NSB026 Nursing Practice Capstone
Question:
Relevance Of Case
- Why is this case important? What are the reasons for choosing this case? Why would graduate RNs be interested in reading about this?
Case Presentation – Nursing Assessment
- Provide a comprehensive case description including the salient patient history, physical assessment data and any relevant investigations using an appropriate assessment framework.
- Make sure your nursing assessment is person-centred.
- Be as descriptive as possible and use data from a range of sources if possible (e.g., handover reports, patient history, physical assessment, patient charts, results of investigations, nursing/medical assessments previously undertaken).
- Remember you must maintain patient anonymity and confidentiality.
This section relates to “Collect cues/information” from the Clinical Reasoning Cycle (CRC).
Process the information (from CRC) (this is a process you will engage in but do not write on your abstract)
Clinical Priorities – Patient Problems
- Identify the clinical priorities in the management of this patient. The clinical priorities are the most important or pressing patient problems or issues based on the assessment data collected.
Identify problems/issues (from CRC)
Planning
- Describe the patient goals and desired outcomes.
Establish goals (from CRC)
Interventions
- Describe all the actual nursing and/or collaborative interventions performed to manage the clinical priorities.
- Only include interventions or actions here (not assessment or evaluation).
- Remember to keep a nursing focus: Make sure you clearly identify all the nursing management and highlight the nursing care that was provided alongside any medical interventions.
Take action (from CRC)
Evaluation
Reflective Points
Answer:
Relevance Of Case
Myocardial infarction is the clinical name heart attack. This had been reported to be the reason for most of the deaths in the world. This study in important because, a proper diagnosis in proper time could save the life of many patients. MI is a serious health problem that can cause mortality. The seriousness of this disease is that one third of the patient has death as their first clinical manifestation. Researches are going on to prevent this. As the pathophysiology of the disease is unfolding, this is also triggering the scope of researches in this field.
Case Presentation – Nursing Assessment
- Case history of the patient
A 59 year old man has been admitted in the hospital. He has stated that he has had a 90 minutes history of severe crushing chest pain.
He has a history of Asthma, but it is controlled and has never reached any severity. He still uses Salbutamol inhaler for the Asthma. It has been reported that he has a history of gastro-oesophageal reflux with Oesophagitis, which has been confirmed by Endoscopy. He is a smoker and smokes as much as 20 cigarettes per day. Consumption of alcohol had not been reported yet.
- Past medical history
History of gastro-oesophageal reflux with Oesophagitis.
- Family history
The patient’s father died out of myocardial infarction at the age of 62, but there is no such other family history.
- Physical examination
Vital signs
Heart rate- 95
Blood pressure- 140/95
Respiratory rate- 24
Saturation-94%
Smoker-20 cigarettes a day.
Body mass index- 26 kg/m^2
Fasting lipid profile
Cholesterol- 6.8 mmol/litre
HDL cholesterol- 1.2 mmol/litre
LDL cholesterol- 4 mmol/litre
Triglycerides- 3.5mmol/litre
- On admission to the hospital, immediate ECG was done, which revealed a 3mm ST segment elevation in V1 to V2, with an acute myocardial infarction. He has been given loading doses of Clopidogrel and Aspirin.
Clinical Priorities – Patient Problems
- Patient Problem list
Severe chest Pain.
Shortness of breadth
Epigastric discomfort leading to nausea or vomiting.
Profuse sweating.
Planning
- Patient goals and outcomes
Restoration of the cardiac muscle function ability
to relieve the chest pain
To lessen the cardiac workload
To revascularise the coronary artery.
To stabilize the rhythm of the heart.
Myocardial tissue has to be preserved.
Interventions
- Nursing intervention
Patient having myocardial infarction should be given a quality that is dependent on the evidence based nursing.
He is given a loading dose of Aspirin and Clopidogrel. If pain is not relieved then Morphine is given.
Oxygenation should be checked for chest pain. Oxygen can also cause vasoconstriction, making the situation difficult. Oxygen should be given only when required.
Nitro glycerine can be given along with aspirin. As it dilates the blood vessels and increases the blood flow.
Continuous ECG should be done for monitoring the life threatening arrhythmias. Nurses should also be alert about premature ventricular beats.
Vital signs should be monitored before and after the administration of the drugs. Pressure should also be monitored during the administration of nitro-glycerine.
Nurses should handle the patient carefully while obtaining the baseline vital signs.
Starting of IV infusion, attachment of the electrodes for ECG monitoring.
Patient should be advices to remain in a supine position for reducing hypotension.
Patient should be counselled and should be properly informed about the condition.
Patient should be assured by the nurse, as patients suffer from anxiety related to the disease.
It is the duty of the nurses to perform their job without any unethical behaviour. The presence of moral dilemma with the patient and the family leads to the recovery of the patient.
Evaluation
Loading doses of Clopidogrel and Aspirin helps in reliving the pain.
About an hour after the admission, he had to undergo a primary, percurtanous coronary intervention, with a stent that eluted drug was inserted into his narrowed left anterior descending coronary artery. 60 minutes after the procedure, it was found that the patient is free of pain and a partial resolution has taken place in his ECG reports.
Reflective Points
Case studies are normally based on the real cases that are common in everyday’s nursing practice. Case studies are normally done to gain knowledge about the varied illnesses. Such a case study provides us with a vivid knowledge about MI. We come to know that it is mainly caused when blood cannot reach the heart, caused by the damage in the tissue. We also come to know about the different nursing interventions like, the continuous monitoring the signs, administration of the medications which gave us a clear idea about the importance of the nurses alongside with the doctors.
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