NURS 340 The Science Of Evidence-Based Practice


Purpose. The nurse’s role in ensuring patient-centered and safe care will be evaluated by the student.

The case analysis will be completed by the student using the criteria below.

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According to our experience, students who are most successful at this assignment pick the patient after the fourth week of clinical.

Answer to Question: NURS 340 The Science Of Evidence-Based Practice


Ostial staining causes narrowing and stenosis in the coronary artery.

Ostial lesions can be caused by calcification and the presence of the ortal wall.

They are highly susceptible to restenosis (Mencel und al., 2013, 2013).

This report describes Renda’s medical condition.

Renda Balley received surgery at Henry Ford Main hospital in October 2017.

She lives in Warren with her husband.

She has no children.

She has been smoking cigarettes for 12 years.

Chantix is an expensive drug which helps to quit smoking. Chantix has stabilised her economic status (Yzer 2015).

Renda resides with her husband’s family which indicates strong cultural values.

She could have Native American heritage, where smoking is a part in their ceremonial lives.

She has high blood cholesterol, high blood pressure and has obstructive or sleep apnea.

She was diagnosed with ostial cardiac artery disease after she had her heart catheterized.

Significant stenosis could be seen at the MLAD or Otitis media 1, Otitis media 1 (OM), ostial right heart artery (RCA), middle RCA, distal RCA, proximal circumflex and left external iliac. The medial branches was also occluded.

The left superficial femoral had only 10% and the left exterior iliac had 20% residual stenosis.

The right internal carotidartery was in a 85% condition but it became less than 10% after surgery.

LAD showed a 20-30% instent restenosis and 99% of the artery was occluded with disease spread.

Superficial Femoral Artery also showed 50 to 80% stenosis.

This report describes the pathophysiology of this disease. It also evaluates the results for various diagnostic tests. Finally, it provides nursing plans and discharge planning.

Acceptance or Medical Diagnoses


Stenosis is a condition that prevents the heart from responding to the increased oxygen demand of myocardium.

Intimal pressure, metabolic rate, diastolic pulse pressure of your aorta and endothelial functions, blood viscosity, and control of the autonomic nervous systems are all important regulators for blood flow in the heart.

The abnormalities of the coronary artery are split origin of right coronary artery and irregular location and position of the coronary ostium.


There are many symptoms that can include myocardial or chest pain, angina, chest discomfort, pressure in the back and jaws, neck, shoulders and arms and heart attack.

Arrhythmia can also be a sign (Nabel & Braunwald (2012).

Heart disease such as coronary hearts diseases is one of the leading causes for death in America.

According to the case analysis, the patient has high cholesterol levels and high blood pressure. He also does not exercise (activity with cane) and is a smoker. These conditions are fatal.

Patient Assessment

A review of her medical history revealed that she suffers from arrhythmia and myocardial damage.

She has had a heart attack.

She also had percutaneous coronary surgery (PCI), to clear her blocked coronary veins (Li, et al. 2013, 2013).

She has OSA and peripheral arterial diseases.

She has high cholesterol and hypertension (higher blood pressure).

She has nocturnal cardiomyopathy.

Patients with ischemic cardiac disease are more likely to have an allergy to antibiotics. Because of the presence of cardiac mast cell cells, patients will need to take Benadryl or penicillin.

She is on a cardiac diet to lower her cholesterol levels and blood pressure.

Nursing Practices & Outcomes

Three possible nursing diagnoses for this case include hypertension and myocardial damage.

Nursing diagnoses related to hypertension and myocardial Infarction include anxiety, decreased cardiac output and insufficient tissue fusion, activity intolerance, digitalis toxicity, and insufficient tissue perfusion.

Hypertension nursing care plans include interventions like explaining to patients the limits of bloodpressure, explaining hypertension and how it affects the heart, helping them identify risk factors such as high sodium and cholesterol, planning exercises, and following a treatment plan.

This is because patients who have symptoms or are severely ill do not understand blood pressure.

It is crucial to assess the patient to ensure that they have an accurate understanding of the disease and treatment.

