017). Prior underdevelopment of the patient care technologies had tragic outcomes for the selected case’s individual since President William Howard Taft died of a heart attack.

Planning, Intervention, Evaluation, and Research

Nursing Diagnosis	Expected Outcome	Nursing Interventions	Rationale	Evaluation
Coronary Artery Disease	The treatment of coronary heart disease necessitates a thorough plan for care that would incorporate addressing the risk factors, manifestations, individual patient particularities, and best treatment practices. A well-tailored care plan should be based on an accurate and measurable goal statement. The patient-centered goal for the case is to stabilize blood pressure to its norm within the range of 120/80 and 140/90 within six months. Another long-term goal is to reduce the chest pain level to 3 on a scale from 1 to ten within six months. The plan of care should also include a long-term goal of decreasing cholesterol level to 200mg/dl within six months. The short-term goal is transitioning to a low-fat, healthy diet of consuming 50% of food in vegetables; the diet should become a regimen within two weeks. Another short-term goal is keeping a consistent physical activity regimen of not less than 150 minutes per week of moderate exercise; the regiment should become consistent within two weeks.	Symptom monitoring ensures their timely management (Jarvis & Saman, 2017). Monitoring of vital signs. Chest pain severity assessment to identify the acuteness of the experienced discomfort (Ramadhani et al., 2019). Identification of activities that trigger pain to promote avoiding them (Ramadhani et al., 2019). Administration and instruction on the intake of medications for coronary heart disease. Educating on the disease management skills and psychotherapeutic services for disease management (Ramadhani et al., 2019). Counseling on a healthy diet and physical activity. The medication types that should be administered to the patient include the following: Pain relief medications (Jarvis & Saman, 2017); Cholesterol-lowering medications (Ramadhani et al., 2019); Medications for thrombolysis (Jarvis & Saman, 2017); Antiplatelet agents, such as “non-enteric coated aspirin” and the “P2Y12 antagonist group of antiplatelet drugs” (Jarvis & Saman, 2017, p. 33); Antihypertensive medications. When implementing a patient plan of care, nursing staff should ensure that the patient is not only properly instructed but also equipped with patient technologies enabling them to manage their condition independently. Multiple patient technologies have been developed to assist individuals suffering from coronary heart disease with tools and applications for treatment consistency and monitoring. For example, the patient might be advised on using a step and heart rate tracker to monitor activity and heart rate, as well as to conduct self-assessment and learn about the condition management (CDC, 2021). Overall, the advancement of technologies related to patient care for individuals with coronary artery disease is sufficient for promoting health. In particular, screening, diagnosing, and treatment technologies are based on non-invasive computer-assisted technologies that allow for timely detection of the impairments and their elimination (Jarvis & Saman, 2017; Ramadhani et al., 2019). Overall, it is essential to disseminate information about the available technologies to empower patients for timely screening and treatment. To decrease medication errors, the nursing staff should educate the patient on proper intake and the risks of neglecting the rules and instructions. The methods of increasing health literacy might be helpful in preventing improper medication intake by the patient (Ramadhani et al., 2019). The level of patient care technologies development is high enough to assist individuals in accelerating their health literacy. The patient for the selected case might utilize self-monitoring devices, access information online, and use medication intake assistant applications to ensure proper treatment plan adherence.	The nursing concerns that are associated with the patient’s condition include the manifestation of coronary heart disease that threatens the patient’s health and life. The prioritized issue is high blood pressure that indicates the existence of plaques and serves as a rationale for the identified goals and interventions. The rationale for addressing chest pain is that it indicates an impairment in heart function that requires immediate treatment (Centers for Disease Control and Prevention [CDC], 2021). Chest pain, or angina, “can happen when too much plaque builds up inside arteries, causing them to narrow” (CDC, 2021, para. 5). Thus, this concern would require a prioritized action from the nursing treatment standpoint The rationale for addressing cholesterol levels is another concern that should be addressed through lifestyle changes, monitoring, and medication to minimize threats (“Coronary heart disease,” n. d.). Goals 4 and 5 are based on the rationale of environment and occupation’s significant role in the case of patient’s condition that should be of concern to nurses. Indeed, since the patient is excessively exposed to stress and long working hours, such a lifestyle increases the likelihood of bearing negative outcomes of the disease (“Coronary heart disease,” n. d.). Thus, integrating these concerns should be prioritized when implementing the patient care plan for the selected patient’s patient. These goals would be proper patient-centered guidelines to adjust the patient’s lifestyle and address the manifestations of the disease. According to the suggested plan, the technologies that might be used to assist in the treatment of the patient should include both monitoring and treatment tools. Firstly, to monitor the development of the disease and the changes in the heart, health care providers might use electrocardiograms and coronary angiograms in the hospital setting, as well as heart rate self-assessment (CDC, 2021). Moreover, the patient might be advised on using some e-Health tracking devices and applications to adhere to a healthy diet and physical activity.	In order to evaluate the outcomes of the implemented plan for care for the patient from the selected study, one should identify some measurable criteria indicating improvements or deterioration of results. The data that would be the most indicative of the plan’s success might include the following. The blood pressure level before and after the interventions should be measured and compared. In the outcome, the patient’s blood pressure is within the range of 120/80 and 140/90 within six months. Chest pain scaling should be conducted before and after the treatment plan to identify the improvement in pain management (Jarvis & Saman, 2017). The outcome is that the patient reports a chest pain level of 3 on a scale from 1 to 10 within six months. The cholesterol level before and after the plan implementation should be assessed and compared to detect changes (Ramadhani et al., 2019). The blood test demonstrates that the patient’s cholesterol level is lower than 200 mg/dl within six months. Adherence to a healthy diet should be measured using the patient’s self-assessment tool. The results should be compared with pre-intervention to detect differences between pre-and post-intervention outcomes. As a result, the patient is capable of cooking and consistently consuming a low-fat, vegetable-rich diet within two weeks. Self-reporting tools for physical activity consistency and outcomes should be conducted in analogy to the measurement of dieting. As the outcome, the patient has a habit of exercising at least 150 minutes per week within two weeks. Self-assessment might be a relatively subjective measure; however, in the context of the patient’s education and counseling during the treatment process, it is anticipated that the patient will demonstrate objectivity and clarity in the identification of the improvements. Overall, the listed measures will allow for an objective evaluation of the results of the treatment process and the success of the interventions for the patient’s health.

