Managing Coronary Heart Disease, Hypertension, and Type-2 Diabetes

Introduction

Coronary Heart Disease (CHD) is the build-up of plaque in the arterial wall which supports blood supply to the heart and the plaque causes narrowing of the arteries resulting to limit blood flow to the heart (Tayefi et al., 2017). As per reports in 2021, nearly 2.3 million people in the UK are suffering from CHD out of 7.6 million people living with various heart and circulatory diseases (CHF, 2021). The presence of high blood sugar due to type-2 diabetes over time causes damage to the blood vessels and nerves leading to support the development of CHD (Zhao et al., 2017). Moreover, CHD development is seen to cause hypertension as the narrowing of arteries due to plaque development causes increased build-up blood pressure to force adequate amount of blood through the artery (Cleven et al., 2020). Thus, two key care interventions for patient named Mr Jones who is suffering from CHD along with hypertension and type-2 diabetes is chosen to be discussed. This is because CHD is one of the prevalent circulatory and heart diseases in the UK. Moreover, hypertension and type-2 diabetes are found to be co-morbid condition and risk for CHD patients, thus intervention for management of the two problems are also be discussed. In this assignment, one pharmacological and non-pharmacological intervention for Mr Jones is to be discussed with the rationale behind its implementation. Thereafter, the role of the nurses in caring for Mr Jones is also to be discussed.

Pharmacological Approach

The patient journey of Mr Jones concludes that he has been suffering from type-2 diabetes for the past 8 years and has currently been admitted to the hospital due to suffering from acute coronary artery disease (CHD) and has been detected with hypertension as a result of the disease. The journey further mentioned that Mr Jones has been diagnosed with myocardial infarction CHD. The NICE guidelines mention that beta-blockers are to be administered to the patient as soon as possible after myocardial infarction in CHD when they are haemodynamically stable (NICE, 2020). This is because beta-blockers travel through the blood to reach the heart to acts to bind with the beta-adrenoceptors for blocking expression of epinephrine hormone or adrenaline (Qian and Wei, 2019). Therefore, stable blood flow is required to ensure transmission of beta-blockers to the heart to act in managing symptoms of CHD. The haemodynamic stability indicates that an individual is required to have stable pumping heart and enhanced blood circulation (Mirakbarovna et al., 2019). In case of Mr Jones, after execution of angioplasty on him for managing myocardial infarction (MI) in CHD, he is seen to have hemodynamic stability as seen from the care history. Thus, beta-blockers can be administered to him in controlling his CHD condition.

The study by Farzam and Jan (2020) informed that epinephrine, non-epinephrine and catecholamines bond with B1 receptors to enhance the automaticity of cardiac functioning and conduction velocity. The B1 receptors also act to induce the release of renin which leads to increase in blood pressure or hypertension in individuals. In contrast, the study by Kotecha et al. (2017) mentions that B2 receptor binding with the epinephrine and others causes dilation of the smooth muscles as well as enhances metabolic effects like glycogenolysis and others. In the study by Kim et al. (2021), it is mentioned that beta-blockers vary in specificity towards different receptors and their effect depends on the type of receptors (B1 or B2) been blocked with the involvement of the organ system. Thus, the mechanism of action of beta-blockers in case of CHD patients includes binding with B1 and B2 receptors to inhibit the chronotropic and inotropic effects of the heart due to CHD and to slow it down to ensure its normal functioning in Mr Jones and similar patients. The beta-blockers apart from supporting enhanced cardiac output in CHD patients also lower hypertension. This is beta-blockers makes the heart to beat slowly with less force that assists in lowering the blood pressure leading to hypertension (Farzam and Jan, 2020). Moreover, beta-blockers act to suppress secretion of renin in the blood by inhibiting the β1-adrenergic receptors present in the heart, kidney and fat cells. The presence of renin does not itself causes hypertension, but it leads to increased production of angiotensin-I in the body by conversion of angiotensinogen which mainly acts to cause vasoconstrictions leading to high blood pressure (Li et al., 2019).

