Running Head: COMPLEX NURSING CARE 1

COMPLEX NURSING CARE

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Actual Health Problem: Pain and its management

Pain related to post-argument with his two sons

The case study clearly indicated that Mr. Anthony Khoury was presented to the UTS Hospital

Emergency Department with chest pain and shortness of breath. Extensive medical history

indicated Mr. Khoury had suffered from angina in the past, which is a discomfort or chest pain

resulting when the heart muscle does not get enough oxygen-rich blood (Lyle, 2012). It is

important to understand that angina is not a disease, it is a sign or characteristic of an underlying

heart problem such as coronary heart disease (CHD). On the other hand, pain is defined as an

unpleasant feelings and experience associated with actual or potential damage which is delivered

to the brain by sensory neurons (Beth & Wisnoff, 2013). Pain can be classified as chronic and

acute pain. Where acute pain occurs naturally as a reaction to tissue injury (Kindler & Polomano,

2014). The acute pain occurs unexpectedly and it transits. Chronic pain is persistent and it

extends beyond the healing stage.

Nursing intervention

The management of chest pain is critical especially to patients who are at risk of cardiovascular

diseases. For example, the patients exhibited symptoms of angina, which is very challenging to

differentiate from other chest pains. The physicians should get adequate information from

medical history of the patients to determine exactly the type of chest pain (American

International Health Alliance, 2015). Based on the extensive medical, there was need for Mr.

Khoury to be immediately examined by the doctor to determine the extend of the pain and

establish whether it is stable or unstable angina that can lead to possible heart attack. The nurses

play crucial role in the intervention process since they assist the patients to overcome the pain.
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It is the responsibility of the nurses to ensure that patients are supported managed in a manner

that their comfort is enhanced. It is their priority to alleviate pain in a appropriate manner and

make the patients more comfortable (Rasha, et al., 2016). In the case of Mr. Khoury, the first

nursing intervention as chest pain management, is the use of pharmacological management.

Considering that the chest pain exhibited by Mr. Khoury is related to peripheral vascular disease

(PVD) and symptomatic neuropathy, which are complications of diabetes, it is critical for the

nurses to monitor vital signs before initiating pharmacological therapy.

The other nursing intervention is the education of the patient and the caregivers about the

importance of self-care. The education should focus on the management of diabetes 2 and the

risk factors. Mr. Khoury should be educated on how to monitor and manage blood pressure,

cholesterol levels and glucose (Ylitalo, et al., 2011). Although, extensive history did not indicate

whether Mr. Khoury was in insulin, it is prudent to educate him on how to monitor blood

glucose. In terms of medication, Mr. Khoury should be educated on how to strictly observe the

time they should take the prescribed medication. This include proper schedule for the meal time

to ensure the level of glucose is maintained in the blood.

More importantly, the caregiver should be educated about appropriate social relationships they

should have with the patient. The daughter and his son should be educated about the need to

avoid argument with their father since little stress can elevate the conditions. They need to

understand that their father needs peace of mind throughout to boost the psychological

status[ CITATION Nat15 \l 1033 ]. In addition, the nurses should initiate counselling therapy on Mr.

Khoury about distress, stress and coping mechanism. He should not feel overwhelmed by the

family business and the family member should help him to run the business in an appropriate

manner. Education ensures that patients understand the importance self-management.

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Lastly, the nurses should intervene anxiety disorders since his daughter indicated that Mr.

Khoury was anxious about the family business. The intervention involves the use of

pharmacological and psychotherapy (Locke, et al., 2015). The intervention through

pharmacological involves the use of antidepressants and benzodiazepines, which are very

effective with non-specific anxiety. While determining the type of drugs to use in

pharmacological, it is important for the nurses to choose the drugs that cannot have adverse

effect to the patients during withdrawal.

In the case of psychotherapy, the nurses use behavioral therapy that leads to exposure and

relaxation. Exposure helps the patient to confront the fear either directly or incrementally an

approach known as flooding or implosion therapy (Forbes, 2013). The objective of behavioral

therapy is to assist the patient to develop endurance towards the fear and phobic stimuli instead

of fleeing it. The other approach to psychotherapy is cognitive therapy which aimed at

influencing the thoughts patterns of the patient. One of the methods of cognitive therapy is

cognitive behavioral therapy (CBT), which involves the combination of both behavioral and

cognitive therapy.

After these interventions, it is important for the nurses to evaluate whether the intervention was

successful. This can be established by assessing the pain level of the patient using the scale of 0-

10. The case study showed that after oxygen administration, the pain level reduced from 4/10 to

1-2/10. In addition, RA increased from 91 % to 95 % with oxygen 6L/min via mask. This is clear

indication that Mr. Khoury was responding well to the intervention and this means that nursing

intervention was successful.

Potential problem
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The potential problem of Mr. Khoury is the risk of hypertension (HTN) which is a predominant

predictor of adverse event. Evidence-based studies have showed that patients with type 2

diabetes have high risk of developing hypertension if the condition is not properly managed.

Therefore, the treatment of blood pressure is critical in reducing major cardiovascular events

such as microvascular outcome, cardiovascular death, stroke and infarction.

Nursing intervention

Nurses should prioritize the monitoring of blood pressure on patients with type 2 diabetes. These

include monitoring systolic blood pressure levels at < 140 mm Hg. Studies have showed that

systolic blood pressure below 140 mm Hg significantly reduces cardiovascular morbidity and

mortality (Ballantyne, 2016). For every clinic visit by diabetic patient, the nurses should measure

blood pressure and incase the level is beyond the required standard, vigorous treatment should

commence immediately. The treatment can be through pharmacological or non-pharmacological

treatment or the combination of the two. Pharmacological treatment involves the use of

antihypertensive drugs, while non-pharmacological treatment involves the use of lifestyle

modification such as weight loss, physical activity and dietary alteration

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References

American International Health Alliance. (2015). Chest Pain: Clinical Practice Guideline for

Primary Health Care Physician. New York, NY: AIHA.

Ballantyne, H. (2016). Developing Nursing Care Plans. Nursing Standards, 30(26): 51-60.

Beth, M. & Wisnoff, W. (2013). Pathophysiology of Pain. Disease-a-Month, 59(10):330-358.

Forbes, H. (2013). Health Assessment. In J. C. (eds), Potter & Perry's Fundamentals of Nursing,

4th Ed. (pp. 621-647). Chatswood, NSM: Elsevier Australia.

Kindler, L. L. & Polomano, R. C. (2014). Pain Management, Adapted by C. Douglas. In D. B.

(Eds), Lewis's Medical-Surgical Nursing: Assessment and Management of Clinical

Problems, 4th edn (pp. 48-80). Chatswood, NSW: Elsevier Australia.

Locke, B. A., Kirst, N. F., & Shultz, G. C. (2015). Diagnosis and Management of Generalized

Anxiety Disorder and Panic Disorder in Adults. American Family Physician, 91(9): 617-

624.

Lyle, W. L. (2012). Man Gets Burning Sensation in Chest During an Argument. Clinician

Review, 22(4):.

National Institute for Health and Care Excellence. (2015). Type 2 Diabetes in Adults:

Management. London, UK: NICE.

Rasha, A., Davies, J. & Malik, S. I. (2016). What is the Role of Coronary Angioplasty and

Stenting in Stable Angina? BJM, 352: i205.

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Ylitalo, K., Sowers, M. & Heeringa, S. (2011). Peripheral Vascular Disease and Peripheral

Neuropathy in Individuals with Cardiometabolic Clustering and Obesity. Diabetes Care,

34: 1642-1647.