Conclusion

Conclusively, the proposed patient care plan is anticipated to yield positive patient outcomes due to the consistency in the set goals, nursing interventions, medications, and technologies integration. The proposed plan incorporates multifaceted and interdisciplinary interventions, including pharmacology, psychotherapy, self-monitoring, and conventional treatment, which is why it is expected to benefit the patient in multiple ways. According to Mao et al. (2019), the treatment of coronary heart disease delivered by a multidisciplinary team yields successful outcomes for patient recovery and long-term health benefits. Therefore, the anticipated goal achievement and overall patient healing following the implementation of the proposed patient care plan is justified and supported by evidence.

References

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Coronary heart disease. (n. d.). National Heart, Lung, and Blood Institute. Web.

Fallon, C. K. (2019). Husbands’ hearts and women’s health: Gender, age, and heart disease in twentieth-century America. Bulletin of the History of Medicine, 93(4), 577-609.

Hajar, R. (2017). Coronary heart disease: From mummies to 21st century. Heart Views: The Official Journal of the Gulf Heart Association, 18(2), 68-74.

Jarvis, S., & Saman, S. (2017). Diagnosis, management and nursing care in acute coronary syndrome. Nursing Times, 113(3), 31-35.

Lao, X. Q., Liu, X., Deng, H. B., Chan, T. C., Ho, K. F., Wang, F., Vermeulen, R., Tam, T., Wong, M. C. S., Tse, L. A., Chang, L., & Yeoh, E. K. (2018). Sleep quality, sleep duration, and the risk of coronary heart disease: a prospective cohort study with 60,586 adults. Journal of Clinical Sleep Medicine, 14(1), 109-117.

Mao, Q., Zhou, D., Li, Y., Wang, Y., Xu, S. C., & Zhao, X. H. (2019). The triglyceride-glucose index predicts coronary artery disease severity and cardiovascular outcomes in patients with non-ST-segment elevation acute coronary syndrome. Journal of the American Heart Association, 9, 1-10.

Porter, E. (2017). Famous faces of heart disease. Web.

Ramadhani, F. B., Liu, Y., Jing, X., Qing, Y., Rathnayake, A. K., Kara, W. S. K., & Wu, W. (2019). Investigating the relevance of nursing caring interventions delivered to patients with coronary artery disease at a teaching hospital in China: A retrospective study. Cureus, 11(5), 1-14.

Severino, P., D’Amato, A., Pucci, M., Infusino, F., Adamo, F., Birtolo, L. I., Netti, L., Montefusco, G., Chimenti, C., Lavalle, C., Maestrini, V., Mancone, M., Chilian, W. M., & Fedele, F. (2020). Ischemic heart disease pathophysiology paradigms overview: From plaque activation to microvascular dysfunction. International Journal of Molecular Sciences, 21(21), 1-30.