Patients with Angina and the Care Environment - Term Paper Example

Knowledge Required for Decision Making in Adult Nursing - A Client Focused Study on Patients Experiencing Chest Pain Caused by Angina - Instructor’s Name Subject / Course Date Total Number of Words: 2,066 Table of Contents I. Introduction ………………………………………………………………………… 3 II. Rationale for Choosing Patients Experiencing Chest Pain Related to Angina …………………………………………………………………. 4 III. Brief Clinical Overview of Patients with Angina and the Care Environment . 4 IV. Pathophysiology of Chest Pain Related to Angina ……………………………. 6 V. Short- and Long-Term Impact of Angina on the Lives of the Patients and Family ………………………………………………………………… 7 VII. Ethical Considerations When Caring for the Patient ………………………….. 8 VIII. Evaluation of Learning Experience and Its Impact on My Future Practice …. 9 IX. Conclusion ………………………………………………………………………….. 10 References ………………………………………………………………………………. 11 - 16 Introduction Coronary Heart Disease (CHD) such as angina is one of the most serious health problems in the United Kingdom. As of 2004, the number of patients who are hospitalized due to angina and chest pain significantly increases over the last decade. (Murphy, 2004) Based on the British Heart Foundation (2006) report, approximately 760,000 and 428,000 men and women under the age of 75 either have experienced or is experiencing the symptoms of angina. Even though the death rate of women in UK who have experienced CHD fell by 44 percent, the number of individuals who does not survive from CHD remains high. (BHF, 2006) Angina is a Latin word for ‘chest pain’. (Home Health UK, 2008) Angina normally occurs when there is a narrowing in the coronary arteries due to a blockage in the heart arteries. In the process, the patients would experience lack of oxygen in the heart causing a mild to extreme chest pain. For this study, the researcher will discuss the rationale behind choosing this topic. In the process, the researcher will provide a brief overview of patients with angina who are provided with necessary care within the health care environment. In line with fully understanding the topic, the researcher will conduct an extensive literature review with regards to the pathophysiology of chest pain caused by angina. Aside from the ethical considerations in the care provision of each patient, the researcher will discuss the short- and long-term impact of chest pain over the well-being of the patients and his/her family members. Prior to conclusion, the researcher will evaluate the learning experience attached with the completion of this paper as well as the impact of the learning experience on the researcher’s future practice. Rationale for Choosing Patients Experiencing Chest Pain Related to Angina For several years, I have been working in a General Intensive Care Unit (GICU) as a nurse. Recently, I have been handling patients who are diagnosed with angina. Most of these patients are suffering from a mild to severe chest pain. Brief Clinical Overview of Patients with Angina and the Care Environment Angina or ‘chest pain’ is one of the most common cases in the emergency department (ED). Patients who are suffering from an acute coronary ischemia are commonly being diagnosed based on the patient’s medical history record, physical examination, and with the use of a 12-lead electrocardiography (ECG). (Storrow & Gibler, 2000; Quin, 2000) A study shows that it is possible for the use of a 12-lead ECG to show a normal result. (Basso et al., 2000) The problem with ECG alone is the fact that it is sufficient to diagnose patients who are suffering with unstable angina. (Fesmire et al., 1998) In line with the inefficiency of ECG on the diagnosis of angina, some of these patients are diagnosed with a non-cardiac chest pain even when the the health condition of the patient is extremely fatal. (Gibler, 1994) The congenital anomalies of the coronary ateries are not easy to detect using the catheter angiography because it shows only a two-dimension image. Instead, a study shows that the use of the MDCT reflecting a three-dimension image could give a more accurate result when diagnosing anomalies in the arteries. (Schmitt et al., 2005) On the other hand, the use of a coronary MR angiography is more effective when it comes to detecting coronary artery anomalies as compared with the use of a catheter angiography. (Bunce et al., 2003) In order to increase the efficiency of clinical diagnosis on patients with angina, several studies show that the introduction of Angina Plan (AP) in the primary health care units could improve the psychological and physical well-being of the patients who have been diagnosed