"Critical Analysis of Treatment &Care for Coronary Artery DiseaseIntroduction: The following essay is a critical analysis or review of the treatment and nursing care providedto a patient with coronary artery disease. Initially, we will discuss the patient’s family history,medication history, and social history to identify the risk factors.Then a discussion onnursing management, medications and follow-up care provided to the patient will be done todetermine the outcomes and alternative treatment options. However, to maintain patientconfidentiality, a pseudonym is used for the patient and the family members, and thehealthcare professions who are involved in this case. In the give case study, the primarycomplains of the patient during the admission at emergency department was unrelievedcentral chest pain which consequently spread to the left shoulder. After admitting in theemergency department, the patient was given Morphine, GTN infusion, and Clopidogrel.Angiography reports suggested that the patient has a blockage in the left anterior descendingartery and 10-20% occlusion in other cardiac vessels. Femoral angioplasty and stentreplacement were performed for the treatment of blockages. GTN therapy was stopped beforereturning the patient to the ward. In the present essay, we will discuss whether the treatmentand care provided to the patient are appropriate. We will also discuss if there are any alternatetreatment options available for improving the patient’s condition and weathered the patientreceived culturally competent care during the hospital stay.Analysis of the case study: The patient is a 78-year-old female who lives alone in a single-storey unit. She is a retriedwidow and has one son, one daughter and five grandchildren who live some distance awayfrom her residence. Patient has a pet dog, and she employs a private cleaner once a week. Sheuses Webster-park for medications and uses a private taxi for transportation.This data suggest the patient has limited physical activity. Physical inactivity increases the risk of heartdiseases and stroke by 50 %. Further, the risk of cardiac disease increases after menopause inthe women, and it doubles every decade after the age of 55 years.Present case History: The patient experienced unrelieved chest pain and left shoulder pain inthe morning at 1015 while she was washing the dishes. As the pain has not subsided after 10minutes, the patient called the ambulance. The ambulance arrived at the patient’s housewithin 8 minutes, and the patient was shifted to ED. Studies suggest that the risk of cardiovascular diseases increases in a woman if her motherhas suffered a stroke. The patient’s family history indicates that the patient’s mother hadcardiac disease, the father had a rheumatic fever in the childhood and sister had breast cancer. Therefore, the risk of developing a heart disease is 50 % greater in the patient whencompared to general population. The patient’s medical and surgical history suggests that she is an ex-smoker and stoppedsmoking 5 years ago. She has a history of gastro-esophageal reflux disorder, hypertension,hypercholesterolemia, osteoarthritis, and type 2 diabetes. The patient underwenthysterectomy 30 years ago. Type-2 diabetes is a major risk factor for coronary heart diseaseand stroke. Tobacco smoking or chewing increases the risk of cardiovascular disease (CVD),especially in women. However, stopping smoking reduces the risk of CVD. Hypertension isidentified as the greatest risk factor for stroke and heart attacks. Abnormal lipid levels in theblood, high levels of triglyceride, low-density lipoproteins and total cholesterol, and lowlevels of high-density lipoproteins increases the risk of heart disease and stroke. However,maintaining a healthy diet, exercise and medications will modify the blood-lipid profile andreduce the possibility of stroke.Gastroesophageal reflux disease is a digestive disorder associated with heartburn. It causescrushing pain in the chest which is identical to the pain of a heart attack. The patient hasinitially though that the chest pain was due to gastroesophageal reflux disease and sheassumed that it would alleviate within 10 minutes. As the patient’s family history and medical history suggest that she has a high risk ofcardiovascular disease and stroke teaching the symptoms of angina and primary caremanagement would be beneficial to the patient.Medications History: Esomeprazole 20 mg nocte, metoprolol 25 mg mane, simvastatin 20 mgnocte, vitamin D and calcium tablet one daily and paracetamol 1g six hourly prn- NMT4g/day. Current or discharge medications: Esomeprazole 40 mg nocte, metoprolol 25 mg mane,simvastatin 20 mg nocte, vitamin D and calcium tablet 1 daily, clopidogrel 75 mg mane andparacetamol 1000 mg TDS. An initial dose of 25 to 100 mg metoprolol PO once a day is prescribed for the treatment ofhypertension in adults. However, a small dose with once-daily administration may notprovide a full effect for 24 hours so larger or more frequent doses may be required to controlB.P for 24 hours. A dose of Esomeprazole 20 mg orally once a day is used for the treatmentof Gastroesophageal reflux disease in adults.A dose of 40 mg of simvastatin orally once aday in the evening is recommended for patients having a high risk of heart disease due toexisting cardiac disease, diabetes, peripheral vascular disease, history of stroke or othercerebrovascular disease. Clopidogrel is an antiplatelet medication which prevents theformation of clots and reduces the risk of heart attack in the patients with the peripheralvascular disease, stroke or recent heart attack. A dose of 75 mg clopidogrel once daily bymouth is prescribed for patients who had a recent heart attack, recent stroke, or peripheral "