Acute Care Management: Assessment and Nursing Management

HS2006 Acute Care Management
HS2006 ACUTE CARE MANAGEMENT
INTRODUCTION
In this project, I will be writing a care study to discuss the recognised assessment tool that will identify my patient’s condition
regarding acute care management. I will be examining my patient, who had intermittent chest pain due to consumption of cocaine. I
will include the critical care, NEWS and the A to E assessment performed on the patient. The NMC code (2015) explains the
importance of always keeping individuals’ privacy rights. The study will shed in - depth light on extended patient condition, nursing
management goals and significant working scenarios for improved healthcare condition.
A pseudonym will replace the participant’s name to maintain confidentiality. The name Rob will be used instead. Firstly, it will be
discussing their care plan whilst using the A-E assessment tool that has been taught to use when working with any patient. Rob
was experiencing acute respiratory difficulties and hypertension, needing immediate care.
PATIENT OVERVIEW
Rob is a 17-year-old boy experiencing frequent and rapid chest pains; therefore, he was brought to the emergency department.
Upon admission, Rob was bradypnoeic (12 breaths/min) and reported difficulty breathing. He was immediately admitted to the

HS2006 Acute Care Management
paediatric ward, and his A-E was performed. Rob had been highlighted as a smoker before his arrival, smoking an estimate of 10
cigarettes a day, and he was a regular user of alcohol as well.
During his initial assessment, Rob was accompanied by his mother to support him.
The following observations were made:
Rob self - ventilating in room air; temperature: apyrexial (36.3°C); BP was hypertensive (126/85mmHg) which according to Freitag
and Vasan, (2003) does not fall within the standard parameter for his age. Hence the patient was questioned about his normal
range of BP, to which he responded by agreeing that it is higher than his usual. Furthermore, his skin had a pink colour in
appearance and was well perfused peripherally and centrally.
Being overweight may be the cause of chest pain and high BP (Vasan and et.al., 2022). Fatty deposits which build up in the
arteries that supply blood to the heart. As a result of this, the arteries are narrowed and the blood flow to the hart is reduced. This
causes chest pain. Being overweight may also be the reason behind High BP in Rob’s case. When a person is overweight, the
heart has to work harder so that the blood is pumped throughout the body. This puts strain on the arteries thus raising the blood
pressure.
The main concern of the patient assessment is mainly because of Rob’s heartbeat, which is unstable due to the suspected use of
cocaine, affecting his heartbeat and blood pressure. Therefore, continuous ECG checks were performed along with frequent
observations, and continuous cardiac monitoring. Also as per the history of patient it was made assumed that the Rob has a
suspected use of cocaine and as a result he had suffered from severe chest pain.
Rob further explained how he has episodes of chest pains that burn in the centre and left side, which radiates upwards. This occurs
several times a day and lasts up to 1-2 hours per occasion. He has a reduced appetite, is sweaty while having episodes of pains

HS2006 Acute Care Management
and feels tightness across the chest; Rob described this as “his heart feeling weird”, and he thought as “his heart may be speeding
up”. This is a concern as he may be at the risk of deteriorating.
As per Huangand et.al., (2020) patient needs to be given effective care by nurses and medical experts, and further be
prescribed medical care and standards for improved longer term healthy recovery. Therefore, the performance of A-E assessment
has been implemented to ensure these are met.
A-E Assessment:
The A-E assessment is a critical assessment to achieve improvement in the patient by determining the severity of the patient’s
condition and to see if they need to start any further treatment (Toki and Ono, 2020). This assessment consists of the airway,
breathing, circulation, disability, and exposure. This is a nursing technique utilised when you are reviewing a patient, whether you
are administering medication, performing observations, or even introducing yourself to the patient.
The patient’s results were:
 Airway- The aim of the airway assessment is to ensure that the anatomical function is achieved if the airway is blocked or
obstructed which is to be identified though nose, mouth, and bronchi (Cathala and costa, 2019). When Rob was suffering
from chest pain and became Bradypnoeic, it clearly shows that the airway was obstructed. This will enable to get breathing
assessment done by best medical experts and doctors, nurses for further extended timely nursing care being given
(Bergersen, Brooke Stevens-Green and Rosellini, 2022.) noted that Angina is a type of chest pain which usually occurs
when there is an obstruction in the flow of blood towards the heart This is a potential diagnosis and may be the cause of
shortness of breath. The pain feels like tightness or pressure in the chest which further spreads around the body. This is a
major reason that would be counted for the Bradypnea

HS2006 Acute Care Management
Complementary, As Rob has smoking habit and he smoke 10 cigarettes a day, it may directly impact towards the respiratory
system and can cause the breathing issue. This is because, the substances of the smoke get deposited on the lung tissue
which further reduces the capacity of lung to diffuse oxygen (Makhmudova, 2022.)In the same way, due to excessive smoking
the user will develop the risk of developing bacterial pneumonia and other lung infection which may have a direct impact on the
breathing of the patient i.e. Rob. This shows that with the habit of smoking and blocking of lungs, the Airway would be affected
(Anzalone and et.al., 2019).
Breathing-.
RCUK (2016) recommend the; look, listen and feel approach which is one of the important aspects which provides a
comprehensive assessment of breathing. Rob displayed some signs of increased effort in breathing and respiratory distress. This
can be observed from the movement of his chest wall which moved in, instead of moving out.
Additionally, Rob remained displaying bradypnoea under which its breathing slowed down to12 breaths per minute. Also
while undertaking the breathing assignment, a smell was found which showed that the Rob may have consumed alcohol. The
symptoms remain as initial assessment.
Also, CRT < 2 seconds, which, according to Fleming, S. et al. (2016) a safe CRT test should not be used to rule out serious
illness in children. Inversely, a prolonged CRT may be considered borderline abnormal as it indicates risk of shock. Thus,
continuous monitoriosation proceeded by applying cutaneous pressure to the fingertip for 5 seconds. (Jevon, P., Gallier, H., 2020)
Circulation- Robs skin was pink toned, well-perfused, and warm to touch. Upon auscultation Rob’s heart beat felt irregular which
according to is defined as arrhythmia (Darmawahyun and et.al, 2022).. The Heart rhythm problem arise when the electrical signal