Myocardial Infarction Nursing Care Plan includes interventions such as: Assessing chest pain characteristics; identifying location, duration and intensity of the pain; determining history and monitoring medication therapy; administering medications and monitoring drug therapy; administering nitroglycerin SLC administration; identifying side-effects and carrying out an Electrocardiogram (ECG).

These measures are meant to help the patient rate the pain, and to explain that oxygen consumption may decrease due to pain. ECG can help determine cardiac damage. Morphine can be given during chest pain.

The nursing plan can provide comfort, lower chest pain, and less anxiety (Bermudez 2012.

In order to treat dysrhythmias in nursing, hemodynamic regulation is used to monitor heart rate, amplitude or regularity, pulse loss, cardiac output, blood pressure, respiration and changes in skin color and urine output. It also helps determine ventricular contractions, fibrillation, tachycardia, fibrillation (Gazarian (2014)).

These interventions allow for the identification of myocardial infarction and digitalistoxicity as well as differences in pulse rate, regularity, heartbeats, hearing, and other important information.Systems Approach

In the treatment of patients, a system-based approach was used.

Aside from cardiac surgeons and general practitioners, telemetry technicians were also present during cardiac procedures.

Telemetry allows patients to be monitored by an electronic system.

Different heart rhythms could indicate problems that may need treatment (Walsh. Topol. & Steinhubl. 2014).

An accurate telemetry technician should be able analyze the electrical impulses. The doctors base their treatment on their analysis.

This case study reveals that the patient has blocked coronary arteries. This can lead to ischemic cardiovascular disease, heart arrhythmias and allergic reactions to penicillin.

These were discovered by telemetry.

This allowed for the necessary safety measures to be taken during planning and cardiac intervention.Discharge Planning

The patient was asked for a diet that would reduce her movement and exertion.

She was asked to use a cane in order to do any activity.

BIPAP was suggested for sleeping.

Penicillin and other antibiotics were advised to be avoided.

This will ensure that the patient has a good diet and is on the right track to avoiding any further cardiac problems.

You can refer the patient to nutritionists, who can prepare a diet plan and consult with sleep specialists to track her OSA progress.

The patient should be aware of resources in the community, including health programs run by institutes such as the National Heart, Lung, & Blood institute.

The Center for Disease Control and prevention also offers many programs for people of different races and ethnicities.

Other community resources include education programs, health programs by doctors, and telephone-based assistance facilities.

It is essential to include in the anticipatory guide information the likelihood of suffering from pain after surgery.

Comprehensive information should be provided about pain management, how to address symptoms, and the best management techniques.

Culturally competent nursing

Based on all the information about the patient, it is possible to say that she’s a Native American.

Native Americans consider smoking to an integral part of their spiritual lives.

You will find them soft spoken, patient and attentive, with a willingness to share your personal space.

The nurse should be soft-spoken, patient-centered, attentive, not make eyecontact, proficient in their native language, and aware of alternatives to smoking cessation methods.

The nurse may recommend that patients use herbs like Lobelia Inflate (Willyard and 2015).

Agency-specific Policies

Pay for performance is an important policy at the hospital.

Payments are determined by the provider’s performance.

These payment methods enable patients to have a structured system of care delivery and allow them to choose high-quality services, as was the case in this instance.

This policy acts as a facilitator to the patient’s care ( – 2017).

Nursing leadership can help ensure high quality and safe care.

The nurse should have a high level of education and be highly skilled. They must also be able to gather quality data, implement effective work planning, and make recommendations.

Ethical & Legal Standards

The National Code of Ethics is a set of guidelines and responsibilities which nurses need to follow.

These ethical responsibilities are divided into “Nurses and People”, Nurses and Practice”, Nurses and Profession”, Nursing, Education and Research”, and?Nurses and coworkers”.

These codes enable nurses to make ethical decisions in their clinical roles, as well as those of administrators, researchers, policymakers, and nurses.

Respect for patient and family dignity and cultural sensitivity is important.

The advancements in medical science make it crucial to make an end of life decision.

Some medical interventions may not ensure that the patient is able to live a meaningful and fulfilling life.

In this way, patients can make their own decisions about the treatment and care they choose.

A directive can be either instructive or proxy and allows the patient to make a decision regarding their healthcare. This will allow them to take the appropriate steps regarding any future illnesses.

