This assessment task allows students to demonstrate theoretical knowledge around pathophysiological changes in disease, pharmacological management of disease, planning nursing care and evaluating...

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Pathophysiology, Risk Factors, and Treatment Options for Angina in the Context of Jon’s Case
Acute coronary syndrome (ACS) categorizes angina that manifests with chest pain in the affected patients (Patel & Zeltser, 2019). Patients with myocardial ischemia and coronary atherosclerotic disease experience high-risk of developing angina. The non-occlusive disruption of atherosclerotic plaque leads to the development of a thrombus that eventually leads to coronary artery narrowing and induction of angina. The blood flow hindrances in cardiac patients substantially disrupt their myocardial perfusion mechanism. The perfusion process follows the route from cardiac structures to the aorta and coronary arteries. The left coronary artery segregates into left anterior ascending and circumflex arteries that descend into smaller arterial structures. The right coronary artery follows the same process ramifies into smaller structures. The delay of vascular flow towards myocardium leads to the development of angina. The cardiovascular blockage in angina cases is based on several factors, including high blood pressure, vasospasm, intraluminal thrombosis, and plaque formation. The combination of these factors substantially triggers the angina episode in the affected patients. Angina patients usually experience shortness of breath and chest pain. They describe the pain feeling in terms of sharp pressure, burning, discomfort, and tightness across the chest region. Angina pain travels from chest to arm(s) or jaw. Other constitutional symptoms of angina include palpitations, dizziness, diaphoresis, vomiting, and nausea. The chest pain worsens with movement or exertion and minimizes in the resting position. The administration of aspirin and nitroglycerin to angina patients reportedly reduces the intensity of their chest pain. The relieving factors in the cases of angina do not completely resolve the chest pain pattern. Angina patients also experience high risk for delayed myocardial infarction. Angina’s key complications include stroke, myocardial infarction, T-wave inversion, ST-segment elevation, and morbidity. The adverse prognostic factors of angina include, sustained VT, hemodynamic instability, MR worsening, congestive heart failure, low ejection fraction, and recurrent angina episodes with therapeutic failure. The antiplatelet aspirin (162-325mg) and nitroglycerin therapies substantially minimize cardiac energy requirements and workload in angina patients. Supplemental oxygen therapy helps in stabilizing the oxygen saturation level; however, beta-blockers and heparin therapy also assist in reducing the cardiac rate, blood pressure, and related energy demand. The preventive medications prescribed in Jon’s case for reducing the risk of angina, include aspirin, pravastatin, metoprolol, and glyceryl trinitrate spray. The treatment goals in Jon’s case relate to stabilization of blood pressure (Morris & Dunham, 2019), cardiovascular disease prevention (Orkaby, et al., 2018), secondary prevention of angina (Ittaman, VanWormer, & Rezkalla, 2014), and cytosolic calcium reduction (DrugBank, 2019). The anginal prevention strategies in Jon’s case include transmyocardial revascularization, coronary sinus restrictors, acupuncture, and lifestyle modification (Winchester & Pepine, 2015).
Physical Nursing Assessments Related to Jon’s Complaint
Chest Pain Assessment
The registered nurse will require evaluating the patient’s pain location, characteristic, onset, and predisposing factors with other clinical symptoms (Ayerbe et al., 2016). Accordingly, the nurse will require diagnosing the level of Jon’s cardiac tissue perfusion and prodromal manifestations. Jon’s physical examination related to cardiac manifestations will assist in determining the existence of cardiac complications related to hypertrophic obstructive cardiomyopathy, valvular heart disease, and hypertension (AIGHD, 2013). The nurse will need to evaluate the duration and quality of patient’s substernal discomfort along with the impact of Jon’s emotional stress on chest pain pattern (Jones, Somerville, Feder, & Foster, 2010). The appearance of aching, heavy or dull chest pain will affirm an angina episode in Jon’s case.
Cardiac Functionality Assessment
The registered nurse will need to monitor Jon’s heart rhythm and rate in the context of evaluating the impact of blood pressure changes that reciprocate with the onset of angina (Wee, 2015). Jon’s cardiac rate assessment will also determine his risk of stress/ischemia-based dysrhythmia/arrhythmia (Fu, 2015). The registered nurse will require evaluating or ruling out the radiation of Jon’s chest pain to his hand, shoulder, neck, or jaw. This will substantially assist in affirming the cardiac nature of his chest pain. The registered nurse will need to evaluate or rule out Jon’s pulmonary edema, mitral regurgitation, and dyskinetic cardiac apex through the assessment of cardiac sounds. The physical assessment will also rule out a range of angina-related complications, including thyrotoxicosis, anemia, peripheral vascular disease, carotid bruits, gallop rhythm, cardiomegaly, ejection systolic murmur, and slow rising carotid impulse (i.e. aortic stenosis) (Boloor & Nayak, 2018, p. 415). The manifestations could indicate the occurrence of reduced myocardial blood flow, elevated oxygen demand and cardiac workload.
Systemic and Integumentary Assessments
Jon’s systemic assessment with integumentary evaluation will determine probable skin changes, including tissue necrosis, bullae, and skin breaks (Sullivan, 2018). The assessment of toxic appearance, immunocompromise, and life-threatening infection in Jon’s case could warrant the need for hospitalization (Wolfson et al., 2010, p. 1207). The lifting of Jon’s left...