NURS 6501 Module 2 Case Study Assignment: CASE STUDY ANALYSIS

NURS 6501 Module 2 Case Study Assignment: CASE STUDY ANALYSIS

NURS 6501 Module 2 Case Study Assignment: CASE STUDY ANALYSIS

Case Study Analysis
Cardiovascular problems are among the health conditions with high prevalence not only in the United States but globally too. These problems act as a source of disease burden to patients and their families due to high costs incurred in their management, loss of productivity and poor quality of life for the patients. Nurses and other healthcare providers must be competent in assessing patients for cardiovascular problems and developing care plans that address the prioritized needs of the patients. Therefore, the purpose of this paper is to explore a case study of a 55-year-old high school teacher who has diagnosed with myocardial infarction. The paper focuses on topics that include cardiovascular and cardiopulmonary pathophysiologic processes contributing to the patient’s symptoms, ethnic or racial variables, and the interaction of the processes to affect the patient.

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Cardiovascular and Cardiopulmonary Pathophysiologic Processes
The patient in the case study suffered a myocardial infarction. Myocardial infection, also known as heart attack arises from complete cessation or decrease in blood flow to the myocardium. Patients may be asymptomatic or develop catastrophic symptoms that cause hemodynamic deterioration and even death. Factors such as coronary artery disease, smoking, hypertension, diabetes mellitus, and raised blood apolipoproteins cause myocardial infarction. Myocardial infarction caused by coronary artery occlusion cause cessation or reduced blood supply to the myocardium. The decreased blood and oxygen supply to the myocardium cause cell death and necrosis. The accompanying symptoms include chest pressure or discomfort radiating to the jaw, neck, arm, or shoulder (Ojha & Dhamoon, 2022). An ECG performed on the patient often reveals tall peaked ST segment and elevated biomarkers such a troponins.
The occlusion of blood and oxygen supply to the myocardium also results in myofibril relaxation and disruption of the sarcolemma. The changes alter the normal mitochondrial functioning and cause its necrosis. Recurrent or prolonged inhibition of blood supply to the myocardium compromises the cardiac function alongside the development of scar tissue from remodeling of the affected tissues. Over time, most of the heart muscle hypertrophies leading cardiac dysfunction. The reduction of oxygen supply to the cardiac muscles also results in myocardial ischemia, which leads to myocardial infarction if not managed timely. The presenting symptoms of myocardial ischemia include chest pain, epigastric discomfort, sweating, abdominal pain, nausea, syncope, fatigue, palpitations, and dyspnea. The pain does not response to positional changes, or active movement of the affected parts (Ojha & Dhamoon, 2022). Therefore, these changes due to reduced or cessation in the blood and oxygen supply to the myocardium led to the client’s presenting symptoms such as cough, chest tightness, chest pain, shallow respirations and pulse, and elevated troponin and ST segment.
Racial/Ethnic Variables that May Affect Physiological Functioning
Racial and or ethnic disparities exist in the risk, rate, and prevalence of myocardial infarction in America. According to Hilliard et al., (2020), collective analysis of data from the United States show that African American adults have the highest rate of cardiovascular diseases such as myocardial infarction as compared to the white adults. The disparity is expected to extend into the future as more Americans (45.1%) are expected to have some type of heart disease by 2035. African Americans also have the highest mortality rate due to myocardial infarction and other types of heart diseases as compared to the American whites (Yandrapalli et al., 2019). The prevalence of cardio-related comorbidities such as diabetes, obesity, chronic kidney disease, and hypertension that cause myocardial infarction is also high among them.
The disparities are also evident in the utilization of treatments for myocardial infarction. Accordingly, African American patients with myocardial infarction are less likely to receive expensive therapies or invasive procedures as compared to the whites. Acute medical treatment for myocardial infarction is similar among white and African American women. However, the rates are lower in African American men when compared to white men (Subramaniam et al., 2021). Studies also show that non-white individuals in America continue to get less guideline-concordant care for myocardial infarction as compared to the whites. The difference in the quality of care for non-whites contribute to an increased risk of adverse outcomes in myocardial infarction management (Simon & Ho, 2020).
A retrospective cohort study conducted by Subramaniam et al., (2021) provides statistical data that increases our understanding of the effect of race/ethnicity on myocardial infarction rates and outcomes. The study investigated the role of ethnicity and race in cardiac arrest outcomes complicating acute myocardial infarction. The study results showed that of 3.5 million admissions due to myocardial infarction, African American patients were highly likely to have more comorbidities as compared to the other races. The adjusted mortality rate was also high among them as compared to the whites. Behavioral factors such as physical inactivity, unhealthy diets, smoking, and low level of awareness among African Americans contribute to the increased prevalence of myocardial infarction and its associated risk factors in them (Patlolla et al., 2022).
Interaction of Processes to Affect the Patient
The above processes interact to affect the patient. First, lifestyle and behavioral factors such as physical inactivity, unhealthy diets, and smoking predispose patients to myocardial infarction. They cause its associated risk factors such as obesity, hypertension, and diabetes mellitus. The increased rates of myocardial infarction among the African Americans imply that they suffer from the increased burden of the disease (Hernandez-Suarez et al., 2019). Challenges in accessing the care they need due to social determinants of health such as low income also contributes to poor outcomes among them.
The pathophysiological processes also interact to affect the client. First, the occlusion of blood and oxygen supply to the cardiac muscles causes a shift from aerobic to anaerobic respiration in the cells. This leads to the accumulation of lactic acid, which cause cardiac muscle ischemia. The resulting symptoms include fatigue, chest pain, chest tightness, sweating, and vomiting. Recurrent episodes of myocardial infarction affect myocardium integrity (Peters et al., 2021). The affected cells heal by hypertrophy and formation of scar tissues, which compromise the myocardium further. If no intervention is adopted, cardiac arrest occurs alongside sudden death.
Conclusion
The patient in the case study suffered a myocardial infarction. This arose from the reduced or sudden cessation of blood flow to the myocardium. The accompanying symptoms include chest pain, chest tightness, nausea, vomiting, and ECG changes such as ST segment elevation. Racial and ethnic factors also account for the development of myocardial infarction. African Americans have the highest rate of the disease and are likely to suffer poor outcomes as compared to American Whites. The interaction between the pathophysiologic processes and racial/ethnic factors increases the risk of individuals developing myocardial infarction.
References
Hernandez-Suarez, D. F., Ranka, S., Villablanca, P., Yordan-Lopez, N., González-Sepúlveda, L., Wiley, J., Sanina, C., Roche-Lima, A., Nieves-Rodriguez, B. G., Thomas, S., Cox-Alomar, P., Lopez-Candales, A., & Ramakrishna, H. (2019). Racial/Ethnic Disparities in Patients Undergoing Transcatheter Aortic Valve Replacement: Insights from the Healthcare Cost and Utilization Project’s National Inpatient Sample. Cardiovascular Revascularization Medicine, 20(7), 546–552. https://doi.org/10.1016/j.carrev.2019.04.005
Hilliard, A. L., Winchester, D. E., Russell, T. D., & Hilliard, R. D. (2020). Myocardial infarction classification and its implications on measures of cardiovascular outcomes, quality, and racial/ethnic disparities. Clinical Cardiology, 43(10), 1076–1083. https://doi.org/10.1002/clc.23431
Ojha, N., & Dhamoon, A. S. (2022). Myocardial Infarction. In StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK537076/
Patlolla, S. H., Shankar, A., Sundaragiri, P. R., Cheungpasitporn, W., Doshi, R. P., & Vallabhajosyula, S. (2022). Racial and ethnic disparities in the management and outcomes of cardiogenic shock complicating acute myocardial infarction. The American Journal of Emergency Medicine, 51, 202–209. https://doi.org/10.1016/j.ajem.2021.10.051
Peters, S. A. E., Colantonio, L. D., Dai, Y., Zhao, H., Bittner, V., Farkouh, M. E., Dluzniewski, P., Poudel, B., Muntner, P., & Woodward, M. (2021). Trends in Recurrent Coronary Heart Disease After Myocardial Infarction Among US Women and Men Between 2008 and 2017. Circulation, 143(7), 650–660. https://doi.org/10.1161/CIRCULATIONAHA.120.047065
Simon, S., & Ho, P. M. (2020). Ethnic and Racial Disparities in Acute Myocardial Infarction. Current Cardiology Reports, 22(9), 88. https://doi.org/10.1007/s11886-020-01351-9
Subramaniam, A. V., Patlolla, S. H., Cheungpasitporn, W., Sundaragiri, P. R., Miller, P. E., Barsness, G. W., Bell, M. R., Holmes, D. R., & Vallabhajosyula, S. (2021). Racial and Ethnic Disparities in Management and Outcomes of Cardiac Arrest Complicating Acute Myocardial Infarction. Journal of the American Heart Association, 10(11), e019907. https://doi.org/10.1161/JAHA.120.019907
Yandrapalli, S., Nabors, C., Goyal, A., Aronow, W. S., & Frishman, W. H. (2019). Modifiable Risk Factors in Young Adults With First Myocardial Infarction. Journal of the American College of Cardiology, 73(5), 573–584. https://doi.org/10.1016/j.jacc.2018.10.084

