Health Promotion Case Study of Patient with Coronary Heart Disease

Introduction

Throughout this assignment I have chosen to discuss a patient I have previously cared for during my placement on a cardiology ward. The patient which I will be writing about was diagnosed with coronary heart disease whilst admitted to the ward.  Coronary heart disease is defined by the NHS website as a condition where your heart’s blood supply is clogged or is interrupted by a build-up of fatty substances in the coronary arteries. Throughout a duration of time the outer layer of the arteries can fur up with fatty deposits (NHS 2017). It is vital that throughout this assignment at all times I maintain confidentiality. Moreover, to ensure the patients confidentiality is kept I will be referring to the patient as patient X. The (NMC) Nursing and Midwifery Council’s Code of Professional Conduct (NMC 2015) has advised that patients confidentiality is kept at all times, therefore I have decided to follow their guidelines throughout this assignment and refer to the patient I will be discussing as patient X. As confidentiality is so important before writing about patient X I gained consent from both the patient and the manager of the cardiology ward. When asking for consent I emphasised that no personal information such as their name or location would be used and both the manager and patient X both trusted me and were happy to give me their consent.

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Throughout this case study I am going to reflect on the experiences not only of patient X but other patients who have been diagnosed with the same condition. Moreover, this case study will show the legal, ethical and policy context linked to the 3 health promotion’s I have decided to discuss in relation to coronary heart disease I have decided to discuss are blood pressure, smoking and nutrition.

Background Information

Patient X was a male who was 71. He went to see his GP due to feeling unwell however when his GP checked he was hypertensive with a result of 209/99 mmHg and his pulse rate was 92. As a result of this the GP immediately sent patient X to the hospital where he was admitted on the cardiology ward. Research from the NICE online website shows that if your blood pressure is 150/90 mmHg or higher you have high blood pressure, which is also known as ‘hypertension’ (NICE 2016). When patient X was admitted his news score was 4. When an individual news score is 4 healthcare staff must continue to carry out observations and increase frequency of observations to every two hours. Then the team must inform either a GP or CM and handover the results and the health status of the patient. (NICE 2017).

A huge factor in relation to patient X hypertension he had a BMI score of 35 which meant he was classified as obese. This means his body cannot pump blood around as effectively as average weighing people (CDC 2017). In addition Patient X has also smoked around 10 cigarettes daily and has done since the age of 26. The NHS website states that if an individual smokes and decides to give up it will reduce their chances of developing Coronary heart disease (NHS 2018).

Smoking

As I have stated previously in this assignment patient X has been smoking since he was 26 years which means he has been smoking for 41 years. This would have damaged his coronary arteries massively over time (NHS 2017). The British heart foundation website has made me aware that individuals that smoke increase the risk of developing coronary heart disease and other cardiovascular diseases such as strokes. Smoking damages the lining of an individual’s arteries which then leads to a build-up/blockage of fatty material also known as atheroma which then results in the arteries narrowing (BHF 2018).

Whilst patient X was admitted onto the cardiology ward, the multidisciplinary team worked together to help him in any way possible to ensure his disease did not worsen. One way in which the team tried to help patient X was by trying to help him quit smoking. Smokefree.com shows that one of the main reasons smokers keep smoking is nicotine. Nicotine is a chemical in cigarettes that makes people addicted to smoking. Individuals bodies gets used to having nicotine and the more they smoke‚ the more nicotine they need to feel normal. When individual’s bodies don’t get nicotine, they may feel uncomfortable and crave cigarettes. This is called withdrawal and this is very difficult when addicted to smoking (Smokefree 2019). Therefore to help patient X and other people who suffer from addiction of cigarettes the smoking cessation nurse was brought up onto the ward to offer advice to patient X and others with the same condition on how to quit smoking and to help them take action.

Another way in which individuals may get help to quit smoking is a pharmacology treatment of varenciciline along with individual or group therapy sessions has been recommended by NICE guidelines (2013). Patient X was very positive about this idea and agreed to try this as another way to try quit smoking.

On the ward we had leaflets which were full of information and advice to help individuals to quit smoking, moreover we gave patient X some to these to read.  Something which patient X was extremely shocked by was some of the information found in one leaflet given to him which was linked with Public Health England (2017). The information patient X was shocked by was that CVD is one of the single largest causes of death in the United Kingdom, killing a huge number of more than 500,000 people a year. Also within one year, the risk of heart attack drops dramatically, and even individuals who have had a heart attack in the past can cut their risk of having another if they quit smoking.

Obesity

At the beginning of this case study I gave background information on patient X whereby I mentioned how he was classified as obese due to his BMI score of 35. His high BMI score is due to poor diet and nutrition. Through my previous research, I have gathered lots of useful information and knowledge on obesity and how it is linked to coronary heart disease. One website I found useful information from was (WHO 2018). The world health organisation website stated that obesity and overweight were defined as a large amount of fat growth that presents a risk to individual’s health. When an individual is obese or overweight there are major risk factors for quite a number of chronic diseases, which include diabetes, cardiovascular diseases and cancer (WHO 2018).

