GCNNK2-Nursing Interventions Related To Common Laboratory

Introduction

Nursing management is an important aspect of patient’s health and well-being. The following summative assessment is based on the critical analysis of a case study and recommendation of effective management strategies in order to improve the disease prognosis. The case study is based on Mr. Ferguson, 76-year old male who was presented in the emergency ward with chest pain, shortness of breath, high blood pressure and irregular respiratory rate. He also has previous medical history of Angina and Non-ST Elevated Myocardial Infarction (NSTEMI), hypertension and hypercholesterolemia. The summative assessment will initiate with highlighting the anomaly in the vital signs and gaps in information which demand further investigations. This will be followed by a detailed pathophysiology of the patient’s condition and followed by effective nursing interventions for overcoming the condition. At last, the paper will discuss the pharmacokinetic of the medications prescribed and its associated considerations plus side-effects. The paper will also highlight the importance of patient’s education for long-term outcome in patient’s care.

Discussion

Deviation from normal finding and further investigation

The first abnormal data recorded in Mr. Ferguson is high level of blood pressure 172/86 (normal range: 120/80-140/90) and irregular heart rate 103 bpm (regular heart beat range: 60 to 100 bpm) (Pocock, Richards and Richards, 2013). The past medical history of Mr. Ferguson shows Angina and Non-ST Elevated Myocardial Infarction (NSTEMI) along with hypertension and hypercholesterolemia. According to Suchy-Dicey et al. (2013) having a past medical history of hypertension along with chest pain myocardial infarction is associated with elevated blood pressure. Moreover, Saydah et al. (2014) has reported that people who are above 65 years of age and have high level of blood cholesterol is found to have tendency of hypertension. Mr. Ferguson, 76 years recorded significant medication against the management of the blood pressure. Thus further nursing intervention will revolve in the domain of whether Mr. Ferguson takes anti-hypertension pills or whether he has suddenly discontinued the same. Suchy-Dicey et al. (2013) stated that sudden discontinuation of anti-hypertension pills might lead to sudden increase in the blood pressure leading to development of chest heaviness and the vulnerability increases among the patients with previous reported cases of cardio-vascular complications. Other aspect of further nursing intervention include making a detailed pain assessment by pain score in order to denote whether Mr. Ferguson is suffering from pain due to chest tightness. Sabatine and Cannon (2015) stated that tightness in chest or discomfort is associated with pain in the upper portion of the shoulder, neck and abdomen. 

Additional information

Mr. Ferguson is found have previous reported cases of hypercholesterolemia and takes Rosuvastatin in order to manage the high cholesterol level. Thus additional nursing information will be directed towards inquiry about diet plan of Mr. Ferguson and whether he was/is addicted to alcohol. According to Kooti et al. (2014) consumption of alcohol for a prolong period of time increase the chances of developing high level of blood cholesterol during the later stages of life. Kooti et al. (2014) also reported that feeding on unhealthy or processed food leads to increase in the tendency of developing of high level of blood cholesterol. Older adults who leave alone mainly thrive on processed food and thus increasing the vulnerability of hypercholesterolemia (Reedy et al., 2014). Thus the nursing professional must also investigate about his family condition. Height and weight is another crucial factor behind diagnosis and treatment of the cardiovascular disease. Hanson et al. (2014) stated that obesity is associated with the development of cardiovascular disease by increasing the fat deposition in the inner lining of the arteries. Thus, proper assessment of the weight or basal metabolic index of Mr. Ferguson will help in framing of the person-centred care plan.

Pathophysiological issues

Mr. Ferguson is presented with high blood pressure, irregular heart rate but with normal oxygen saturation (Spo2) [97%] and tympanic body temperature of 36.8 degree C and normal Glassgow Coma Scale (GCS).  Mr. Ferguson is suffering from tightness of chest and chest heaviness 2/24 this has resulted in the development of the irregular heart rate. Lymperopoulos, Rengo and Koch (2013) stated that under the condition of the persistent and heavy mechanical load on the heart as defined by heaviness in chest, the calcium signalling of the heart becomes unstable resulting in the generation of the irregular heartbeats. Irregular heartbeats results in increase vulnerability towards sudden cardiac arrest. Mr. Ferguson appears pale, diaphoretic and short of breath however, his oxygen saturation levels are normal. According to Delacroix, Chokka and Worthley (2014) shortness of breath reflects a low saturation of oxygen however, it is possible to develop this symptoms even under normal oxygen saturation. The percentage of oxygen saturation is defined as a measure of oxygen dissolved in haemoglobin and it is always not proportional to dyspnea. Delacroix, Chokka and Worthley (2014) stated that patient with chronic obstructive pulmonary disease (COPD), the mechanism of shortness of breath under normal oxygen saturation is mainly cause by heart failure. Increase in the blood pressure results in reduction in the cardiac output. Decrease in the cardiac output is associated with decrease in the volume of blood that the heart can pump into various part of the body leading to oxygen supply in the organs causing shortness of breath. Lack of proper supply of oxygen in the body is making Mr. Ferguson appear pale (Hammer & McPhee, 2014). Glyceryl trinitrate pump generates localised yet temporary relaxation of the smooth muscles thus giving minimal relief (Delacroix, Chokka & Worthley, 2014). 

Gokhroo et al. (2016) stated that excessive sweating is a characteristic of ST?Segment Elevation Myocardial Infarction and acute coronary artery symptoms. Mr. Ferguson has previous case history of Non-ST Elevated Myocardial Infarction (NSTEMI) along with angina and thus increase in the blood pressure might be due to cardiac complications and sweating is the first sign or manifestation behind the vulnerability of heart attack.

