Case Study in Nursing

Priority nursing care

The ABCD nursing technique is applied to all patients, both children and adults. It is mostly applied to all patients in critical condition due to their similar clinical signs irrespective of the underlying cause. Therefore, the technique is employed to Mr. Henry who was brought in emergency department with chest pain and shortness of breath. Based on ABCD principles, the initial assessment of Airway, Breathing, circulation, and disability were done continuously and simultaneously while administering relevant treatment. The patient airway was examined by testing of his voice. It was established that the patient could speak alright, a clear indication that his airway was clean. However, the assessment of respiratory rate and symmetry of thoracic wall during movements indicated difficulties in breathing. The patient recorded a respiratory rate of 18, though normal there was still showed signs of struggle while breathing.  The two assessments are very essential since they determine the survival of the patient. Airway and breathing problem can initiate cardiac arrest on patient. In addition, the patient was admitted with chest pain which was not accompanied by cough or heavy breathing, therefore, there is a chance that the patient was suffering from heart condition.

In circulation assessment, the patient was noticed to have a high pulse rate of about 84 bpm, normal 37.2, but he was still sweating,  and a high pressure of 150/90 mmhg. A 12 lead electrocardiograpy was employed to monitor the patient’s heart beats blood pressure. The ECG results show inconsistent pulses, which were faint in the all four columns. This result indicated STEMI condition. The third assessment directs the doctor to the patient’s real condition. It gives direction to the right treatment and any advanced nursing care to be given to the patient.  It also opens a room for further analysis in establishment of the patient’s real condition.  The disability assessment was evaluated by establishing the Glasgow Coma Score, which showed a result of 15. This indicated that the patient was very alert. This assessment is essential since it shows the urgency of the patient’s case (Thim et al., 2012).

Pathophysiology of the Case Study

The ABCD assessment indicated a number of clinical abnormalities. Chest pain that lasted for more than one hour and a pain score of 8/10, breathing difficulties, diaphonic condition, and high blood pressure. The patient can be termed as obese considering the weight- height ration. The 12 lead ECK readings indicate T-wave inversion in the first row for I, aVR, and in V1. It also shows ST-segment elevation in V4. In the second row, there is ST-segment elevation in II and V5, and ST-segment depression in aVL and V2. In the last row, there was ST-segment elevation in all columns that include III, aVF, V3, and V6. However, there is no consistency in the results or in the rate of elevation from one column to another.  The ST-segment elevation shows that coronary artery is totally blocked by a blood clot. This results to death of almost all muscles of the heart that are supplied by the affected artery. The cardiac marker results indicate the CK-MB: 1.0mcg/L and Troponin I:  2.0mcg/L. All these symptoms show a great likelihood that the patient suffers from ST-segment elevation myocardial infarction STEMI (Helmink, 2013).

 

 

Pharmacological agents

The patient had difficulties in breathing and therefore, he was administered with 6 liters of oxygen through Hudson mask to ensure enough supply of oxygen to the blood. The nursing responsibility in this procedure is to ensure that the oxygen flows accordingly. Nurses also monitor the patient in case of any urgency that would require brief removal of the mask for instance, vomit. In addition, they are supposed to remove the mask once the oxygen supply is over.  The two most important medications in this case are Morphine and aspirin. Morphine is an opioid pain killer that combines the central nervous system (CNS) and brain’s opioid receptors, lowering the perception and the response of emotion to pain. In Mr. Henry’s case, Morphine is specifically used to relieve the patient from chest pain. Aspirin is an antiplatelet drug that lowers the platelets stickiness. It therefore prevents the patient from developing any blood clot that can result to intracoronary thrombus that obstructs the flow of blood. In addition, aspirin also lowers nonfatal stroke and reinfarction. In Henry’s case, aspirin was used to reduce platelets stickiness (Zafari, 2013). The nursing responsibility in the two prescriptions is to administer the right measurement of the drug and to monitor patient’s development. To manage high blood pressure, Atenolol is administered. This is aimed at lowering blood pressure as well as handling other heart complication that include chest pain initiators. The nursing responsibly in blood pressure management is to monitor the patient’s blood pressure, by measuring it regularly, ensure the patient rest at elevated head position while lying on a bed. High blood pressure can aggravate the STEMI condition; therefore, nurses should ensure all hypertension medication and management procedures are observed. The nurses are also required to keep a close watch on the patient and record his progress after every medication process. Any complication should be reported immediately to avoid loss of life.

 

 

References

Helmink, B. (2013). Treatment guidelines for ST-segment elevation myocardial infarction (STEMI) and non ST-segment elevation myocardial infarction (NSTEMI). Retrieved from < http://bjhelmink.wikispaces.com/file/view/STEMI+vs+NSTEMI.pdf>

Thim, T., Krarup, N. H. V., Grove, E. L., Rohde, C. V., & Lofgren, B. (2012). Initial assessment and treatment with the airway, breathing, circulation, disability, exposure (ABCDE) approach. International Journal of General Medicine, 5, 117-121.

Zafari, A. M. (2013). Myocardial infarction treatment & management. Medspace Reference. Retrieved from <http://emedicine.medscape.com/article/155919-treatment#aw2aab6b6b7>

 

 

 

 

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