The beta-blockers do not only manage maintaining stable heart condition but also benefits to block stress hormones which with time may cause bone thinning and increased hypertension (Andreasen and Andersson, 2018). However, the side-effects of beta-blockers include feeling sick, clod fingers, difficulty in sleeping and others. This is because beta-blockers act to lower secretion of melatonin which is responsible for managing sleep cycle and it results to cause sleep changes (Rodriguez and Alkhateeb, 2020). Moreover, beta-blockers affect blood supply to the hands and feet due to which they may become cold (Rodriguez and Alkhateeb, 2020). As argued by Stanford et al. (2020), beta-blockers lead to cause weight gain in individual as side-effect. This is because beta-blockers target increased secretion of H1 histamine receptors which acts to increase the brain’s signalling for increase of appetite resulting in overeating and weight gain (Muddana et al., 2018). Thus, the side-effects may influence Mr Jones to face dizzy and increased appetite with initial use of beta-blockers which is required to be controlled with effective support from nurses and physicians.

The NICE guidelines mention that the target dose of beta-blockers is to be titrated according to the toleration and need of the patient (NICE, 2020). The dose for beta-blockers varies from 25 to 100mg per day to be provided to the patient (Bunge et al., 2019). In case of Mr Jones, the dose is to be determined by the physician according to his tolerance for the medication. The NICE guidelines mention that beta-blockers are to be continued minimum for 12 months after myocardial infarction for patients without left ventricular ejection fraction and lifetime for patients with left ventricular ejection fraction (NICE, 2020). In case of Mr Jones, he has suffered myocardial infarction (MI) and has expressed no issue of left ventricular ejection fraction due to which the medication is to be continued by him for minimum of 12 months. However, if adverse impacts are seen and harmful consequences are faced such as hindered heartbeat, blood pressure and others, then the medication is to be discontinued before 12 months. The beta-blockers otherwise are to be discontinued for patients without left ventricular ejection fraction and MI after 12 months if no further clinical indication of use of the medication is perceived (NICE, 2020). The beta-blocker is usually administered orally, and subcutaneous or ophthalmic way of administration is taken when the patients is unable to take it orally (NICE, 2020). In case of Mr Jones, in the rehabilitation phase after surgery for MI, beta-blocker is to be administrated orally to him as he does not require immediate presence of the medication in the blood as developed through intravenous administration of the medication because the clinical symptoms are somewhat controlled through surgery.

Non-pharmacological Approach

The non-pharmacological intervention immediately required by Mr Jones in controlling his CHD condition and type-2 diabetes along with hypertension is weight management. This is because apart from CHD, Mr jones is mentioned to be suffering increased weight which is evident as his BMI level is 32 (BMI above 30 indicates obesity) and his waist girth is 35 inches indicating excess central obesity. The presence of increased weight or being obese makes people be at risk of hindered heart management and development of hypertension. This is because obese individuals are seen to need increased supply of oxygenated blood and nutrients in the bodies which makes the heart to beat faster than normal and raises increased blood flow leading to hypertension or high blood pressure (Aguiar et al., 2021). In contrast, the study by Lean et al. (2019) mentioned that healthy body weight after myocardial infraction in patients leads them to maintain stable heart condition and normal blood pressure. This is because no extra need of nutrients and blood is required by them to support their health as seen in obese patients.

The study by Lean et al. (2018) mentioned that weight gain or obesity acts as an independent risk factor for presence and worsening of type-2 diabetes. This is patients with obesity are seen to have increased amount of NEFA, cytokines, glycerol, proinflammatory and other substances which are responsible for increasing insulin resistance within the body leading to type-2 diabetes (Lean et al., 2019). In contrast, the study by Hamdy et al. (2018) mentioned that presence of healthy body weight and involvement in weight management leads to increase in the efficiency of the muscles of the body to use insulin. Thus, effective weight management intervention for Mr Jones is immediately required for supporting him to develop enhanced holistic health and well-being.

The NICE guidelines mention that all individuals with obesity after myocardial infraction (MI) are to be supported in healthy management of body weight. For this purpose, the local general physicians (GPs), commissioners of care and others are to be involved in providing weight management support for the patient (NICE, 2020). Thus, Mr Jones is to be supported by local authorities and GPs in weight management as it is required to manage healthy life after MI and control hypertension and worsening of type-2 diabetes. The weight management is to be made by Mr Jones by initially involving in regular physical activity. This is because physical activity helps the body burn extra fats by creating a demand of increased energy. It also helps to reduce fat present around the waist and the total body (Fruh, 2017). Since Mr Jones has most fat in the wat area, therefore physical activity is essential part of his weight management.

