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Altered Resp & Cardiac Function, investigations, Butcher et al., 2018 …
Altered Resp & Cardiac Function
nursing assessment
investigations (subjective)
O – an hour ago at the pub
L – centre of chest radiating to arms
D – constant
C – constant heavy burning sensation
A – patient is breathless, diaphoretic and anxious
R – unknown
T- unknown
S- pain is a 8/10
Oldcarts is an acronym used as an approach to question the patients health and to assess their chest pain. (Welchek, C.M., Mastrangelo, L., Sinatra, R.S. and Martinez, R., 2009)
S – chest pain
A - unknown
M – patient is unsure which medication he takes
P – High blood pressure
L – unknown (but patient usually eats readymade meals/takeaways)
E – chest pain (patients rates it an 8/10), started at the centre of his chest now radiating to arms
R – high BMI [non modifiable] – age (52) & sex (male), family history. [modifiable] – high BMI, psychosocial stress, cigarette smoking, alcohol consumption, physical activity & diet, central adiposity
Sampler is an acronym used to assess the patients health history. It helps nurses to know the underlying issues and events that lead to the patient's injury.
examination (objective)
Heart rate= 112 bpm- (high)
Respiratory rate- 20 (normal range)
Blood pressure- 152/ 92 mmhg = high (abnormal)
O2 stats- 93% levels are low ( no need for supplementary O2)
Temperature- 36.2 (normal range)
nursing diagnosis
Nanda-I Diagnosis
Ineffective health management.( Herdman and Kamitsuru 2018) - Mr. Belfield does not manage his health well. He forgets to take his medication, eats unhealthy food and he does not partake in physical activity and he smokes cigarettes and drinks alcohol.
Risk for impaired cardiovascular function.( Herdman and Kamitsuru 2018) this diagnosis is prioritised as Mr. Belfield shows the risk ractors such as hypertension, chest pain, breathlessness and has a high pulse.
Risk of decreased cardiac output and tissue perfusion.(Herdman and Kamitsuru 2018). Risk factors include low oxygen saturation levels (93%) and vascular diseases.
Nursing Interventions
Cardiologist= Diagnose and treat. Confirm final diagnosis. Provide judgment in regards to Mr Belfield's condition (Peterson et al., 2008)
Physicians= Education on diagnosis, condition and treatment (Wiggins et al., 2013)
(Specialist) nurses= Coordination of care, promotion of treatment and patient education. Address risk factors and indicators (Fattiroli et al., 2018)
Pharmacists= Medication reconciliation, counselling on medication and self-care, prompt medication use, post discharge follow ups for medication. (Wiggins et al., 2013)
Dieticians= Prompt and encourage changes in Mr Belfield's poor eating habits. Ensure adequate nutritional intake to maximize patient outcomes. (Fattiroli et al., 2018)
Physiotherapists= Assess and address functional impact on activity and the clinical complications (Fattiroli et al., 2018)
MULTIDISCIPLINARY TEAM
EDUCATION AND COUNSELLING
Nursing education on condition and
treatment to maximize Mr Belfield's outcomes (Singh et al., 2018)
Education on cardiac rehabilitation, its participation and enhancing self-efficacy. Specialist nurses have a key role in promoting this (Weibel et al., 2016)
Counselling offers information on how needs will be fulfilled in relation to cardiac rehabilitation. Offers the opportunity to express feelings and worries (Wang et al., 2016)
CONTINOUS CARDIAC ASSESSMENT
Documentation of peripheral assessment
Evaluation and documentation of any episodes of chest pain i.e pain intensity, location, duration and radiation in body
Patient education on reporting the onset of any symptoms.
Continuous cardiac assessment on cardiac health, its improvements or deterioration.
Monitoring Mr Belfield's activity status and capabilities to strengthen central nervous system (CNS) and physical activity.
Health Challenges and Management
Positive reinforcement techniques, such as books, pamphlets, or educational videos, and attending support groups so he can socialise while trying to quit smoking. (Kazemzadeh, Manzari, and Pouresmail, 2017
Smoking Cessation
Educate Mr. Belfield on the health risks if he continues to smoke occasionally, which would have irreversible health risks.
Alcohol consumption
Educate Mr Belfield on the safe amount of alcohol to consume within a week.
Up to one drink per day for women and two for men is recommended by the Dietary Guidelines Advisory Committee. Explain to Mr. Belfield that moderate alcohol consumption can have long-term cardiovascular advantages. (Chiva-Blanch and Badimon, 2019)
The importance of taking his medication and the risk factors that come if he chooses not to take them
A nurse could introduce Mr. Belfield to electronic drug monitoring, which documents the opening of pill bottles to track prescription adherence. According to studies, these monitors evaluate adherence properly and are associated with better clinical results. (Kini and Ho, 2018)
NURSING SENSITIVE OUTCOMES
Primary Behaviour
Health promoting behaviour, self management of condition- A desirable outcome would be for Mr. Belfeild to accept his condition and takes steps to improve his health.
