NRSG353 : Nursing - Emergency Department - Case Study Assessment Answer

Nursing Case Study Assignment

Assignment Task

Outline the causes, incidence, and risk factors of the identified condition and how it can impact on the patient and family

Linked to case study.

Provides comprehensive identification of causes, incidences and risk factors.

Provides comprehensive understanding of the disease impact on patient and family.

• Cause/risks of disease needs to be focussed on what the pt has presented with
• The incidence of the disease needs to be as current as possible, and based in Australia. Using other stats will mean you will lose marks
• Impact on family MUST be linked back to the patient you have chosen. If there is no link it is not a case study
• Refrain from listing, as we are looking for you to provide a rationale for all your answers
• Financial impact as evidenced by increased acuity leading to sick leave and no income etc

2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words) 15%

This can be done in the form of a table – each point needs to be appropriately referenced

Provides a comprehensive look at the identified five common signs and symptoms.

Provides a comprehensive link to pathophysiology.

• The signs and symptoms can be taken from those listed in the case study, or you will find more relevant ones when completing your research
• As long as you are able to link it back to the patho of the current patient condition and explain why you have chosen it that is fine
• Pathophysiology needs to be in depth and at the cell level where possible

3. Describe two common classes of drugs used for patients with the identified condition including physiological effect of each class on the body

This does not mean specific drugs but rather the class that these drugs belong to. 15%

Two (2) classes of drugs appropriately identified.

A comprehensive understanding and explanation of the physiological effects on the body.

• The drug classes chosen can be from the case study or what you think may be used to manage the patient's condition
• Need to include drug CLASSES, not specific drug names, or broad types
• Loop diuretics - CORRECT. Diuretics - INCORRECT. Frusemide - INCORRECT. All diuretics have a different mechanism of action, so stating diuretics is not acceptable
• You need to explain how each drug class works at the cell level where possible, and LINK it back to the patient in the case study. Why are these drugs indicated for the patient?

4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient

The care plan was articulate, logical, balanced and convincing.

A diverse range of perspectives offered. All important aspects are covered demonstrating comprehensive knowledge of the key areas.

A strong attempt at analysis and critique.

Nursing care strategies prioritised.

• PRIORITISE your care - if it helps, number it
• Every nursing care priority must include a rationale as to why it needs to be done
• This includes nursing care, not medical management. For example, if you think that a patient may need thrombolytics but are not ordered this, phrase it in a way that links it back to nursing. What are your nursing considerations in this case then?
• The parameters are in the first 24 hours only which will help you narrow your care

Introduction

Several incidences of chest pain are caused by various reasons. One of the reasons that causes chest pains is the failure of the heart muscles to have enough blood. Such conditions will always create discomfort and pain to the person and hence the case is known as stable angina. The myocardium at that point fails to have enough supply of blood as it demands. That is mostly resulting from a narrow coronary artery. The heart will always demand a lot of blood pumped when individuals are engaged in active physical activities. It can be confirmed from the case study that Mr. Suvea was an active man working at local hospital. In addition, he has been reported to be having a history of stable angina. That increases the chances of him suffering further forms of related diseases. That implies that blood circulation increases and blood is required in the more active regions of the body to supply oxygen which is used for respiration. However, if one of the coronary artery narrows there will be insufficient supply of blood to the heart and that causes pain. Apart from that, it has also been found that emotional stressing conditions may also result to stable angina.

Recent studies in the UK reveal that 8% of men are suffering from the disease aged 55-64 years(Yang, 2015). Further data reveals that 3% of women aged 55-64 suffer from myocardial angina. In addition, as the age increases the more the severe of prevalence of the disease. From the case study the patient is almost falling in the population described above. Consistent research has always associated high prevalence of the disease for the people who have low socio-economic background(Washington, 2011). Apart from that the diseases has always been associated with people of south Asian origin. In fact, people from south Asian origin have been found to be at high risk of contracting ischemic heart diseases compared to people living in the UK(Coventry, 2011). The fact that Mr. Savea is from Samoa also makes his condition to be more prevalent. However, he has lived in Queensland for 20 years. That does not change his background and hence the genetic factor remains. Tobacco use is associated with many heart diseases. Coronary atherosclerosis amongst other heart diseases have been associated with tobacco use(Culin, 2013). In addition, diseases like obesity and diabetes have also been associated with the disease. Mr. Sevea has been diagnosed with clinical obesity another risk factor that could be accelerating and causing his heart condition. Increased weight may lead to fat deposition around the heart region and that may prevents the heart valves from pumping blood far to other parts of the body which may contribute largely to stable angina and myocardial infarction(Dawson, 2008). In addition, Mr. Savea was also to be found to be a social drinker. His consumption is higher and that would also contribute to obesity and cases of atherosclerosis.

