Prioritisation of Complex Patient Health Issues – Cardiac Case Study

Part One 

This essay takes into consideration a cardiac case scenario involving Mathew Cottrell, a 65-year-old male having a history of complex health issues. Mr. Mathew Cottrell presented in the emergency department early morning at 07:00 hours on 12th August 2020 as he was exhibiting elevated shortness of breath and chest stiffness and rigidity. Mr. Mathew Cottrell’s partner accompanies him to the hospital’s emergency department as he complains of the two above mentioned conditions. Mr. Mathew Cottrell has a past medical history comprising of the diagnosis of idiopathic (non-ischemic) Dilated Cardiomyopathy two years ago. According to the New York Heart Association (NYHA), idiopathic dilated cardiomyopathy is categorised as a class two heart condition and this function classification is widely utilised in practice as well as clinical studies.

 According to a study carried out by Stolfo et al. (2018), the health issues pertaining to idiopathic dilated cardiomyopathy were evaluated with arrhythmic risk stratification remaining a major concern for both patients and clinicians. Patients who are diagnosed with dilated cardiomyopathy mostly suffer from compromised and impaired left ventricular ejection and hence, leading to inadequate heart function (Stolfo et al. 2018). Furthermore, Mr. Mathew Cottrell also presents a past medical history of suffering from Hypertension for which he adheres to Metoprolol in order to counteract the effects of the prevailing medical condition. Apart from this, he also suffers from Type II Diabetes Mellitus and due to this, is advised to follow a stringent diet plan. Mr. Mathew Cottrell also adheres to drinking four to five bottles of wine in a week along with smoking a pack of cigarettes. 

Mr. Mathew Cottrell manages a wine vineyard and lives with his wife and son in the south coast. Initially, when Mr. Mathew was admitted to the emergency department in the morning, he presented to have been suffering from tachycardia, chest tightness, hypertension, difficulty in breathing and swelling in ankles up till the knee joints. However, after the three tests including, electrocardiogram, echocardiogram and chest x-ray (CXR) were performed on Mr. Mathew Cottrell, additional medical conditions were observed. Hence, the three major health problems that Mr. Mathew Cottrell is suffering from include hypertrophy in the left ventricle with no variations in the ST segment as exhibited by the electrocardiography examination and hence, there is a risk for arrhythmic stratification. Furthermore, the echocardiogram showed that there was substantial reduction in the fraction of the blood ejected from the heart ventricles thereby exhibiting a potential for heart failure and the chest x-ray (CXR) demonstrated that there was congestion in the bilateral lower lobe and that there was considerable enlargement in the size of the heart hence, again serving as a risk for myocardial infarction. 

Thus, these are the three cardiac related health issues which constitute a core part of the cardiac case study given and are linked towards Mr. Mathews past diagnosis of idiopathic (non-ischemic) dilated cardiomyopathy and also serve as the basis for prioritisation of complex patient health issues. According to a study carried out by Li et al. (2018), a comparison between alcoholic cardiomyopathy and idiopathic dilated cardiomyopathy was drawn. Samples from six regions of the explanted heart were acquired including those from left and right atrium as well as the right and the left ventricle. In both the samples, significant fibrosis in the myocardium was observed and hence, this exhibits the negative impact exerted on the heart due to intake of alcoholic substances (Li et al. 2018). This also explains why Mr. Mathew Cottrell is experiencing conditions such as chest stiffness and shortness of breath as it is evident from his medical background that he is a regular drinker adhering to consumption of four to five bottles of wine per week. 

Part Two 

Congestion in the bilateral lower lobe and substantial enlargement in the size of the heart can be considered as the most critical and serious health issue being faced by Mr. Mathew Cottrell. Increase in the size of the heart leads to accelerated pressure being exerted on the cardiac muscles as well as other organs and the rib cage. Furthermore, congestion in the bilateral lower lobe induces sufficient pain and enhances the risk for heart failure and other associated conditions. This is reflected by the assessment carried out on Mr. Mathew Cottrell when he presented himself with his partner in the emergency department. His assessment report exhibited a pain score of 6 on a pain scale having the highest value of 10. As per the study executed by Santos-de-Araújo et al. (2019), a pain score of 5 or more is considered as the worst possible pain that an individual can experience and needs to be dealt with immediate attention and treatment. 

