Coronary Heart Disease Comprehensive Nursing Essay Example

BIG GEMS Report: Coronary Heart Disease Comprehensive Nursing Essay Example

BIG GEMS is a mnemonic that lists the social determinants of health, including behavior, infection, genetics, geography, environment, medical care, and socioeconomic status. The framework provides a convenient mechanism for recalling the social determinants of health and is useful when assessing a patient or population, diagnosing, and conducting patient education. The paper utilizes the BIG GEMS mnemonic to identify potential social determinants of coronary heart disease in a case scenario.(Coronary Heart Disease Comprehensive Nursing Essay Example)

(Coronary Heart Disease Comprehensive Nursing Essay Example)

Clinical Scenario

Michael is a 45-year-old male living with his wife and three children. Two days ago, he had just started his routine physical activity in the house when he suddenly felt a sudden heaviness in his chest. Consequently, he felt short of breath and collapsed. Before then, Michael was diagnosed with atherosclerosis. He had also reported high urination frequency, forgetfulness, exhaustion, and feeling chilled. Michael had smoked and consumed alcohol for the last 25 years due to prolonged depression and anxiety. Besides, he had a CHD family history, including a paternal uncle, elder brother, and maternal aunt. The initial physical exam showed elevated blood pressure (BP) of 151/99 mmHg, heart rate 97 bpm, respiration rate 20, temperature of 36.6 °C, and oxygen saturation of 90%.(Coronary Heart Disease Comprehensive Nursing Essay Example)

CHD is a leading cause of death around the world and in the USA. Typically, CHD is thought to affect people in their middle age and the elderly. While CHD’s etiology, clinical presentation, and risk factors vary among individuals experiencing premature CHD, its incidence increases with age. The primary symptom of CHD is chest pain – angina, which is characterized by chest discomfort.  CHD is characterized by light-headedness, shortness of breath, faintness, nausea, chest pain, and body pain.(Coronary Heart Disease Comprehensive Nursing Essay Example)

Michael’s scenario shows how several determinants of health can affect the incidence of CHD, severity, and development of a disease. Using BIG GEMS mnemonic, this paper elucidates how each social health determinant impacts Michael as follows:(Coronary Heart Disease Comprehensive Nursing Essay Example)

Behavior: Individualistic behaviors play a significant role in the development of CHD. Alcohol consumption and cigarette smoking are known risk factors of CHD (Khayyam-Nekouei et al., 2013).  Cigarette and alcohol consumption has been attributed to anxiety and depression. Modifying these behaviors can decrease premature morbidity and mortality associated with CHD.(Coronary Heart Disease Comprehensive Nursing Essay Example)

Infection: Several bacterial and viral pathogens are associated with CHD and are known to cause arteries’ inflammation –atherosclerosis (Pothineni et al., 2017). For instance, the herpes viruses such as cytomegalovirus and herpes simplex type 1. Atherosclerosis is characterized by obstructed blood flows due to a build-up of cholesterol on arterial walls. This condition can cause a rupture, leading to the artery’s acute occlusion, leading to adverse health outcomes.(Coronary Heart Disease Comprehensive Nursing Essay Example)

Genetics: CHD can be inherited from one’s parents at a rate of 40-60% (McPherson & Tybjaerg-Hansen, 2016). However, the condition can also be developed without genetic inheritance.(Coronary Heart Disease Comprehensive Nursing Essay Example)

Geography: The incidence, prevalence, and mortality of CHD vary dramatically throughout the world (Casper et al., 2016). This shows the different levels of risks that each geographical condition experiences. For instance, effects of war, the genetic component of a given population, and other risks such as infectious diseases.

Environment: The physical environment in which a person dwells harbors factors that predispose an individual to CHD. For instance, indoor air pollution such as smoke, carbon monoxide, and arsenic; outdoor air pollution such as pollutant gases from traffic, particles in the air; and excessive heat contribute to CHD (USEPA, 2009).

Medical Care: CHD can affect a person’s daily routine due to its symptoms (Wirtz & von Känel, 2017). Therefore, an effective nursing regime and treatment regimen can help tackle comorbidities and other underlying effects.

Socioeconomic-cultural: A person’s socioeconomic status influences their lifestyles, leading to the development of CHD (Casper et al., 2016). Individuals with the lowest income, education, and less paying occupations have higher risks of CHD. This is because they might lack knowledge of risk factors, lack of healthy foods, and proper healthcare. (Coronary Heart Disease Comprehensive Nursing Essay Example)

(Coronary Heart Disease Comprehensive Nursing Essay Example)


Casper, M., Kramer, M. R., Quick, H., Schieb, L. J., Vaughan, A. S., & Greer, S. (2016). Changes in the geographic patterns of heart disease mortality in the United States: 1973 to 2010. Circulation133(12), 1171-1180. (Coronary Heart Disease Comprehensive Nursing Essay Example)

Khayyam-Nekouei, Z., Neshatdoost, H., Yousefy, A., Sadeghi, M., & Manshaee, G. (2013). Psychological factors and coronary heart disease. ARYA atherosclerosis9(1), 102.

McPherson, R., & Tybjaerg-Hansen, A. (2016). Genetics of coronary artery disease. Circulation Research118(4), 564-578. (Coronary Heart Disease Comprehensive Nursing Essay Example)

Pothineni, N. V. K., Subramany, S., Kuriakose, K., Shirazi, L. F., Romeo, F., Shah, P. K., & Mehta, J. L. (2017). Infections, atherosclerosis, and coronary heart disease. European heart journal38(43), 3195-3201.(Coronary Heart Disease Comprehensive Nursing Essay Example)

The United States Environmental Protection Agency [USEPA]. (2009). Environmental Hazards Weigh Heavy on the Heart—Retrieved 8 February 2021, from

Wirtz, P. H., & von Känel, R. (2017). Psychological stress, inflammation, and coronary heart disease. Current cardiology reports19(11), 1-10.

(Coronary Heart Disease Comprehensive Nursing Essay Example)

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