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Obesity is a risk factor for CAD this is due to the cholesterol plaque build-up in the arteries of the heart, which means patient X being obese is most likely a factor to his coronary heart disease. Obesity is also interconnected to sleep apnea, which causes high blood pressure and also lung problems, both of which can ultimately lead to heart failure (NICE 2017). Sleep apnea is whenever the upper airway is blocked either partly or completely. It normally causes individuals breathing to pause during their sleep even though the person may be trying to breathe normally (NICE 2016).

As a multidisciplinary team we looked into and discussed the best options for patient X in relation to losing weight and bringing his BMI down. As a result we came up with a couple of different options, our first one was to educate patient X about issues such as making behavioural changes , changes to regular portion sizes and healthy eating. In order to educate him we organised a meeting with patient X, the lead nurse on the ward, a dietitian, an obesity administrative assistant and a consultant who was specialised in cardiology. During the meeting the team spoke to patient X about diet programmes and fad diets. Patient X was advised to avoid fad diets that endorse unsafe practices, such as fasting. Research which was last updated on the 7^th of February 2018 on the NHS website shows that this particular diet doesn’t work long term and they can make individuals very ill (NHS 2018). Patient X listened to this idea and agreed that he also believes diet programmes and fad diets isn’t the correct path for him to go down however he was happy to be educated on healthy eating by the professionals in the team.

Our second option for patient X was exercise as reducing the total of calories in your diet may help you lose weight, but maintaining a healthy weight individuals requires physical activity in order to burn energy (NHS 2019). Physical activity has many health benefits alongside of helping individuals maintain a healthy weight. Physical activity can prevent/manage over 20 conditions one being coronary heart disease.  The heart is a muscle and like any other muscle within the body it benefits from exercise. A strong heart can pump more blood with less effort around your body (NHS 2017). Any aerobic exercise like swimming, walking or dancing makes your heart pump blood faster and therefore makes your heart work faster and keeps it healthy (NHS 2017).  With this option patient X was less positive as he said he never was an active person, from this we then stressed the importance of exercise to patient X whilst agreeing to discuss other options with him as we had come up with quite a few before this discussion.

Then our final option for Patient X was weight loss surgery (bariatric surgery).  Weight loss surgery is a huge operation and therefore there are a lot of criteria to fill before this would be available to you. Only individuals suffering from severe obesity could think about getting this type of surgery, individuals need to score BMI

Bariatric surgery is usually only available on the NHS to treat people with severe obesity who fulfil all of the following criteria:

• They have a BMI of 40 or more, or between 35 and 40 and another serious health condition that could be improved with weight loss, such as type 2 diabetes or high blood pressure

• Accessed on 19/06/19 https://www.nhs.uk/conditions/coronary-heart-disease/ published in 2017
• Accessed on 19/06/19 https://www.nice.org.uk/guidance/cg127/ifp/chapter/High-blood-pressure Published in 2016
• Accessed on 19/06/19 https://www.cdc.gov/obesity/adult/defining.html Published in 2017
• Accessed on 19/06/19 https://www.nhs.uk/conditions/coronary-heart-disease/prevention/ published in 2018
• Accessed on 19/06/19 https://www.bhf.org.uk/informationsupport/risk-factors/smoking published in 2018
• Accessed on 19/06/19 https://smokefree.gov/quit-smoking/getting-started/why-quitting-is-hard published in 2019
• National Institute for Health and Clinical Excellence (2007) acutely ill patients in hospital: Recognition of and response to acute illness in adults in hospital. www.nice.org.uk
• Coronary heart disease (7 April 2017)  https://www.nhs.uk/conditions/coronary-heart-disease//
• https://www.cdc.gov/tobacco/data_statistics/sgr/50th-anniversary/pdfs/fs_smoking_CVD_508.pdf
• https://www.who.int/topics/obesity/en/ published 2018
• Cardiovascular disease prevention- NICE guidelines (June 2010)https://www.nice.org.uk/guidance/ph25/chapter/Introduction
• Do we need a new definition of hypertension after sprint? -Ernesto L. Schifrin David A. Calhoun John M. Flack Journal of Hypertension, Volume 29, Issue 10, 1 October 2016, Pages 1127–1129. https://academic.oup.com/ajh/article/29/10/1127/2622244
• Nursing and midwifery Code of Conduct, 2015. https://www.nmc.org.uk/standards/code
• https://www.nhs.uk/conditions/obesity/treatment/ published 2019
• https://www.nhs.uk/conditions/coronary-heart-disease/prevention/ published 2017