NUR 443 Evidence-Based Nursing Research And Practice


This synthesis report was based upon Renda Balley, a patient with cardiovascular diseases.

She was suffering from myocardial injury, which can cause cheat pain and angina.

Patients suffering from chest pain should be treated by nurses.

These can be achieved by administering smooth muscle relaxants, such as morphine or nitroglycerin.

Failure to follow proper nursing procedures can result in serious consequences, including death or cardiac shock.

To prevent future health problems such as coronary heart disease, it is important to take preventive steps.

Exercise is one of the best preventive measures. This can open up new possibilities for preventing high-risk medical conditions.



Renda Balley’s case involved the diagnosis of heart disease. She had hypertension, arrhythmias, dysarrthymia and myocardial damage.

She was a regular smoker with a history of heart abnormalities.

In order to correct her cardiac arrhythmia, she underwent radiofrequency ablation.

She was given nursing suggestions and implications, including assessment of her chest pain, breathing, blood pressure, electrocardiogram, and respiration (Bandstein et. al., 2014).

Additionally, the patient had dysrhythmias. As a result, hemodynamic regulation was included in her nursing care plan to determine pulse, ventricular contractions, and tachycardia (Stouffer 2017,).

These nursing interventions are extremely relevant in the care of patients with heart disease.

This paper aims to present the two nursing plans: Nitroglycerin SL administration (and morphine administration) that would have helped the patient overcome the chest pains associated with ostial stenosis.


In this case, the patient was suffering from coronary heart disease.

Her severe stenosis was a blockage or stenosis of the coronary blood vessels.

Percutaneous coronary interventions were performed on her to unblock the blocked coronary arteries.

Stents were also used for improving the luminal diameter of her coronary vessels.

However, a previous XIENCE failed was reported.

She was not given morphine nor nitroglycerin SL in an attempt to ease her chest pain. This is due to her blocked coronary arteries.

She was also given a BIPAP which can increase the risk of myocardial damage.

Literature Review

Angina, or chest pain, is caused by a low oxygen supply to the myocardium or heart muscles.

Angina is a feeling similar to pressure or pinching of the heart (Chitra Jegan and Ezhilarasu 2017).

This pain can affect the jaws, arms and back, as well as other areas.

Angina is commonly associated with coronary arterial disease.

Plaque buildup inside the coronary vessels can lead to coronary heart disease.

Also, myocardial injury is associated with higher mortality rates and morbidity among elderly people.

One study shows how opiods can provide pain relief for patients suffering from myocardial damage.

Myocardial damage can cause anxiety, breathing difficulties and pain.

The objective of the empirical research article was to evaluate the clinical efficacy, and the outcomes of morphine usage in patients suffering from acute myocardial damage.

Pre-hospital use of Morphine causes a haemodynamic response, which is beneficial for patients suffering from acute myocardial damage.

It also did not cause any side effects.

It reduces the heart rate and does not alter the systolic pressure.

This makes it an effective treatment for patients with severe chest pain after myocardial damage (Puymirat, et al. 2015).

Morphine is a treatment that provides relief from chest pains not treated by nitroglycerin.

Acute heart disease is a condition where doctors, nurses, or healthcare personnel must provide quick relief to patients.

Nursing interventions in this area involve the monitoring of patients for signs and symptoms that may require immediate attention.

To control the ventricular rate of patients with acute cardiac failure, vasodialaters such nitroglycerin must be used.

Morphine can, however, reduce afterload, preload, alleviate dyspnea, and slow down the heart rate (Mebazza and al., 2015).

Myocardial Infarction, angina, chest pain, and myocardial ischemia are all treated with nitroglycerin as the first line.

In order to produce nitric dioxide, nitroglycerin causes vasodialation. It also increases blood flow to myocardium and the muscles of the heart.

In creating equilibrium between oxygen and nutrient supply, nitroglycerin aids in the development of an ischemic heart.

Tolerance can be caused by excessive nitroglycerin use. This could lead to increased vasoconstrictor sensitivity and pro-oxidant reactions (Ferreira, Mochly, 2012).

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

These interventions might have helped the patient to get relief from their chest pain.

Nursing Implications

A relaxant effect is achieved by Nitroglycerin on smooth vascular muscle.

The ostial blockage of the coronary arteries can lead to coronary artery disease (Strauss and colleagues, 2015).

Due to ostial stenosis, the heart muscles are unable to supply enough oxygen and blood. This can cause severe chest pain or even angina.

This helps increase oxygen and blood supply for the heart muscles, or myocardium.

This is used to dialate the veins in the peripherals. Higher doses may cause the peripheral arteries dialate. It can also reduce afterload and preload as well as the oxygen consumption of myocardium.

Myocardial Infarction is often associated with pain in the chest, pressure, tightness, and squeezing.

The pain may spread to the arms and back as well as the jaws.

Morphine can be used instead for chest pains.

It reduces heart rate, blood pressure, venous return, and heart rate. It can also stimulate localized histamine regulated processes.

This lowers the myocardium’s oxygen demand.

Morphine reduces pain from ischemic tissue damage.

It also offers anxiolysis (Parodi, et al. 2015).

Poor nursing care can cause myocardial damage.

The three main types of complications are ischemic and mechanical (Kutty Jones, Moorjani, 2013,).

Ischemic refers to angina, reinfarction, or extension.

Mechanical can include heart failure, aneurysms or cardiac rupture, shock, and shock.

To reduce the death rate of patients and provide pain relief to those suffering from coronary heart disease, nursing interventions must be done quickly.


This synthesis report is focused on the clinical issues that can arise from poor nursing care. It also includes the Renda balley case study.

Renda Balley suffered from chest pain and cardiovascular diseases.

The nursing implications of Renda Balley’s case were not to administer any heart muscle relaxants. However, it was revealed that her case study did not include the administration of any heart muscles relaxants. This would have helped her with her chest pain.

She was also provided with a BIPAP which can worsen her myocardial injury.

A proper nursing plan was not followed, which could have severe consequences for her health.

High cholesterol and high bloodpressure are often associated with coronary artery diseases.

This is usually caused by poor nutrition and lack of exercise.

It is therefore necessary to find new ways that people can get involved in physical activity.

Hospitals and insurance companies must offer incentives that encourage people to exercise daily.

It is essential to evaluate the level of physical fitness in order monitor the overall health of patients with cardiovascular disease and the general population.

Healthy lifestyles can help prevent more serious health problems in the future.

Therefore, physical activity can reduce the risk factors and long-term health problems that are gradually gripping the current generation.


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Circulation Journal, 76.1(1), 15-21.

Mechanical complications of acute coronary infarction.

Recommendations regarding pre-hospital and emergency hospital management of acute coronary syndrome: a consensus paper of the Heart Failure Association of European Society of Cardiology, European Society of Emergency Medicine and Society of Academic Emergency Medicine.

European journal on heart failure, 17(6). 544-558.

In patients with ST elevation acute myocardial injury (STEAMI) who are undergoing primary percutaneous coronary surgery, Morphine has a delayed effect on oral antiplatelet drugs.

Circulation: Cardiovascular interventions, 8(1).

Pre-hospital morphine intake in ST elevation myocardial ischemia patients and its association to in-hospital outcomes, long-term mortality and other factors: The FASTMI (French Registry of Acute ST Elevation and Non-ST Elevation Myocardial Ifarction) programme.

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

Cardiovascular hemodynamics for clinicians.

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