precautionary measures to protect and manage coronary heart disease
Individual Client Health History and Examination: Catherine’s Struggles with Coronary Heart Disease
Abstract
This paper examines the medical history of Catherine, a 59 year old woman with a coronary heart disease. Catherine is a divorced, but is currently living with her younger daughter and three grand children. In addition to coronary heart disease, Catherine has developed kidney problems. However, although her family has a history of heart diseases, Catherine does not take adequate precautionary measures to protect and manage her condition. For example, she is a heavy smoker (at times smokes Marijuana) and drinks occasionally but neither engages in active exercises nor sticks to recommended diets.
Introduction
Catherine’s family history has increased her chances of developing coronary heart disease; nevertheless, her condition keeps on worsening due to her lifestyle. Notably, Catherine’s mother died of stroke at the age of 71 while her father suffered from inflammatory heart disease. Moreover, older people are at more risks of developing heart diseases. This is because the disease results from plaque buildup in the coronary arteries over a long period. As such, the arteries become narrow and rigid thereby lowering the capacity of oxygenated blood to flow into the heart. In other words, the heart is not supplied with oxygen and nutrients, which it requires to function normally. Kokkinos (2010) cites that the cholesterol-laden plaque often start building up from childhood. Therefore, as one gets older the plaque layers increases eventually cutting off the blood supply.
In some cases, plaques release chemicals, which make arteries sticky thereby, allowing more substances such as inflammatory cells and lipoproteins to block the blood vessels. However, in other cases, plaque promotes blood clotting that might completely block the blood supply, causing a heart attack (Kokkinos, 2010). Therefore, Catherine’s age indicates that her health is likely to deteriorate unless she gets appropriate health care. According to Gordon Functional Health Pattern Assessment, Catherine’s history with heart disease can be summarized into 11 factors including:
Health Perception: Despite her condition, Catherine is reluctant to abide by the recommended medical and therapy interventions. She admitted that although she is aware her drinking and smoking habits contribute largely to her present condition, she has not sought professional help. Currently, she smokes a minimum of 20 cigarettes a day.
Nutrition and Metabolism: Given Catherine’s health condition, she should eat healthy foods such as carbohydrates with low sugar contents and low-fat dairy products among other foods rich in high-fiber. However, despite warning from her previous doctor, Catherine sometimes eats food rich in calories. As a result, more fat deposits in her blood vessels further blocking her blood supply.
Elimination: Catherine complains of polyyuria (frequent urination). According to Desilva (2013) Polyuria arise when tiny blood vessels that filter waste from blood in the kidneys are damaged by the plaques. This implies that Catherine’s kidney has been damaged.
Activity and Exercise: Due to Catherine’s weak heart, she has completely withdrawn from active physical activity. In addition, although she sometimes does house hold tasks, she only does light work. However, before Catherine became weak, she loved swimming and jogged for about twenty minutes before leaving for work.
Cognition and Perception: Catherine has not been following prescribed medications because of cultural beliefs. That is, since she comes from Caribbean where smoking marijuana is perceived to be healthy, Catherine believes that she can neither function effectively nor achieve emotional satisfaction without smoking.
Sleep and Rest: Review of Catherine’s’ past medical record shows that she experienced sleep problems. This could be attributed to the likelihood that her blood contains high levels of harmful chemicals such as serotonin and dopamine that cause body dysfunction like loss appetite loss, sleep problems, and inability to respond to stress.
Self Perception and Self-Concept: Due to her weak immune system, Catherine has lost interest in activities, which used to make her happy. Such low self-esteem increases the chances that she would resist prescribed intervention therapies.
Roles and Relationships: Catherine has three children and six grandchildren whom she loves very much. Currently, she is living with her youngest daughter and three grandchildren who have played key roles in improving her health. For instance, she revealed to her doctor that her grandchildren always ensure that she takes her medication in time.
As such, Catherine’s medical condition can be modeled using S-BAR (Situation-Background-Assessment and Recommendation) as follows:-
Situation
Catherine was recently admitted after experiencing a heart attack. She was diagnosed with angina, but after receiving medication her condition stabilized. However, she has started complaining of chest pains and discomfort that lasts for a few minutes then goes away. She is also experiencing shortness of breath and fatigue. Moreover, her ankles, feet, and veins in the neck are swollen (Alfaro-LeFevre, 2014).
