Nursing Interventions for Mr. Smith's CVD

The assignment details the nursing care provided to Mr. Smith, who was hospitalized due to critically sick conditions related to cardiovascular disease (CVD). The nurse analyzed his case study, supported him, and applied interventions to stabilize his vitals and improve his condition. A discharge planning was formulated to continue treatment after hospitalization, including a daily routine and therapy sessions. The assignment provides a detailed rationale for the nursing interventions and highlights the importance of continuity of care in managing CVD.

CASE STUDY

TABLE OF CONTENTS
INTRODUCTION ..........................................................................................................................1
PRIMARY PRIORITIES.................................................................................................................1
INTERVENTIONS .........................................................................................................................2
Intervention 1...............................................................................................................................2
Intervention 2...............................................................................................................................3
DISCHARGE PLANNING ............................................................................................................5
CONCLUSION ...............................................................................................................................5
REFERENCES................................................................................................................................7

INTRODUCTION
Health is the state of complete well being of individuals in terms of physical, social and
mental status and professionals are required to manage and maintain it under a legislative
framework. Nursing is an important area in the health and social care sector to provide patient
centred care in proper and systematic manner. Their roles and responsibilities are crucial in
understanding the patient's pathophysiological changes (Butcher and et.al., 2018). It is
demonstrated that they are not only supporting the patients and their families but also direct them
by recognising the optimal symptom management. This assignment is based on the case study in
recognising the contribution of a registered nurse in overall analysis of the patient's conditions. It
includes the identification of health care priorities and related interventions to manage it
effectually. Moreover, a discharge planning is given to be aligned with the social justice
framework and in accordance to the pathophysiological changes.
PRIMARY PRIORITIES
This is required to know about the relevancy of the decisions during the application of
interventions. The two healthcare priorities are the cardio vascular health and the mental health
aspect. Herein ABCDE Approach is the immediate organised assessment for critically ill patients
and has been used to apply during emergency time (Smith and Bowden, 2017).
Airway: Mr. Smith has been complaining of chest pain with shortness of breath (sob). Along
with this, he also has heart rate (HR) of 105 beats per minute which is considered as the targeted
heart rate range. Due to onset of hacking cough which infers wet cough, his airway has been
partially obstructed.
Breathing: His SpO2 (Pulse oximeter) levels has been recorded under normal range but presence
of shortness in breadth was evident. Moreover, the Glasgow Coma Score (GCS) of 15 is
considered as the best, however Mr. Smith lacked the strength to continue doing the daily
activities due to old age.
Circulation: His ECG (Electrocardiography) showed minute abnormalities and the initial blood
samples has negative troponin in the range of 0.02. However, he has been kept under
observations with regular medicines.
Disability: He had been under proper treatment plan and supervised by the nurses, where he has
been suffering from bilateral bibasal coarse crackles.
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Exposure: He was suffered with an exacerbation which was demonstrated by the Congestive
heart failure. His ageing also led to pleuritic nature and also put an emphasis on the overall
critical conditions of his survival.
INTERVENTIONS
Nursing interventions are necessary tools to bring the changes in the real time world by
applying the strategies to maintain the impact in positive ways and enhancing the relationships
between the professionals like nurses, practitioners etc. and the patients with their families. There
are several typos such as independent type of intervention, nurse initiated interventions,
collaborative interventions and more (Perry and et.al., 2019). Moreover, the focus is to include a
direct means of communication to address the queries as well as bringing awareness to the
patients for their recovery stage. For instance, when a nurse knows the medical history, the
symptoms and the vital signs, then the nurse is able to monitor, supervise, analyse and implement
the procedure more efficiently.