Congestion in the bilateral lower lobe and enlargement in the size of the heart can be considered as the most significant health issue affecting Mr. Mathew as its serves as a basis of pain caused by early arrhythmic scenarios (Santos-de-Araújo et al. 2019). Due to increase in the size of the heart, the rate or the rhythm of the heart can be significantly affected and comprises of the heart either beating too fast, a condition referred to as tachycardia or beating too slow, a condition known as bradycardia (Losurdo et al. 2016). The pain score of 6 examined on Mr. Mathew can be linked to the heart rate detected exhibiting 110 beats per minutes which reflects the condition of tachycardia and poses the potential for heart failure.

Left ventricular hypertrophy as exhibited by the electrocardiogram should be given the second priority as one of the complex health issues being faced by Mr. Mathew Cottrell. Hypertrophy refers to accelerated increase in the size and growth of the muscle cells and hence serves as a major risk for inadequate heart function and ultimately heart failure. According to a study carried out by Myers et al. (2017), a major reason pertaining to hypertrophy of cardiac muscles and no variation in the ST segment of the heart rhythm is the elevated blood glucose level. The blood glucose level of a healthy individual lies between 4.0 and 5.4 mmol/L in case of fasting and up to 7.8 mmol/L two hours after having a meal. Blood glucose levels beyond these values can lead to hypertrophy as well as induce pain. However, certain activators can improve glucose levels, but don’t necessarily decrease hypertrophy (Myers et al. 2017). A similar analysis was made in a study carried out by Jin et al. (2017), where increase in the blood sugar level was examined in rats and the results exhibited increase in muscle size. Hypertrophy has been given the second priority as the assessment report of Mr. Mathew reflects a blood glucose level of 9.6 mmol/L which is way beyond the normal value. 

The third priority should be given to the echocardiogram result which shows reduction in the fraction of the blood being pumped out from the ventricles. This relies on the first and second priority health issues mentioned above and if these two are tackled with adequate measures, the third priority health issue can be managed as well. As per the study of Bloom et al. (2017), reduced ejection fraction of blood was evaluated to be in relation to increase in the heart size and cardiac failure. 

Part Three 

Healthcare industries and hospitals all across the globe tend to employ registered nurses (RN) who are expected to carry out their duties with utmost determination in order to optimise patient health and safety. In relation to the three major health issues presented by Mr. Mathew Cottrell, the responsible registered nurse (RN) will be mandated with a vast array of responsibilities including detecting, managing and averting a surge in the cardiac related health problems described in the case study. According to NHQHS (2020), a core responsibility of registered nurse (RN) catering to the need of patients such as Mr. Mathew suffering from cardiac health issues is to make sure that they observe the vital parameters accurately, introduce exercises that help to enhance ejection fraction as well as reduce pain along with executing appropriate measures in case of emergencies (NSW Health 2020). 

According to (ARC) (2020), the Australian Resuscitation Council aims to bring about awareness among nurses and other medical professionals about the essential skills and measures that they need to exhibit in case of catering to patients such as Mr. Mathew that suffer from hypertrophy and diabetes mellitus. The registered nurse (RN) attending Mr. Mathew should also follow the standards that have been precisely formulated so that patient health and safety can be optimised. The RN should regularly observe the assessment parameters being presented by Mr. Mathew including the heart rate, blood pressure, RR interval and the pain score and communicate with other specialists as well such as an assigned cardiologist and nephrologist (Nursingmidwiferyboard 2020). Registered nurses are also required to cater the needs of patients such as Mr. Mathew who present a past medical history of smoking and drinking to hold seminars and persuade them to avoid consuming such substances in the future so that their cardiac functions can be enhanced (Cashin et al. 2017).