Pathophysiology of Mr. George Orwell’s chest pain

Posted: June 6th, 2021

Pathophysiology Case Study: Chest Pain. Mr George Orwell is a 68-year-old male residing in rural South Australia. His deceased wife, Heather had terminal breast cancer. Mr. Orwell arrived at, and was admitted to, the Farquharson Memorial Hospital with chest pain. His admission assessment verified he was alert and orientated with unremarkable vital signs. Pre- admission conditions include pitting oedema in both legs prior with an associated diminished pedal pulse, he suffers breathlessness on exertion and has uses an angina relieving spray on average about 4 times a day. Evidentially, the purpose of the case report is provide information about the pathophysiology of his condition, two nursing problems and required interventions to assist successful management in his respite period as well as the plan for discharge.
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Pathophysiology of Mr. George Orwell’s chest pain:
Introduction
This case study aims to provide an overview of the pathophysiology underlying Mr. George Orwell’s presentation with chest pain, identify two key nursing problems, and propose appropriate nursing interventions. Mr. Orwell, a 68-year-old male, presented to Farquharson Memorial Hospital with complaints of chest pain. A thorough admission assessment revealed additional pre-existing medical conditions including lower limb edema, breathlessness on exertion, and frequent use of angina spray.
Pathophysiology
Coronary artery disease (CAD) is the most likely cause of Mr. Orwell’s chest pain. CAD occurs due to the buildup of fatty plaques, known as atherosclerosis, within the coronary arteries which supply the heart with oxygen-rich blood (American Heart Association, 2020). Over time, the plaques can harden and narrow the arteries, reducing blood flow to the heart (Mayo Clinic, 2022). Mr. Orwell’s risk factors for CAD include his age, gender, and history of smoking (Centers for Disease Control and Prevention, 2016). The reduced blood flow from CAD can cause chest pain, known as angina, particularly during physical exertion when the heart requires more oxygen (National Heart, Lung, and Blood Institute, 2019). Mr. Orwell’s symptoms of breathlessness and frequent angina are consistent with CAD.
In addition to CAD, Mr. Orwell’s lower limb edema and diminished pedal pulse suggest he has peripheral arterial disease (PAD). PAD occurs when arteries outside of the heart and brain become narrowed due to atherosclerosis, reducing blood flow to the limbs (American Heart Association, 2022). PAD is commonly caused by the same risk factors as CAD such as smoking, diabetes, and hypertension (Norgren et al., 2007). The reduced blood flow in PAD can cause symptoms such as leg pain and swelling at rest or with activity (Centers for Disease Control and Prevention, 2022). Mr. Orwell’s PAD has likely contributed to his decreased mobility and exertional dyspnea.
Nursing Problem 1: Risk for Activity Intolerance
Mr. Orwell’s CAD and PAD have significantly reduced his functional capacity. His symptoms of chest pain, breathlessness, and leg swelling with exertion place him at high risk for activity intolerance. Inadequate rest following activity could exacerbate his angina and shortness of breath, potentially leading to cardiac events like myocardial infarction or heart failure exacerbation (American Heart Association, 2020; Centers for Disease Control and Prevention, 2022).
Nursing Intervention 1: Activity Monitoring and Modification
The nurse should complete a full mobility assessment of Mr. Orwell to determine his baseline functional status and limitations. An individualized activity plan should be created with graded increases in activity to promote cardiac rehabilitation while avoiding overexertion (American Heart Association, 2020). Mr. Orwell’s vital signs and symptoms should be closely monitored during and following activity to ensure tolerance. His activity level should be slowly advanced under medical supervision.
Nursing Problem 2: Risk for Noncompliance with Medical Regimen

Mr. Orwell uses an angina spray approximately four times daily, indicating his CAD symptoms are not well-controlled with medication alone. Noncompliance with lifestyle changes and prescribed medications is common in patients with cardiovascular disease and negatively impacts outcomes (Kini and Ho, 2018). Barriers like the complexity of Mr. Orwell’s medical regimen, cost of medications, forgetfulness, and lack of social support could potentially lead to nonadherence.
Nursing Intervention 2: Health Education and Medication Counseling
The nurse should provide one-on-one education to Mr. Orwell on CAD, risk factor modification, medication management, and importance of compliance (Kini and Ho, 2018). Printed materials and visual aids should be used to reinforce teaching. The nurse should review each medication, its action, side effects, dosage schedule, and ensure Mr. Orwell understands how and when to take them correctly. An adherence aid like a pill organizer could help. Follow up calls after discharge can identify and address ongoing barriers to compliance. Social services may assist with transportation to medical appointments or acquiring subsidized medications if cost is an issue.
Discharge Planning
Prior to discharge, the nurse should confirm Mr. Orwell has follow up appointments scheduled with his primary care provider and cardiologist to continue monitoring his condition. A referral to a cardiac rehabilitation program is recommended to help manage his risk factors through supervised exercise and education (American Heart Association, 2020). The nurse should ensure Mr. Orwell has a list of emergency contacts and review signs and symptoms that warrant immediate medical attention like new onset chest pain or shortness of breath. Clear communication with community nurses and social workers can facilitate a safe transition home.
Conclusion
In summary, this case study outlined the pathophysiology of CAD and PAD underlying Mr. Orwell’s presentation with chest pain. His risk for activity intolerance and noncompliance with treatment were identified as key nursing problems requiring focused interventions. A multidisciplinary approach emphasizing health education, medication management, activity modification, and close follow up is necessary to optimize Mr. Orwell’s recovery and long term cardiovascular health outcomes.
References
American Heart Association . (2020). Coronary artery disease. https://www.heart.org/en/health-topics/consumer-healthcare/what-is-cardiovascular-disease/coronary-artery-disease
American Heart Association. (2022). Peripheral artery disease research essay writing service. https://www.heart.org/en/health-topics/peripheral-artery-disease
Centers for Disease Control and Prevention. (2016). Heart disease facts. https://www.cdc.gov/heartdisease/facts.htm
Centers for Disease Control and Prevention. (2022). Peripheral artery disease. https://www.cdc.gov/heartdisease/pad.htm
Kini, V., & Ho, P. M. (2018). Interventions study bay to improve medication adherence: A review. JAMA, 320(23), 2461–2473. https://doi.org/10.1001/jama.2018.19271
Mayo Clinic. (2022). Coronary artery disease. https://www.mayoclinic.org/diseases-conditions/coronary-artery-disease/symptoms-causes/syc-20350613
National Heart, Lung, and Blood Institute. (2019). What is angina? https://www.nhlbi.nih.gov/health-topics/angina
Norgren, L., Hiatt, W. R., Dormandy, J. A., Nehler, M. R., Harris, K. A., Fowkes, F. G., & Bell, K. (2007). Inter-Society Consensus for the Management of Peripheral Arterial Disease (TASC II). European journal of vascular and endovascular surgery: the official journal of the European Society for Vascular Surgery, 33 Suppl 1(Suppl 1), S1–S75. https://doi.org/10.1016/j.ejvs.2006.09.024