Intervention 1
Rationale of intervention:
AIM: To maintain the heart rate and minimise the causes for the shown abnormalities in the ECG
of Smith, it is important to have nurse initiated intervention
The major reasons behind this intervention is to identify, analyse and later monitor the
symptoms and the ongoing conditions of the patients. The nurse initiated intervention is
considered as one of the effective attempts to improve the patient centred care. Nevertheless, this
is important to make the nursing diagnosis to be focused on the concerning areas where the
patient's health gets reflected. These are the real based action plans to mitigate the causative
agents and influence the patient to maintain the well being by being vigilant and participative in
nature as well. Moreover, it helps the nurses to practice their principles and ethical standards in
uniform manner to maintain the patients' engagement through complete cooperation and mutual
trust.
Discussion of nursing care: The nurses have crucial role in understanding the symptoms' and the
ongoing progression of the conditions of the patients like Smith. They must promote proper
participation from the patients to make them aware about the diagnosis and the process measures
to bring improvisations among the ongoing treatment plan of the patients. In addition to these,
they have the access to all the confidential data and information which might act as bridge to
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remove any gaps and help in improving the interactions (Cabilan and Boyde, 2017). The
patients are in constant supervision as seen in the case study of Mr. Smith who is an elderly and
is in need of constant help and assistance. Thus nurses were on proper rounds for note keeping
the daily diagnosis for better gaining of knowledge and understanding the prognosis regarding
the treatment plan which was base don taking medicines such as penicillin,
frusemide,metoformin and others.
Alongside, the overall records of past illnesses involving angina, hypertension with an
increased Body Mass Index (BMI) of 34. It was evident that Smith was having difficulties
initially but was conducting his daily chores in an uninterrupted manner. For instance, before
admitting to the hospital, he had a normal day but suddenly was taken to the nearest hospital
which was three hours away. Thus, the nurses made him comfortable and did not wait for any
tests or diagnosis, they started his treatment plan by giving him 5 mg of IV morphine, 1 gram of
paracetamol to decrease his pain levels which was 2 when he was admitted.
The cardiovascular health disease (CVD) is in great demand due to high levels of stress
and anxiety in today's time. The elderly population in most of the developed countries are on an
alarming rise and thus, the nurse initiated intervention help in educating the self care steps under
a clinical setting. Furthermore, there is also requirement of nurses to manage the advanced
practices to evaluate the risk management associated with the people suffering from high BP or
unstable RR and more. Along with this, the nurses supported in bringing changes by significant
contributions.
Intervention 2
Rationale of intervention:
AIM:To maintain the collaborative treatment plan for improving interaction and assist in mixing
the multidisciplinary approaches for patient centred care
The collaborative type of nursing intervention is effective in bringing the patients
involvements at all the stages of the treatment plan. This is significant in making a
comprehensive change by combining all the work people from several functional departments to
give better services and delivery of care and support properly. Additionally, it focuses on the
inclusion of several professional levels code of conduct to maintain the patient-practitioner
relationship and also assist in minimising the complexities that are associated with the
experimental type of interventions. It has also been demonstrated that this nursing intervention is
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useful in bridging the gaps that has often been seen when giving services and complete
assistance to the patients who are unable to take proper care of themselves.
Discussion of nursing care: The nurses must try to bring the focus on mitigating the stress levels
and irregularities in the blood pressure patterns. For instance, Smith was not empowered in
gaining knowledge about its own key information in context to the CVD. He was unaware about
the five E's such as education, engagement, environment, evidence and evaluation. Along with,
this led to his mental well being as well wherein the aforementioned factors had drastic effects
and led to hampering impact. There was lack of perspectives in giving quality delivery of
services to maintain the consistency in the treatment plans (McWilliam and Fernández Valero,
2015.). Earlier he was given penicillin and later he was shifted to analgesics which clearly
demonstrated that he had issues due to the ageing and the lack of active participation.