Signs and Symptoms

Classes of Drugs

The maim classes of drugs used in the treatment of myocardial infarction are mainly aimed at reducing the pain and improving oxygen supply in the blood. Vasodilators are amongst the classes of drugs that are mainly used in controlling the chest pain. That is because vasodilators play the huge role of dilating the arteries and the veins. They include the nitrodilators. Others include the angiotensin converting enzyme inhibitors (ACE inhibitors). The enzyme plays an important of relaxing the blood vessels and that will help reduce the chest pain. Others include the angiotensin receptor blockers. The drugs play an important role of reducing blood pressure. That will also reduce the chest pain. The statin class of drugs have been found to be reducing the rate of elevated cardiovascular diseases. That is because the statin drugs play a huge role of reducing the levels of cholesterol in the patients. The patient had been diagnosed to be having high cholesterol levels. That has to be reduced. Cholesterol have been found to be contributing to increased cases of atheroma. Atheroma are fatty droplets that clog the blood vessel. That means that the lower the levels of cholesterol the better for Mr. Savea and that reduces any likelihood of heart attack. The nitrates and beta-blockers drugs have also been found to be very effective in treatment of the diseases because they increase the myocardial oxygen levels. At the same time the drugs also reduce the myocardial oxygen demand. That will help reduce the chest pain and improve the oxygen levels and hence the pain will reduce(Andrade-Castellanos, 2014). On the other hand it must be noted that the clot must also be removed as it prevents sufficiently flow of blood and causes blockage of blood vessels. For that reason, the thrombolytics becomes a very important class of treating myocardial infarction. That is because the thrombolytics are clot busters and play the huge role of dissolving the clots. The drugs can be used with morphine which is mainly useful in controlling pain.

Nursing care

Myocardial Infarction can be deadly and hence decisions should be made quicker in order to reduce the incidence of the disease. Immediately the patient is admitted to the CCU the thrombolytic therapy should begin instantly. However, the patient should be confined to bed in order to reduce oxygen requirements. The moment the patient is active and moving up and down the oxygen requirements increases and that causes more pain. Considering the recommendations by the national service for framework of coronary heart disease in April 2003 the door to needle should be maintained at 20 minutes(Detrano, 2008). For the first 24 hours the patient is usually at pain and hence pain management is very important. It is necessary that pain is reported in time. That is because if there is a delay in reporting then the time taken to relive the pain increases. That may prompt the nurses to induce larger doses of pain reliever’s drugs and that may damage the heart. In addition, constant pain may also cause shock to the patient and aggravate the cardiac damage strain. To reduce that instruct the patient to always report on any form of chest pain.

As a nurse conduct and monitor any form of pain in a scale of 0-10. At this point the titrated nitroglycerine comes in handy as it is infused intravenously to reduce the chest pain. However, if the blood pressure is reading below 100mmHg the infusion must be stopped immediately. That is because low blood pressure may result to more chest pain. However, administration of 2-4mg of morphine intravenously is recommended at this point(Mehta, 2014). That can be done at intervals until the patient assures the nurses that the pain has gone. The injection is given intravenously. Besides that class of drugs, the beta-blockers, nitrate and thrombolysis can also be used to reduce the pain. It is also recommended that all verbalizations are responded to without fear. That will help the patient and the nurse to clear off any sign of misconceptions regarding the disease. It will also give the patient a clear guideline about the interventions and the therapeutic prognosis. Within the first 24 hours it is also important as a nurse to assess all the knowledge about CHD. By that the nurse is expected to be in a position to tell the patient clearly the meaning of thrombolytic therapy whose main aim is dissolving the fresh clot and to stimulate the heart muscles so that they can continue with the pumping of blood while limiting the damage.

Moreover, constant monitoring of vital signs that may lead to any form of potential bleeding may also be conducted at this point by the nurse. For example, blood samples can be taken and the cardiac enzyme levels can be monitored to verify the extent of damage of the blood vessels. During this time, the nurse is also supposed to be monitoring any form of internal and intracranial complains like dizziness, abdominal pain, headache, bloody secretions etc. That can easily be done through the stool tests, urine, or even vomitus(Yang, 2015). The physicians should then be notified immediately of any of these changes are observed in the patient. Moreover, continuous monitoring of reducing chest pains and the returning of the ST segment to baseline since it was initially elevated will be positive signs for the patient recovery. However, any forms of cardiac rates, rhythm and conduction should be reported to the physician immediately. During all this time the nurse should be able to show control over the situation. In addition, there should be some sense of positive attitude in order to help the patient to reduce stress. Presence of family is always important for a patient. That is because family play a big role in encouraging the support and providing care. Upon realizing that the patient is in a stable condition family members can be encouraged to visit and talk to the patient. That helps in reducing stress levels allowing easy time for the cardiac muscles. Further clinical assessment and evaluation can be given after the post 24 hours nursing care.