Patients have the ethical right to autonomy, and beneficence.

Autonomy refers both to the individual’s right to make their own decisions and to earning respect from others regarding medical care.

Beneficence means that the physician must respect and encourage patients’ decisions (Reynolds, Drew & Dunwoody, 2013.).

Reflection of Additional Education

The nurses can learn additional skills to enhance patient care. These include being more people-oriented rather than task-oriented, developing a connection with patients and providing undivided focus.


This case examines the treatment of a heart attack victim.

Her medical condition was caused primarily by her lifestyle choices and smoking.

She had been through a series of surgeries that helped her get over her issues.

This report describes how severe the patient’s condition is.

The report includes a detailed description of the patient’s medical condition, an assessment of the patient and discharge plans. It also defines nursing ethics.

ReferencesBermudez, N. (2012).

ACS: MI starts with a trifecta of difficulties. Nursing made Incredibly Easy, Vol: 10(6), pp: 14-17, doi: 10.1097/01.NME.0000421577.99021.b3.Cicolini, G., Simonetti, V., Comparcini, D., Celiberti, I., Di Nicola, M., Capasso, L. M., & Manzoli, L. (2014).

A controlled, randomized trial investigating the effectiveness of a nurse-led reminder email program to reduce cardiovascular risk in hypertensive subjects. International journal of nursing studies, Vol: 51(6), pp: 833-843, doi:10.1016/j.ijnurstu.2013.10.010.Ding, Q., Yehle, K. S., Edwards, N. E., & Griggs, R. R. (2014).

Geriatric Heart failure: Awareness, evaluation, & treatment in primary healthcare

The Journal for Nurse Practitioners. Vol. 10.1, pp. 49-54. doi:10.1016/j.nurpra.2013.06.014.Gazarian, P. K. (2014).

This descriptive study examines the nurse’s response to various electrocardiography alarms. International journal of nursing studies, Vol: 51(2), pp: 190-197, doi: 10.1016/j.ijnurstu.2013.05.014.Kounis, N. G., Soufras, G. D., & Hahalis, G. (2013). Anaphylactic shock: Kounis hypersensitivity-associated syndrome seems to be the primary cause. North American journal of medical sciences, Vol: 5(11), pp: 631, doi: 10.4103/1947-2714.122304.Li, J., Elrashidi, M. Y., Flammer, A. J., Lennon, R. J., Bell, M. R., Holmes, D. R. & Lerman, A. (2013).

Long-term outcomes of fractionalflow reserve-guided vs. angiography-guided percutaneous cardiac intervention in current practice. European heart journal, Vol: 34(18), pp: 1375-1383, doi: 10.1093/eurheartj/eht005.Mahmod, M., Francis, J. M., Pal, N., Lewis, A., Dass, S., De Silva, R., & Ashrafian, H. (2014).

Myocardial perfusion, oxygenation, and energy are reduced in severe aorticstenosis. These factors correlate with impaired energy and subclinical leftventricular dysfunction. Journal of Cardiovascular Magnetic Resonance, Vol: 16(1), pp: 29, doi: 10.1186/1532-429X-16-29.Mazur, W., Siegel, M. J., Miszalski-Jamka, T., & Pelberg, R. (2013).

Coronary Artery Nomalities.

CT Atlas of Adult Congenital Heart Disease. 183-202). Springer London. Retrieved from:, G., Kowalczyk, J., Swierad, M., Swiatkowski, A., Honisz, G., Kalarus, Z., & Sredniawa, B. (2013).

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American Society for Pain Management Nursing position paper: Pain management at end of life. Pain Management Nursing, Vol: 14(3), pp: 172-175, doi: 10.1016/j.pmn.2013.07.002.Walsh, J. A., Topol, E. J., & Steinhubl, S. R. (2014).

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Pharmacotherapy – Quest for the Quitting Pill. Nature, Vol: 522(7557), pp: S53-S55, doi: 10.1038/ (2017). Glossary. Retrieved 26 October 2017, from, M., Weisman, S., Mejia, N., Hennrikus, D., Choi, K., & DeSimone, S. (2015).

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