NUR 443 Evidence-Based Nursing Research And Practice


This is a summary report based in part on Renda Balley’s clinical case. Renda was suffering from heart disease.

She had myocardial ischemia, which causes cheat pain or angina.

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Nursing care should include providing relief for patients who are suffering from chest discomfort.

These can be done by giving smooth muscle relaxants such morphine, nitroglycerin and others.

Neglecting to properly address nursing issues can have serious consequences. This could lead to death or cardiac arrest.

It is also important to take preventive measures to avoid developing future serious health issues like coronary artery disease.

The best preventive measure is exercise. This will open up new opportunities to prevent high-risk conditions in the future.

Answer to Question: NUR 443 Evidence-Based Nursing Research And Practice


Renda Balley, a patient, was diagnosed with cardiovascular disease. This included hypertension, dysarrthymias, myocardial ischemia, arrhythmia, and hypertension.

She was a frequent smoker, had a history involving cardiac abnormalities, and had undergone surgeries.

Radiofrequency ablation was used to relieve her cardiac arrhythmia.

Her nursing recommendations or implications included assessment of chest pain and respiration, blood pressure and electrocardiogram among other things (Bandstein und al., 2014.).

Furthermore, the patient suffered from dysrhythmias. Accordingly to Stouffer, 2017, hemodynamic regulations were added in the nursing care plan. These regulation included the determination of pulse rate, ventricular contractions, and tachycardia.

These nursing interventions can be very useful in caring for patients suffering from cardiovascular diseases.

The purpose of this paper is to present the two nursing treatment plans: Nitroglycerin SL administration or morphine administration. These would have helped the patient overcome the chest pain that can be caused by ostial stenosis.


The case study showed that the patient had suffered from coronary heart disease.

There was severe stenosis and blockage of the coronaryarteries.

Percutaneous coronary surgery was performed to free the blocked coronary veins.

To increase the luminal size of the coronary blood vessels, stenting was also performed.

However, XIENCE had previously failed.

She was not given morphine nor nitroglycerin SL. However, her chest pain from blocked coronary arteries is still present.

BIPAP was also prescribed, which can increase the likelihood of myocardial ischemia.

Literature Review

Angina or chest discomfort is caused by low oxygen levels in the heart muscles and myocardium.

Angina feels like you are pressing down on your heart (Chitra Jegan, Ezhilarasu and Ezhilarasu 2017.

This pain can be felt in the jaws and arms as well as the back.

Angina is most often associated with the development of coronary artery disease.

Plaque buildup within the coronary veins can cause coronary hearts disease.

The increased morbidity and mortality associated with myocardial infarction are also factors.

One study demonstrates the role of opioids in pain relief for patients with myocardial ischemia.

Myocardial Infarction can lead to anxiety, breathlessness, and pain in patients.

The purpose of this empirical research article is to examine the clinical efficacy as well as the outcomes of morphine use in patients suffering from acute coronary syndrome.

The study revealed that prehospital morphine usage causes a haemodynamic impact, which is beneficial to patients suffering from acute coronary syndrome.

It did not have any side-effects and was free of complications.

It causes a decrease in heart rate, but it does not affect the systolic and diastolic blood pressure.

It’s a great treatment option for patients who have severe chest pain from myocardial infarction (Puymirat (2015)).

Morphine offers relief from chest pain that is not treatable with nitroglycerin.

Acute Heart Failure is a condition that requires immediate attention from healthcare staff, doctors and nurses.

Nursing interventions in this field involve acute monitoring of patients to identify any symptoms that might need immediate attention and treatment.

For patients suffering from acute heart failure, vasodialaters (like nitroglycerin) are necessary to lower the ventricular rates.

Morphine, on other hand, can reduce afterload, prevent load, relieve dyspnea, and lower heart rate (Mebazza. et. al., 2015.

When there is angina or chest pain, myocardial damage, or angina, the first line treatment is Nitroglycerin.

Nitric oxide is produced by nitrogenglycerin, which causes vasodialation.

It helps to create equilibrium between the supply and demand of oxygen and nutrients.

But, excessive use of nitroglycerin could cause tolerance, increase vasoconstrictor sensitivity, and prooxidant effects (Ferreira-Rosen (2012)).

These nursing interventions are nonsurgical options that could have helped the patient as described in the case. They also can be used before or after surgery such as percutaneous coronary procedures.

These interventions could have provided relief for the patient with chest pain.

Nursing Implications

It relaxes the smooth vascular muscles with its nitroglycerin.

Ostial Stenosis can cause blockage in the coronary blood vessels, which is known as coronary heart disease. (Strauss, et al. 2015).

