Case study-Myocarial infarction

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NUR 364:

Human Sciences in Nursing 2

Alice Pryce-Williams

March 2007 Cohort


Human Sciences in Nursing 2

This assignment is going to explore how biological, psychological and social factors of a person’s life may impact upon their health status.  This will be done by including a detailed patient profile of Jane, a 55 year old patient, who suffered a myocardial infarction (MI) and was nursed in an acute hospital setting.  The altered physiology that occurred as a result of the MI will be looked at with consideration to psychosocial factors that may have contributed to the patient’s illness.  MI is one of the most common manifestations of CHD according to Todd (2008) and so Jane’s main risk factors for the development of coronary heart disease (CHD) will be identified, with particular attention on the issue of smoking.  How smoking may have contributed to the cause of an MI will then be explored, with an analysis of the factors that may have influenced Jane taking up smoking.  The main factors that will be looked at will be how living in a low social economic household gives more chance of becoming a smoker, and how influences from family and peers may trigger smoking behaviour.  Government interventions such as the smoking ban will then be looked at, and how National Service Frameworks (NSF) have been put in place to tackle the high numbers of CHD, as the disease accounts for almost a third of all smoking related deaths in Britain (Royal College of Physicians 2000).  Confidentiality will be respected throughout the assignment since the Nursing and Midwifery Council (NMC) (2008) states that a persons right to confidentiality must be respected at all times and so for this reason, any names used will be changed and the location of the care provided will not be recognisable.  

The concept locus of control and the sick role model will be looked at in relation to Jane’s health behaviour and beliefs and brief descriptions will be given of the two.  How Jane has taken on the sick role during her illness will be identified, and the problems that may arise because of this will be explored such as Jane adhering to treatment and adapting her lifestyle.  A conclusion will then follow which will review the main points that have been explored through the assignment, including an analysis of how the bio-psycho-social (BPS) model has assisted with the assessment of Jane and enabled transition to part B of the care study.  Therefore, two care problems will be identified that will be critically analysed in part B.  Lastly, a personal reflection will be given that will demonstrate what has been learnt through the completion of this assignment and how this new knowledge will be used to improve practice.  

First of all however, the full patient profile on Jane will be looked at.  To begin with, Jane was asked about her childhood and she stated that she came from a poor background as she lived in a cramped, three bed roomed house with her mother, father and four siblings.  She said the house was clean, but it was difficult living on top of one another and having to share a room with her two sisters.  As Maynard and Thomas (2004) state, housing is an important element in a child’s life, as poor housing or overcrowding can seriously affect a child’s physical and mental health.  Jane stated that she was quite unhappy at home as her parents often used to argue, mainly over money, as they used to struggle financially which used to be very upsetting for her and her siblings.  It is often external factors such as poor housing or financial hardship that cause depression and marital conflict, which can in turn affect children psychologically (Golombok 2000).  This was the main reason Jane moved away from home when she was 16, and went to live in Manchester where she found a place to live with two girls and work as a shop assistant.  She said she loved this time of her life as she had her own independence and didn’t really get homesick as she was glad to be away from the cramped lifestyle and the arguing of her parents.  After living in Manchester for two years, Jane decided to move on and moved to Wales where she stayed with her auntie and gained work in a factory.  She said that this was hard work and long hours, but was the only work she could find and do at the time, having only school education and no other qualifications or experience then shop work.  It is often only the poorly paid, manual work that people can gain who have no qualifications as Skelton et al. (2006) states.  

