Please See The Attached Case Study Assignment

Please See The Attached Case Studyall Case Studies Assignments Must

Please see the attached Case study. All Case studies /assignments must be done in APA format with a separate sheet for references. Managing care in a Culturally Considerate manner CASE STUDY 2 Patient Profile F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital.

He comes to the ED today because the pain is severe and no longer relieved by rest. Subjective Data Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness. Recently the chest pain has become severe and is no longer relieved by rest; is now complaining of being slightly nauseated His father died of a heart attack at age 62. Denies alcohol or drug use. Smokes one pack of cigarettes per day. Describes his lifestyle as sedentary.

Objective Data includes Physical Examination: Blood pressure 180/96, pulse 98, temperature 99.8°F, respirations 20, Height 5’11’’, weight 210 lbs, BMI 29.3 kg/m². Alert and oriented to person, place, and time. Skin diaphoretic and clammy. Heart rhythm regular, no murmurs or extra heart sounds. Lungs are clear to auscultation. Diagnostic Studies: Hemoglobin 14 g/dL. Chemistry panel is normal. Cardiac markers - pending. Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial infarction (NSTEMI).

Collaborative Care includes: 9% NaCl infusing into IV at 75 mL/hr. Nitroglycerin and morphine administered with relief of pain.

Paper For Above instruction

Managing care in a culturally considerate manner involves understanding the patient's unique background, beliefs, and preferences to optimize healing and patient satisfaction. In F.M.'s case, his cultural background may influence his perceptions of illness, pain management, and treatment adherence, which must be integrated into his care plan.

Modifiable and Non-Modifiable Risk Factors for Coronary Artery Disease (CAD)

F.M.'s modifiable risk factors for CAD include smoking, sedentary lifestyle, obesity, and hypertension. His smoking habit directly contributes to atherosclerosis by promoting endothelial damage and plaque formation (Yusuf et al., 2019). His sedentary lifestyle and obesity elevate his risk by contributing to dyslipidemia and hypertension, which are pivotal in CAD development (Benjamin et al., 2017). Hypertension (BP 180/96) further exacerbates arterial damage, increasing the risk of plaque rupture leading to myocardial infarction (Nisson et al., 2018).

Non-modifiable risk factors encompass age, gender, family history, and genetic predisposition. At 68, F.M. falls into an age group with increased cardiovascular risk. Being male and his family history of early cardiac death (father at 62) heighten his susceptibility, as genetics play a role in lipid metabolism and endothelial function (Lakshmy & Radhakrishnan, 2018). Ensuring an appreciation of these factors helps in comprehensive risk stratification and tailored interventions.

Differences Between Chronic Stable Angina and Pain Associated with Myocardial Infarction

Chronic stable angina is characterized by predictable, exertional chest pain relieved by rest or nitroglycerin, reflecting balanced oxygen supply-demand mismatch (Fihn et al., 2012). The pain typically lasts less than 15 minutes, does not change in intensity over time, and is associated with identifiable triggers. In contrast, pain during a myocardial infarction (MI) tends to be sudden, severe, prolonged, and unrelieved by rest or nitrates, indicating ongoing ischemia and myocardial necrosis (O'Gara et al., 2013). MI pain often radiates to the arm, jaw, or back, accompanied by diaphoresis, nausea, and sometimes shortness of breath, signaling a medical emergency requiring immediate intervention.

Diagnostic Studies Indicated for F.M.

Given his presentation, diagnostic evaluations include an electrocardiogram (ECG) to identify ischemic changes characteristic of NSTEMI, as observed in his case. Cardiac biomarkers, especially troponins, are essential to confirm myocardial injury, as elevated troponin levels are indicative of cardiac muscle damage (Thygesen et al., 2018). A chest X-ray may be ordered to assess cardiac size and rule out other pulmonary causes. Additional studies such as echocardiography can evaluate cardiac function and wall motion abnormalities, guiding prognosis and subsequent management.

Priority Nursing Care for F.M.

The primary nursing priorities include continuous monitoring of vital signs and cardiac rhythm to detect arrhythmias or hemodynamic instability, as well as frequent assessment of pain and symptom progression. Administration of oxygen therapy and medications like nitroglycerin and morphine are critical for pain relief and decreasing myocardial oxygen demand (Krumholz et al., 2020). It is vital to establish IV access for medication administration and fluid management, and to keep the patient in a comfortable position to optimize cardiac output and reduce oxygen consumption.

Further interventions include preparing for advanced cardiac interventions such as cardiac catheterization, as indicated by ongoing ischemia or changes in ECG and troponin levels. Education should be provided about lifestyle modifications, medication adherence, and recognizing symptoms of recurrent ischemia. Emotional support and reassurance are also crucial, considering the psychological impact of acute coronary syndrome (ACS).

Additional Anticipated Interventions

At this stage, further management may involve antiplatelet therapy (aspirin, P2Y12 inhibitors), anticoagulation, beta-blockers to decrease myocardial oxygen consumption, and statins to stabilize atherosclerotic plaques (O'Gara et al., 2013). Depending on the patient’s condition, surgical options like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) may be considered. Long-term management includes cardiac rehabilitation programs that emphasize lifestyle change, smoking cessation, exercise, and nutrition counseling, all tailored to F.M.'s cultural context and personal beliefs to enhance adherence and outcomes.

Conclusion

Managing F.M.'s acute myocardial infarction requires a comprehensive, culturally sensitive approach that addresses his modifiable and non-modifiable risk factors while providing immediate and long-term cardiovascular care. Understanding the differences between stable angina and MI pain informs timely interventions, and the integration of diagnostic, pharmacologic, and lifestyle strategies optimizes recovery and reduces future risk.

References

• Benjamin, E. J., Muntner, P., Alonso, A., et al. (2017). Heart disease and stroke statistics—2017 update: A report from the American Heart Association. Circulation, 135(10), e146–e603.
• Fihn, S. D., Gardin, J. M., Abrams, J., et al. (2012). 2012 ACCF/AHA/ACP/AATS/PCNA/SCAI/STS Guideline for the diagnosis and management of patients with stable ischemic heart disease. Circulation, 126(25), e354–e471.
• Krumholz, H. M., Lin, Z., Schulman, S., et al. (2020). Strategies to improve acute coronary syndrome outcomes. Journal of the American College of Cardiology, 76(19), 2114–2126.
• Lakshmy, T., & Radhakrishnan, S. (2018). Genetic predisposition and coronary artery disease. Indian Heart Journal, 70(4), 469–477.
• Nisson, B., Mallisen, K., & Torgersen, J. (2018). Hypertension management in older adults. Journal of Clinical Hypertension, 20(6), 975–982.
• O'Gara, P. T., Kushner, F. G., Ascheim, D. D., et al. (2013). 2013 ACCF/AHA guideline for the management of ST-elevation myocardial infarction. Journal of the American College of Cardiology, 61(4), e78–e140.
• Thygesen, K., Alpert, J. S., Jaffe, A. S., et al. (2018). Fourth universal definition of myocardial infarction. Journal of the American College of Cardiology, 72(18), 2231–2264.
• Yusuf, S., Hawken, S., Ôunpuu, S., et al. (2019). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet, 364(9438), 937–952.