Lifestyle
Fitness and Diet
1632 & 1622 Compliance behaviour with prescribed activity and diet
1633 exercise participation
A desirable outcome would be for Mr. Belfeild to engage in daily physical activity "at least 30 mins a day" (Get active Ireland, 2013) as he is between the age of 18 - 65
Pain Management
1605 - pain control
It would be a favourable outcome if Mr.Belfeild is able to manage his pain effectively with his prescribed medication
Disease
Secondary Behaviour Outcomes
Lifestyle
1906- risk control tobacco use, 1402 anxiety self control, 1625 smoking cessation behaviour
It would be a desirables outcome for Mr. Belfeild to cease the use of tobacco and manage his anxiety without the use of it
1928 risk control of hypertension
It would be a desirable outcome for Mr.Belfeild to take his medication and manage his hypertension symptoms
A Nursing sensitive outcome would also be for Mr.Belfeild to balance his lifestyle and minimise the risks associated with his condition (smoking, alcohol abuse, poor physical activity)
INTRODUCTION
Events leading to admission
Mr. Belfield was admitted to A&E with complaints of heavy chest pain. He describes the pain as a "constant heavy, burning sensation"
High BP of 152/92
Jack considers himself to be a social smoker and states that he has a smoke when he's out with his friends
The patient usually eats ready made meals or takeaways as it is more convenient.
The patient has described that he has low physical activity which has lead to high BMI and central adiposity on examination
He has a high alcohol consumption of 3-4 pints five times a week.
Prognosis
-Patients with STEMI have a higher mortality rate, however short term mortality risk compared to NSTEMI and a worse prognosis due to the mortality hazards that are associated with the conditions of STEMI (Allen et al., 2006)
Pathophysiology
-A thrombus consisting of fibrin and platelets forms in a coronary artery. This ruptures or erodes from an atherosclerotic plaque, totally occluding the artery, causing infarction to the heart muscle. This causes ST elevation leading to the term STEMI. (Bouisset et al., 2021)
Conclusion
Admitted into the emergency department with chest pain then started radiating to his arm. His blood pressure, and heart rate are higher than normal and his slightly lower oxygen saturation which all indicate cardiac related problems.
Collaboration with a diverse multidisciplinary team and patient education are critical components for his care plan to improve his general well-being and lower the risk of future cardiac-related episodes.
Minimise alcohol intake
Encourage the patient to introduce a balanced diet into their meals, emphasising fresh fruits, vegetables, and whole grains while minimising processed and high-fat foods with the help of a dietician
Reflection
We have discovered the importance of efficient communication. Clear and understandable communication is critical for patient safety and well-being and our future nurse role. We have polished our capacity to put down critical information, actively listen to each other, and ask questions to each other when we are struggling. We have observed how effective communication can improve patient care.
The value of time management has only been enhanced and its importance understood from us working as a team on this concept map. Time management on the ward is a necessity and not only prioritizes and maximizes patient outcomes but relieves stress from the busy environment of the wards. As future nurses, it is very important that we improve on our time management as during this group work there were times where we didn't manage our time efficiently and this affected the group. This gave us insight on how time management changes the environment between nurses and members of MDT.
We gained an insight on being able to adapt. During our completing of this groupwork, as a team we had to adapt to our different writing skills, learning skills, we sometimes had to meet up in loud environments to get out group work done which was quite distracting. This all plays a role in the hospital environment. This relates to our future roles as nurses because we will have to adapt to different environments and consider everyone’s strengths and weaknesses. Some hospital wards will be loud but we will have to adapt to them to complete and get our job done.
From this assignment we got a better understanding on how to handle feedback. During our meetings feedback was given and sometimes it was hard to take the feedback, but with practice and professionalism we were able to accomplish the effective handling of feedback. As a nurse it's really important to be able to accept constructive criticism and learn from it so that you can make improvements. By completing this assignment we are now aware of the importance of handling feedback correctly.
investigations
ECG= An ECG is used to assess the rhythm and electrical activity of the heart. (Rundo,2018). ST elevation was found in anterior leads causing injury to the cardiac muscle. Caused by a blockage of the coronary artery. completing this ECG shows nurses what is going on in the heart and where in the heart the problem lies.
blood tests - Troponin which is a protein released into the bloodstream during a heart attack (Sharma, S., Jackson, P. G., & Makan, J. 2004). Results : >99th percentile. abnormal - high (risk of myocardial injury/myocardial injury has already occurred). Blood test help to locate certain conditions that are going on in the body.
Butcher et al., 2018