Nursing Diagnosis

Placing Mr. Ferguson will be position in Fowler’s or sitting position: It is a standard patient position where the patient is seated in semi-upright sitting position (60 to 40 degrees from the surface of the bed) with knees bent towards the chest (Vrachatis et al., 2014). According to Kuhajda et al. (2015), this posture helps to promote oxygenation through maximum expansion of the diaphragm and thereby by helping to relive from the respiratory distress. Fowlers’ position also helps to relax the abdominal muscles and thereby helping to promote improved breathing. It is the duty of the nursing professionals to instruct the patient to inhale and exhale slowly through nose by placing the palms upside down over the belly.

Relaxation of the patient and pain management: It is the duty of the nursing professional to make Mr. Ferguson stay relax and clam in order to ease the process of breathing and decrease the excessive sweat. This can be done by the application of the proper music therapy. Loewy et al. (2013) are of the opinion the proper application of the music therapy helps in mind relaxation and thereby helping to ease the process of breathing. Proper application of the music therapy is also helpful for reducing pain as in case of Mr. Ferguson who was suffering from chest heaviness since last day before hospital admission (Gutgsell et al., 2013).

The evaluation of the overall interventions will be done based on monitoring of the vital signs of Mr. Ferguson after every 30 minutes. The main vital signs that will be monitored include blood pressure, respiratory rate and heart rate and body temperature. The improvement in the vital signs will indicate positive prognosis of the patient’s condition (Hammer & McPhee, 2014). Verbal feedback from Mr. Ferguson will also be considered as an important aspect of evaluation of the nursing interventions.

Pharmacokinetics of prescribed medications

Aspirin is a non-steroidal anti-inflammatory drug (NSAID). It inhibits the activity of the enzyme cyclo-oxygenase (COX). COX leads to the formation of prostaglandins by breaking arachidonic acid. Prostaglandins are primary mediators that cause swelling pain and fever. Thus administration of oral Aspirin will prevent the formation prostaglandins and thereby helping to Mr Ferguson to recover from pain arising from tightness in chest (Loewy et al., 2013).

Morphine sulphate is a principal alkaloid in opium. It is a prototype of opiate analgesic and has widespread effects in the central nervous system and on the smooth muscles. It mainly helps in the treatment of the chronic pain. In relation to Mr. Ferguson it can be said that morphine sulphate administered intra-venously generates vaso-dilation of the smooth muscles and thereby helping to decrease the tightness of chest and creating ease in breathing (Agewall, 2017). 

Heparin infusion: Heparin infusion increases the dilation of the blood and thereby helping to make the blood thinner. The thin or dilated blood flows swiftly through the blood vessels and thereby helping to restore the oxygen demand in different organs of the body (Hammer & McPhee, 2014).

Fentanyl it is a narcotic analgesic is classified under the mu-opiod agonist. It is used as an anesthetic for the people with respiratory compression. It causes dilation of the smooth muscles thereby helping to reduce the chest pain and tightness of chest. At the same time, it reduces the pain. Çoruh, Tonelli and Park (2013) it also helps to reduce the rigidity of th chest wall and thereby helping to promote well-being to the patient. 

Medication, contradiction and side-effects of the medication

The main contradictions associated with aspirin include renal problem, kidney dysfunction and hepatic complications along with intestinal ulcer. Reedy et al. (2014) people who are above 65 years of age are vulnerable in developing several organ dysfunction thus administration of oral aspirin to Mr. Ferguson must be done after proper validation of the organ functions. The main side-effects of aspirin include vomiting, nausea, stomach pain and rapid breathing.

The major contradictions for analgesic-opioid drugs used as the vasodilator include primary respiratory depression and increase in the intracranial pressure. The side-effects of the opioid analgesic include nausea, vomiting and constipation. Thus, Mr. Ferguson’s vital signs like respiratory rate, blood pressure and gastro-intestinal conditions must be monitored daily in order to avoid complications (Agewall, 2017).

 The main contradiction and side-effects of heparin infusion include increased dilution of the blood thus it might lead to sudden bleeding or delay in wound healing. Thus proper nursing safety measures must be taken in order to protect Mr. Ferguson from encountering injury through accidental factor. Weekly PT-INR test must be conducted in order to estimate the blood dilution rate (Broyles et al., 2017). 

Patient Education

Patient education will be given about the importance of taking medications on time and weekly monitoring of the vital signs. According to (Broyles et al., 2017), taking cardio-vascular and respiratory medication on time and regular monitoring of the vital signs helps to decrease the threat of sudden increase in blood pressure and generation of shortness of breath. Mr. Ferguson will be educated about importance of diet for effective non-pharmacological management of hypercholesterolemia. Decrease in the blood cholesterol will help to reduce the chances of cardio-vascular complications (Reedy et al., 2014).

Conclusion

Thus from the above discussion, it can be concluded that the main deviation from the normal findings in case of Mr. Ferguson is high blood pressure and irregular heart rate however, further investigation must be undertaken in order to detect if Mr. Ferguson was under anti-hypertension pills. Additional information include whether Mr. Ferguson was alcoholic and about his diet plan to find the main roots behind hypercholesterolemia. The main pathological issue leading to the development of shortness of breath and chest heaviness might be associated with his previous reported cases of angina and myocardial infarction. Mr. Ferguson might also develop Chronic Obstructive Pulmonary Disease (COPD) and this is the reason why he is looking pale and having shortness of breath while normal oxygen saturation at room-temperature. Nursing diagnosis will include music therapy for pain recovery and mood relaxation and use of Fowler’s posture to ensure ease of breadth. Mr. Ferguson was mainly administered with opioid medication which acts as vaso-dilators for the dilation of smooth muscles and making it easier to breath. However, precaution must be taken taking his age into consideration. The patient must be educated about importance of taking medication on time and healthy lifestyle. 

References

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