When Jane was 23 she got married to Tom, her boyfriend of two years, and had three children very close together, so Jane stayed at home whilst Tom went out and worked as a mechanic.  Jane stated that it was difficult having to look after three young children with no family support, whilst Tom went out and worked, only earning enough to pay the bills and rent.  However, when their youngest child started in full time school, Jane decided to go back to work part time.  She found work in the local shop just whilst the children were in school.  Jane states that this helped out with the bills and took some of the strain off Tom who was bringing the only money into the household.  As the children became a little older, Jane decided to find another job with better prospects, but longer hours to earn more money, so she looked around and found work as a care assistant in a nursing home nearby.  She said she was lucky to get the job with no experience, but was taken on because of here maturity and willingness to work, as her last employer had giver her an excellent reference.  Jane stated she loved this job and felt like she was doing something worthwhile with her life and more fulfilling whilst Tom continued to work as a mechanic.  Jane still works as a care assistant and says she works full time now that her children have all moved away from home.    

Jane was then asked if she was a smoker and she stated that she started smoking when she moved to Manchester when she was 16.  As Esmond (2001) states, most smokers take up the habit when they are teenagers where it may signify they are maturing and becoming independent.  Jane stated that she gave up smoking when she had her children, but unfortunately, started smoking again when she was 35 and has done to this day.  However, she stated that she usually only smokes 10 cigarettes a day as she does not smoke in the house and so finds she smokes less.  When Jane was asked whether she consumes alcohol and if so how much, she said that she only occasionally drinks alcohol when she meets her friends in the local pub maybe once per week.  

Jane was then asked about her diet and exercise habits and she stated that she has a reasonably healthy diet, but when asked what she would typically eat in a day, it became clear that Jane did not really have a true understanding of what a healthy diet included.  She stated that a typical day’s food included a sandwich, a packet of crisps and a yoghurt for lunch and a curry or chinese for tea.  When Jane was then asked about her past diet she stated that it used to be difficult to eat healthy because of money and time looking after the children and home.  People’s perception of healthy eating does vary, but some have the perception that it cheaper to buy convenience foods and tinned food than to buy the ingredients to make their own food (Hitchman et al. 2002).  Jane then stated that she didn’t really have time for sports activities, but said she felt she was active because of her job and the fact she didn’t drive so walked to work when the weather was nice.  However, Jane’s weight of 13 stone 9 pounds and her height of 5 feet 2 inches show that there has to be a problem with her diet and /or the amount of exercise she undertakes as she states she has been overweight since she had her children and stopped working.  People with a low level of education, and/or are on low incomes, are prone to having weight management problems according to Pearson (2003).  From Jane’s weight and height, a body mass index (BMI) (See appendix 1) of 35 shows that Jane is classed as obese.  The World Health Organisation (WHO) (2005) states that CHD is one of the main consequences of obesity in Europe.  

One afternoon, Jane was brought into the accident and emergency unit by her husband complaining of chest pain. She stated that she had never suffered anything like this before and was normally always fit and healthy apart from suffering from occasional back pain.  Jane stated that the pain was in the middle of her chest and was radiating down her left arm.  She was seen by the nurse and doctor immediately because she also appeared clammy, was profusely sweating and short of breathe.  The doctor quickly assessed Jane and treated her condition as an MI.  An MI occurs when a blood vessel supplying the heart with O2 becomes blocked by an atherosclerosis or a coronary thrombosis and causes a region of the heart muscle to die (Nelson and Cox 2005).  The affected tissue degenerates, causing a non-functional area known as an infarct (Gillespie and Melby 2003).  When this occurs it can be accompanied by symptoms of sweating, tiredness, weakness, pallor and dyspnoea; the difficulty or shortness of breathe (Thompson and Webster 1992).  

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A full assessment of Jane was carried out which showed that she was tachycardic, with a pulse rate per minute of 118, and hypertensive with a blood pressure of 182 systolic over 102 diastolic.  However, the tachycardia Jane was experiencing may have been due to the pain, or stress and anxiety of the situation (Lippincott Williams and Wilkins 2007).  An electrocardiogram (ECG) test was then carried out which is used to show the electrical activity of the heart including heart rhythm and rate (Handler and Coghlan 2007).  The reading from the ECG showed ST segment elevation which signifies that ...

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