with anigna. (Sykes et al., 2006; Lewin et al., 2000) The positive clinical evidences of ‘rapid access chest pain clinic’ (RACPC) has been effective in convincing the health care authorities to introduce and implement this service throughout the health care institutions in the United Kingdom. (DOH, 2000) Several studies show that the implementation of the RACPC could significantly reduce the number of preventable hospital admissions. (Newby et al., 1998; Davie et al., 1998a & b; el Gaylani et al., 1997) Today, it is a protocol for the National Service Framework (NSF) on the coronary heart disease (CHD) to directly refer the patients who shows symptoms of angina directly to the general practitioners’ office to gain access to RACPC. (DOH, 2000) During the health consultation, the general practitioner should provide necessary health care advice such as ways on how to quit on smoking habit or other related modifiable risk factors aside from the possible treatment care. In the process, the general practitioner could minimize the health risks of people with potential coronary heart disease. The RACPC is usually being operated by a well-trained and reliable medical staffs who applies safe and effective evaluation approaches, the proper health care management on patients with heart disease symptoms and triage. (Wood et al., 2001; Davie et al., 1998 a & b; Newby et al., 1998; el Gaylani et al., 1997; Jain et al., 1997) This group of health care professionals are using the electrocardiogram combined with a test for exercise stress which is necessary in determining the health risk stratification in patients. (Davie et al., 1998a; Newby et al., 1998) Today, a more effective technique that could detect an increase concentration of the cardiac Tropinin T (cTnT) or the Troponin I (cTnI). (Hamm et al., 1997; Stubbs et al., 1996) This method is being utilized in order to diagnose the early stage of a possible myocardial necrosis in order to avoid or minimize the risk of possible death due to myocardial infarction. (Kanojia & Salih, 2000; Stahmer, 1998; Hamm et al., 1997; Stubbs et al., 1996) Pathophysiology of Chest Pain Related to Angina Angina is a symptom of a coronary artery disease (CAD) wherein plaque are formed on the sides of the heart arteries causing an insufficient supply of oxygen and blood to the heart. (National Heart, Lung, and Blood Institute in Medline Plus, 2008) The two classifications of congenital anomalies of coronary arteries can either be malignant or non-malignant. (Yamanaka & Hobbs, 1990) The main reason behind the anomaly is due to a twist at the edge of the left or right vessel ostium between the pulmonay artery and the aorta which causes the orifice found in the aortic wall to collapse. (Cheitlin et al., 1974) A malignant anomalies – a high risk of myocardial ischemia or a sudden heart attack, normally occurs between the pulmonay aorta and artery which is usually present on the left sinus of Valsalva. (Attili & Cascade, 2006) The same high risks is evident when the left anterior decending artery as well as the left coronary artery arises from the right sinus of the Valsalva. On the other hand, a myocardium or a ‘myocardial bridging’ occues in the left anterior decending artery. (Ferreira et al., 1991) The thin bridges that builds-up on the left anterior decending artery is still considered as benign since the blood flow occurs during diastole. However, it could result to a little compression (Möhlenkamp et al., 2002) causing the patient could feel a little chest pain or angina (Alegria et al., 2005). Another possible causes of angina is the presence of high amount of calcification causing a plaque in the coronary artery (LaMonte et al., 2005; Arad et al., 2005) even though there is a reasonable correlation has been evident between the possible narrowing of the coronary artery and the CT calfication build-ups (Detrano et al., 1996). Short- and Long-Term Impact of Angina on the Lives of the Patients and Family Angina could significantly and negatively affect the ‘health-related quality of life’ of the patients. (Treasure & Gallivan, 1995) Most of these patients experience physical immobility which directly affects their social lives. (Pocock et al., 1996) Aside from the physical discomfort and pain the patients are experiencing, some of these individuals are also experiencing emotional distress due to lack of quality sleep and their inability to work efficiently like a normal person. (Asadi-Lari et al., 2003; Pocock et al., 1996) As a result of a low self-esteem, they tend to isolate themselves from other people including their family members and love ones. (Pocock et al., 1996) In line with the medical