Ostial stenosis is a condition in which the heart muscles cannot supply enough oxygen and blood to the body. This can cause severe chest discomfort or angina.

The oxygen and blood supply of the heart muscles or myocardium can be increased by Nitroglycerin.

This aids in dialating the peripheral veins. When taken in high doses, it can cause the dialation of the peripheral arterial arteries. This will reduce the afterload, preload and subsequent oxygen consumption for the myocardium.

Myocardial ischemia is characterized as pressure, tightness, or squeezing pain in the chest.

The pain often spreads to the arms or back, as well as the jaws.

Chest pains can be treated with Morphine if they are not nitrate-resistant.

It lowers heart rate and blood pressure. Additionally, it can stimulate locally mediated histamine regulatory processes.

This helps reduce the oxygen need of the myocardium.

Morphine is a pain reliever that can be used to treat ischemic tissues destruction.

It also helps to reduce pain associated with ischemic tissue destruction (Parodi und al. (2015)).

Poor nursing care can lead meocardial infarction to cause many complications.

The three most common complications are ischemic mechanical and arrhythmic (Kutty Jones & Moorjani (2013).

Ischemic means angina and reinfarction.

Mechanical includes heart failure, aneurysms cardiac rupture, shock and mechanical. Arrhythmias include atrioventricular node or sinus dysfunction.

Therefore, timely nursing interventions are essential to prevent patients from dying and to provide pain relief to those with coronary disease.


This synthesis report discusses the potential clinical problems caused by poor nursing care.

Renda Balley was suffering with chest pain due to cardiovascular diseases.

Her case study revealed that Renda Balley was not eligible for any heart muscle relaxationants. This would have helped her with her chest pain.

BIPAP was also prescribed to her. This can cause myocardial damage to worsen.

The nursing care plan she received was inadequate, and could have adverse effects on her health.

Coronary artery disease is often linked to high cholesterol and high blood pressure.

These conditions can be caused by poor diet and lack of exercise.

There are new ideas that could encourage the public to exercise.

Hospitals as well as health insurance companies need to offer rewards that would encourage people to do daily activities.

Also, it is crucial to assess your physical fitness for the purpose of monitoring the health of both the general population or patients with heart disease.

Healthy lifestyles can help prevent future problems for the health of people.

Physical activity is a good way to prevent long-term health problems and risk factors that are slowly affecting the present generation.

ReferencesBandstein, N., Ljung, R., Johansson, M., & Holzmann, M. J. (2014).

Undetectable high-sensitivity cardiac Troponin T level in emergency department. Risk of myocardial Infarction.

Journal of the American College of Cardiology.Chitra, R., Jegan, C., & Ezhilarasu, R. (2017).

Analysis of heart disease risk factors and myocardial-infarction risk factors.

Biology & Medicine Case Report. 1(1).Ferreira, J. C., & Mochly-Rosen, D. (2012). Nitroglycerin use in myocardial infarction patients.

Circulation Journal 76(1): 15-21.Kutty, R. S., Jones, N., & Moorjani, N. (2013).

Mechanical complications of acute heart attack. Cardiology clinics, 31(4), 519-531.Mebazaa, A., Yilmaz, M. B., Levy, P., Ponikowski, P., Peacock, W. F., Laribi, S.,& McDonagh, T. (2015).

Recommendations in pre-hospital & early hospital management of severe heart failure: a consensus paper of Heart Failure Association of European Society of Cardiology and the European Society of Emergency Medicine.

European journal for heart failure, 17(6).Parodi, G., Bellandi, B., Xanthopoulou, I., Capranzano, P., Capodanno, D., Valenti, R., … & Alexopoulos, D. (2015).

Morphine may cause delayed action of oral antiplatelet medications in patients suffering from ST-elevation acute heart attack.

Circulation, Cardiovascular Interventions, 8(1). e001593.Puymirat, E., Lamhaut, L., Bonnet, N., Aissaoui, N., Henry, P., Cayla, G., & Goldstein, P. (2015).

FAST-MI (French Registry of Acute ST–elevation and non–ST-elevationMyocardial Injury) has established a correlation between prehospital morphine and ST-elevation infarction patients.

European heart journal 37(13), 1063-1071.Stouffer, G. (2017).

Cardiovascular hemodynamics: A guide for the clinician.

John Wiley & Sons.Strauss, R. A., Johnson, A., Lampert, R. C., Aziz, S. R., & Wessel, J. (2015).


Maxillofacial, Oral and Maxillofacial Surgery Secrets-E-Book.