Moreover, patients like Smith suffered from clinical manifestations that act as hindrance
when giving proper treatment plans. There is a need to know about the safety of the patients'
during the challenging situations and fluctuations regarding the stressors. Consequently, due to
breathing problems and erratic changes in the weight, RR and other parameters, the patient of the
case study defined the need to understand the role of nurses who were presented for 24*7. While
doing the allotted tasks, it is necessary to understand that nurses must be in good connecting
links with the other departmental people to have better grip on the prevalent issues and the
patient's well being.
In regard to the mental health of individuals, nurses are imperative to make the patients
believe that they are not alone and become friends by communicating under a transparent and
reliable channels. The nurses give self guided information and bring proficient methods' ad usage
of tools to maintain the patients' engagement for better recovery. Smith was given an inter
professional nurse led intervention to bring an overview regrading dressing the issues with
respect to the personal, socio-relational and psychological.
In addition to these two interventions if followed correctly, Mr. Smith would be able to
get discharged on time and under proper guidance of nurses, he might be able to take steps to
bring awareness and implement it to complete the medication and the other related treatment
plans or strategies for faster recovery.
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DISCHARGE PLANNING
Discharge planning is defined as the procedure that signifies complete recovery of the
patient and move out of the hospital through smooth movement of activities under a legal
framework. This also reflected upon the type of treatment plan that the patient must be receiving
after getting out of the hospital area and must follow to maintain the well being in all the aspects
(Cameron, 2018). It has also emphasized on the needs of the patients to give them a platform to
understand their conditions and the basic requirements to become healthy and if requirement of
an assistance then this is also considered.
In the given case study, Mr. Smith would be only be ready to move out after the vitals get
stabilised. His shortness of breath and fatigue has caused him to be bedridden completely.
However, the initial abnormalities also led to negative troponin of TNI. This made the doctors to
take him under the Intensive Care Unit (ICU) and also made him follow a daily routine by
consuming several medicines to bring the vitals stable. His weight was also increased and this
indirectly affected his overall mental well being and has to be decreased by proper diet plan and
other therapy sessions.
Therefore, this patient Mr. Smith must be kept in the hospital premises for at least four
weeks until the vitals are maintained and brought down to the normal range. In regard to the
same, the nurse must try to be supportive and make him understand for doing less physical tasks
such as gardening, brisk walking etc. and control the diet so that whenever he would be
discharged, he might be able to maintain the weight and other parameters. Henceforth, the
discharge planning must be only be implemented when the patient is completely in sync with the
prescribed normal range of all the components related to CVD and make the practitioner believe
that he is able to complete tasks and conduct activities without any problems.
CONCLUSION
It has been summarized that Mr. Smith who was hospitalised due to critically sick and
required proper attention by the nurses, who analysed his case study and gave him support and
undivided attention for quicker recovery. His conditions got stabilised and led to improve after
applying the nursing interventions by understanding the overall needs to meet the
pathophysiological changes of the chosen case study. Furthermore, the interventions have been
elaborate using a rationale and specific set of guidelines. Lastly a discharge planning has also
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been formulated to continue the treatment plan along with following the prescribed medications
in proficient modes.
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REFERENCES
Butcher, H.K. and et.al., 2018. Nursing Interventions classification (NIC)-E-Book. Elsevier
Health Sciences.
Cabilan, C.J. and Boyde, M., 2017. A systematic review of the impact of nurse-initiated
medications in the emergency department. Australasian Emergency Nursing
Journal.20(2). pp.53-62.
Cameron, B., 2018. The impact of pharmacy discharge planning on continuity of care. The
Canadian journal of hospital pharmacy.47(3).
McWilliam, R. and Fernández Valero, R., 2015. Implementing components of the routines-based
model. Diversidade e educação: Desafios atuais: Colóquio Internacional Psicologia e
Educação, 2015. (175). p.165.
Perry, A.G. and et.al., 2019. Nursing interventions & clinical skills. Mosby.
Smith, D. and Bowden, T., 2017. Using the ABCDE approach to assess the deteriorating
patient. Nursing Standard (2014+).32(14). p.51.
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