treatment of patients with angina, the study of Raft et al. (1985) shows that angina patients who has undergone a percutaneous transluminal coronary angioplasty (PTCA) who return back to work after 6 to 15 months are experiencing a better work functioning as compared to those individuals who has a coronary artery bypass grafting (CABG). The interrelationship between the health care providers and the patient should be good in order to hasten the recovery period and promote a better quality of life on the part of the patient. (Asadi-Lari et al., 2004) Normally, patients who are experiencing the symptoms and health deterioration caused by angina have more social needs. (Asadi-Lari et al., 2003) For this reason, health care professionals should render a holistic care to the patient which includes not only the physical, emotional, mental needs but also the patient’s spiritual needs. (Epstein, 2007; Parry-Jones & Soulsby, 2001) Ethical Considerations When Caring for the Patient The health care code of ethics states that health care practitioners should at all times respect the confidentiality and anonymity of patients with learning disability, communication difficulty, or those who are physically- or mentally-ill patients. (Bailey, 2007; Kneafsey, 2007) Prior to any research activities, the health care practitioner should seek an informed consent in case they need to use the patients’ personal or health information in a clinical study. Based on the EU Directive 2001/20/ED, the health care practitioners should seek a parental guidance in case the patient is a minor. (Kneafsey, 2007) Basically, in order for the consent to be considered as legal, the consent must be given voluntarily by the informed individual whose age is 18 and above. (DOH, 2001a: p. 4; DOH, 2001b: p.7) In case the patient is below the age of 18, the any health care professionals should seek a parental guidance from the patients’ parents especially before giving any major intervention on the health care service given to the patients. (DOH, 2001a: p.8) The principles of health care ethics and its corresponding legality serve as the standards for the clinical practice of all the health care professionals. Health care practitioners should be knowledgeable and updated with the health care ethics and legal issues behind it in order to prevent themselves from being legally held liable in the court. Evaluation of Learning Experience and Its Impact on My Future Practice Having completed this paper, I learn that nursing ethics is an important part of the nursing profession. In order to minimize the unnecessary risk of being legally sued by the patients and their family members, updating my knowledge on the nursing ethics and law is necessary. I have also learned the importance of providing a holistic care to patients with angina. Roughly, this paper has given me an idea with regards to the emotional distress and physical discomfort they are experiencing that causes some of them to isolate themselves from other people. The fact that these people are not physically fit to do their regular activities of daily living (ADL), it becomes one of the major responsibility of the nurses to assist them in being able to complete some minor and major tasks. I have encountered patients who are feeling negative about themselves. Prior with working on this paper, I find it hard to understand what exactly is causing them to act negatively on almost anything around them. I also was not aware that these individuals have a spiritual need that nurses should consider. In the future, I will ensure that I remember these three major factors in rendering a nursing care to patients who are diagnosed with angina. I also feel that knowing what the patients are going through physically and mentally could enable me to relate to them better in terms of providing them with more emotional comfort. Conclusion A large percentage of patients who are being hospitalized are experiencing angina. For this reason, it is necessary to know the proper way of rendering a holistic care for them. Aside from the need to provide them with a good quality life, nurses should always respect the confidentiality and anonymity of the patients. *** End *** References: Alegria, Jorge R., Herrmann, Joerg., Holmes, David R., Lerman, Amir., & Rihal, Charnajit S. (2005). Myocardial Bridging. European Heart Journal , 26:1159 - 1168. Arad, Yadon, Goodman, Kenneth J., Roth, Marguerite, Newstein, David, & Guerci, Alan D. (2005). Coronary Calcification, Coronary Disease Risk Factors, C-Reactive Protein, and Atherosclerotic Cardiovascular Disease Events: the St. Francis Heart Study. 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