Role of Nurses

In the implementation and continuation of the mention intervention for Mr Jones, the nurses have the initial role is to inform him in detail about the dose and way of administration of each medication along with assist him in using technologies and strategies to ensure remembering of medication intake without delay. This is because delay or uncontrolled medication use in patients with CHD leads to relapse their condition and worsen their health (Marcinkiewicz et al., 2017). According to NMC Code of Conduct, the patients are to be provided autonomy in deciding their own care (NMC, 2018). In this context, the nurse caring for Mr Jones has the role of supporting his autonomy to decide the nature of care to be accepted by him. The nurse caring for Mr Jones has the role to remain in contact with the patient and inform the patients regarding the routine health assessment to be made after surgery regarding MI. This is because it ensures continued health monitoring and assessment of the patients which helps in identifying early indication of any relapse of symptoms regarding CHD and the impact of the care been provided to the patient (Guetterman et al., 2019).

The nurse caring for Mr Jones has the role to arrange multi-disciplinary team support required by the patient for his weight management. This is because support from multi-disciplinary professionals in weight management such as physical trainer and dietician helps the patients to determine the nature of physical activity suitable for them and nature of healthy food to be eaten and in what amount to remain healthy (Mendell et al., 2019). As argued by Livori et al. (2021), inability of the nurses to arrange multi-disciplinary care for cardiac patients leads to face lower well-being. This is because expert assistance required to meet their varied health needs is not met with quality care support. The role of the nurse caring for Mr Jones is to inform him about the benefits and side-effects of the medication provided to him for MI management. This is because it would help the patient understand the risk and importance of abiding with the medication and provide informed consent regarding the care (Herlian et al., 2017). It is essential as NMC Code mentions nurses are to access informed consent regarding care and act in best interest of the patients to ensure their enhanced health (NMC, 2018).

The nurse’s role for Mr Jones includes education him regarding the importance of abiding weight management. This is because it would make the patient develop awareness regarding the need for weight management and show interest in participating in the intervention (Grant et al., 2017). As argued by Priano et al. (2018), lack of advocacy by the nurses in educating patients regarding health intervention leads the patients to avoid compliance in care. This is because the patients being unaware of the intervention consider it to be useless and extra care which is not required leading them to avoid accepting the care. The role of the nurse caring for Mr Jones is to provide him care with dignity and ensure his self-respect is maintained in all condition. This is because it would make the patient feel valued and show enhanced compliance in care (Grant et al., 2017).

In regard to family-centred care, the nurse’s role caring for Mr Jones is to educate and train his wife regarding the way she can support him to continue the care in the rehabilitation stage and maintain enhanced well-being. This is because the case study informs that his wife is his key carer and adequate age to take effective care of him as well as support his well-being. In case Mr Jones try to discontinue the weight management strategies due to long time been taken in reducing his weight, it is the role of the nurses to boost and encourage him in continuing the program by explaining to him about the final consequences if not following as well as following the program. This is because making patients understand the importance an impact of the health intervention leading them to gain encouragement in continuing it and avoid its untimely discontinuation (Myklebust et al., 2018).

Conclusion

The above discussion informs that Mr Jones is suffering from CHD and has suffered myocardial infraction for which angioplasty is been done. He also has type-2 diabetes and currently suffering from hypertension. In this condition, the key pharmacological intervention is use of beta-blockers as they are effective in blocking epinephrine action in the body which results to slow increased heart rate and lower blood pressure to ensure smooth flow of blood. The weight management is the non-pharmacological intervention to be used for Mr Jones in managing his obesity as well as controlling diabetes and hypertension. The weight management intervention is required to include information regarding physical activity and healthy diet to be abided by Mr Jones. The role of the nurse caring for Mr Jones in regard to the intervention includes informing his about the importance and dose of medication, arrangement of multi-disciplinary support for weight management, support monitoring of his health and others. In addition, the nurse has the role to ensure autonomy, dignity, respect and informed consent regarding care is ensured for the patient.

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