Background
Catherine has been living with a coronary heart disease for the past ten years from the first diagnosis in 2003. However, she might have developed the disease in the late 1990s. Her past medical records show that although this was the first heart attack, she has been admitted several times with heart related diseases. Similarly, for the past three days that Catherine has been in the hospital, her heartbeat has been irregular. That is, sometimes her hearts beats faster than normal while sometimes it skips. An electrocardiogram test shows her hearts’ pumping chambers are normal while chest X ray taken few days ago indicates that there are fluids in her lungs. In addition, coronary Angiography done on Catherine revealed that her arteries have been damaged. Moreover, fasting lipoprotein tests showed that her blood high-density lipoprotein exceeded 240 mg/dL (Alfaro-Lefevre (2014). This means that Catherine’s blood contains a high amount of toxic cholesterols that further increases the clogging of the blood vessels.
Assessment
Such symptoms mean she is likely to experience another heart attack or a total heart failure. Particularly, the shortness in breadth indicates that her heart has become weak such that it cannot pump blood around the body. Consequently, fluids have built up in the lungs that make it difficult to breathe.
Recommendation
Catherine needs to take diuretics and Angiotensin Converting Enzyme Inhibitors (ACE) inhibitors. Diuretics would help reduce the fluid buildup in the lungs and the swelling in the legs and neck. However, ACE inhibitors would lower the blood pressure and reduce strain on her heart. In this case, angiotensin are chemicals produced by the body cells which cause muscles surrounding blood vessels to contract which it turns causes the blood vessel to narrow. This implies that, taking ACE inhibitors would stop the production of enzymes, which facilitates the blood vessel narrowing thereby reducing possible future heart attacks.
At the same time, for Catherine to manage her health, she should adopt a new lifestyle. Most importantly, she should quit smoking. This is because; first, cigarette smoking increases heart dysfunctions through increasing fatty acids build ups in the blood stream. Secondly, smoking narrows the blood vessels thereby reducing blood circulation. This is evident from recent studies shows that have indicated that smokers with heart diseases are more likely to experience more complications such as nerve damage and kidney diseases than non smokers. For example, Xiu, Wu and Wakui’s (2009) studies revealed that those who smoke at least 20 cigarettes daily were 61% more likely to develop heart complications than those who do not or smoke less than 20 cigarettes daily. On the other hand, quitting smoking leads to immediate health benefits.
Additionally, Catherine should eat foods that do not contain high cholesterols, high fiber, and carbohydrates with low sugar contents. Such foods include unprocessed fruits and vegetables, whole grains, legumes, fish, and lean meat. Moreover, Catherine should engage more in active physical exercises. Desilva (2013) advices older persons to undertake at least 150 minutes physical activity weekly. This might include walking, gardening, swimming, and jogging.
In conclusion, Catherine’s condition has been deteriorating because she has persistently refused to abide by the prescribed medication. However, she revealed to her doctor that she was ready to go an extra mile to improve her health. In fact, prevention and control of heart diseases depends on one’s choice of lifestyle. Therefore, by eating healthily, exercising regularly, and quitting smoking, Catharine’s health would significantly improve.
References:
Alfaro-LeFevre, R. (2014). Applying nursing process: The foundation for clinical reasoning. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
DeSilva, R. (2013). Heart disease. Santa Barbara, Calif: Greenwood.
Foye, W. O., Lemke, T. L., & Williams, D. A. (2013). Foye’s principles of medicinal chemistry. Philadelphia: Wolters Kluwer Health/Lippincott Williams & Wilkins.
Kokkinos, P. (2010). Physical activity and cardiovascular disease prevention. Sudbury, Mass: Jones and Bartlett.
Xie X. Liu, Q. Wu, J. & Wakui, M. (2009). Impact of cigarette smoking in type 2 diabetes developments, Acta Pharmacologica Sinica (30)11: 784-787.
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