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CASE STUDY ANALYSIS

An understanding of the cardiovascular and respiratory systems is a critically important component of disease diagnosis and treatment. This importance is magnified by the fact that these two systems work so closely together. A variety of factors and circumstances that impact the emergence and severity of issues in one system can have a role in the performance of the other.

Effective disease analysis often requires an understanding that goes beyond these systems and their capacity to work together. The impact of patient characteristics, as well as racial and ethnic variables, can also have an important impact.

An understanding of the symptoms of alterations in cardiovascular and respiratory systems is a critical step in diagnosis and treatment of many diseases. For APRNs this understanding can also help educate patients and guide them through their treatment plans.

In this Assignment, you examine a case study and analyze the symptoms presented. You identify the elements that may be factors in the diagnosis, and you explain the implications to patient health.

RESOURCES

Be sure to review the Learning Resources before completing this activity.

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WEEKLY RESOURCES

To prepare:

By Day 1 of this week, you will be assigned to a specific case study scenario for this Case Study Assignment. Please see the “Announcements” section of the classroom for your assignment from your Instructor.

The Assignment

In your Case Study Analysis related to the scenario provided, explain the following

The cardiovascular and cardiopulmonary pathophysiologic processes that result in the patient presenting these symptoms.

Any racial/ethnic variables that may impact physiological functioning.

How these processes interact to affect the patient.

BY DAY 7 OF WEEK 4

Submit your Case Study Analysis Assignment by Day 7 of Week 4

Reminder: The College of Nursing requires that all papers submitted include a title page, introduction, summary, and references. The sample paper provided at the Walden Writing Center provides an example of those required elements (available at https://academicguides.waldenu.edu/writingcenter/templatesLinks to an external site.). All papers submitted must use this formatting.

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