New England Journal of Medicines

Scenario 1: Carol Jones
Consider the patient
situation
Carol Jones, 45 years old, is away on an interstate business trip and presented to a GP clinic on the outskirts of the Flinders
Ranges in South Australia. Her main concern is feeling breathless and nauseated. She also complains of occasional chest pain
which goes away when she rests. Her BP is 170/93 mmHg and she is mildly tachycardic. The GP on duty reassures her and
suggests she follow up with her regular GP upon her return home. However, as Carol is leaving the clinic she suddenly
experiences an episode of breathlessness. You, the Practice Nurse on duty, witness this and notice that Carol is pale. When you
check her pulse, it is 160 bpm and irregular.
Collect Cues: Review the existing documentation;
Social History
Carol Jones is a consultant engineer specialising in concrete structures for bridge construction. This requires her to travel
interstate frequently for long periods visiting construction sites. Carol has recently separated and has 5 children ranging from 6
to 18 years of age who reside with their father when Carol is away. Carol’s busy lifestyle precludes her from daily exercise and
much of her dietary intake when she is away is ‘on the run’ takeaway fast-food and alcohol – she states that she has ‘a beer at
lunch and a couple of glasses of wine in the evening to help me relax after a hectic day’. Carol is a non-smoker and denies any
use of recreational drugs.
Recall:
Before you continue with this assignment you should recall and apply your existing knowledge to the above situation to ensure
you have a broad understanding of what is/may be occurring.
Process information Interpret:
In the following table, list the data that you consider to be normal/abnormal (not included in word count)
Normal (Subjective & Objective Data) Abnormal (Subjective & Objective)
Objective: Carol is 45 years old. Subjective: She had complained of nausea, breathlessness and

Scenario 1: Carol Jones
Subjective: She frequently travels for her business trips. chest pain.
Objective: Her BP is 170/93 mm/Hg.
She has mild Tachycardia.
Her pulse is 160 bpm and her heartbeat are irregular in the
clinic.
It was observed that Carol was pale.
Relate & Infer: (250 words)
 Relate: cluster cues by identifying relationships between them.
• Infer: make deductions as to why a cue, or a cluster of cues may be considered abnormal in this context. Justify by
referring to appropriate anatomy, physiology and pathophysiology.
Refer to Levett-Jones (2018) Clinical Reasoning p7.
•Based on your interpretation of all the information/cues presented, form and justify an overall opinion on what may be
happening
Carol has a busy work life and increasing stress due to her job. She travels frequently due to the demand of her profession,
which makes her neglect her diet and get into toxic elements to release her stress. She consumes alcohol whenever she is out
for her business trips, beer for lunch and wine in the evenings. She is also dependent on fast foods due to time constraints.
Considering her past medical history and ongoing lifestyle it can be seen she has tendencies of being a cardiac patient. She has
tachycardia, which is a heart rhythm disorder in which the heart rate is higher than normal.
Due to her frequent consumption of alcohol, fast food and ongoing stress she is vulnerable to several diseases. Her constant
complains of nausea, breathlessness and chest pains could be a sign of cardiovascular disease. Her vital signs are also above the
range, which indicates that she is suffering from high blood pressure. When she went to the clinic for her check-up she

Scenario 1: Carol Jones
experienced an episode of breathlessness and she turned pale, with an irregular pulse when checked.
Some of the causes of cardiovascular disease is alcohol, saturated fat and stress because it increases the plaque formation in the
arteries of the heart (Rehm et al. 2016). Stress increases the chances of heart because it releases adrenaline that enhances the
rate of heart and blood pressure. Chronic stress leads people to depend on toxic substances such as alcohol and that damages
the walls of the arteries. Carol had a pulse rate of 160 bpm and she was feeling breathless, this shows that her heart rate was
speeding up due to several reasons such as alcohol and stress. Another issue is her constantly eating fast food during trips,
which can be another threat to her heart health. The reason for her breathlessness and turning pale is tachycardia and that is
what might be happening in the clinic.
Predict: (100 words)
Explain what may happen to your patient if no action is taken
The patient has a medical history of tachycardia, which is an issue of fast heartbeat and pulse rate. If no action is taken about
her heart health then she can suffer from cardiac arrest if it will lasts for more than few minutes. She was getting pale and her
breath was becoming fast paced. This can be fatal if not treated in the same time. She needs to get diagnosed to detect any
present issues with tachycardia, so she can receive the required treatment. Her pulse is 160 bpm and it indicates that it is higher
than usual, which can lead to death (Kelly, Wicker and Gerkin 2014).
Identify the
Problem/s
List in order of priority at least two key nursing problems (not included in word count)
The 2 nursing problems will be:
-Excess consumption of alcohol
-Work stress and time constraints leading to a habit of fast food consumption
Establish Goal & For your (ONE) highest priority nursing problem: (300 words)
 Establish one goal