Practice Portfolio of Evidence PART B: Clinical Encounter Analysis

CNA344: Becoming a RN: Practice consolidation
Practice Portfolio of Evidence PART B: Clinical Encounter Analysis
Consider the
patient
situation/context
Provide an overview
of the encounter.
What happened,
how it occurred, etc
what was it that
alerted you to that
fact that you needed
to take action in the
encounter.
(150 words)
A patient was admitted to the emergency department with severe chest pain, sweating, body discomfort, palpitations, breathlessness
and light-headedness. He was immediately put on supplemental oxygen therapy though nasal cannula and an Electrocardiography was
performed to monitor the patient’s heart conditions. The patient was administered with sublingual nitroglycerin in conjunction with
morphine to relieve the severe chest pain. The patient was given ticagrelor, a platelet aggregation inhibitor to prevent any blood
clotting. A mild dose of aspirin was administered along with ticagrelor. Two hours post administration, noticeable drop in blood
pressure was observed followed by severe nose bleeding; difficulty in breathing was aggravated. Monitoring the ECG showed a
significant drop in pulse rate or bradycardia. Severe nose bleeding, bradycardia, dizziness and breathing difficulties and worsening
patient condition post administration of pain relievers and ticagrelor raised an alert signal which brought me, a registered nurse by
profession into action.
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Review: what key
information was
already available to
you and how did this
influence your
thinking? (eg:
handover, history,
charts, result of test,
assessments,
medical orders
etc.).
(150 words)
Gather:
What was the new
information you
gathered from
Review: In response to the patient’s critical condition, the patient’s past medical records and the family history of cardiac details are
taken into consideration. The ECG reports were available which were assessed for specific criteria. Shift nurses were assigned for the
patient’s monitoring and diagnosis purpose. The clinical handover reports of the shift nurses were available for consideration. From
the patient provided medical history records, the patient had allergy from aspirin so aspirin as analgesic was not administered; instead
morphine was administered to relieve pain. The patient had reported continuous chest pain and discomfort for the last 24 hours;
increase in severity of pain caused him to seek for emergency help. Prior cardiac occurences have been mentioned in the patient’s
medical history. The patient’s past cardiac reports showed an administration of ticagrelor to prevent blood clotting. The medications
and diagnosis have been provided according to the patient provided medical details.
Relevant medications (where relevant): (not included in word count)
Gather:
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additional
assessment?
(150 words)
Dot points are fine
for this section
Recall:
Recall and apply
your existing
knowledge to the
above situation to
ensure you have a
broad understanding
of what is/may be
occurring before
proceeding with the
Additional assessment of the patient made certain revelations. Drug treatment was intended to minimize the patient discomfort;
however, the patient responded with severity post drug treatment. The symptoms with which the patient was admitted were elevated,
which was a concern for consideration. The patient’s medical records revealed that the patient had allergy due to aspirin. The patient
had recurrent hypertensive episodes. The patient showed a significant drop in pulse rate of 40 beats per minute compared to normal
pulse rate of 80-120 beats per minute. The blood pressure showed an elevation compared to before admission. Reddened and itchy
rashes were found in certain areas of patient’s body; a mild swelling of the face was noticeable. On assessment, the patient reported
that he suffered from constipation and did not have any appetite. A feeling of nausea and vomiting accompanied the patient’s
symptoms. The patient showed an increased level of anxiety and impatience.
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rest of the cycle.
What was telling
you that the
encounter was
presenting you with
a problem that
required resolution?
(200 words)
Use scholarly,
evidence-based
literature/clinical
guidelines and/or
policy/NSQHS
materials to
substantiate your
Recall: Administration of the drugs namely nitroglycerin, morphine, ticagrelor had been in accordance with the patient’s past medical
reports. However, while assessing the diagnostic reports and test results, the dosage of the drugs may play a crucial role in worsening
the conditions of the patient. According to research evidence, sublingual nitroglycerin may not pose any negative effect on the
patient’s condition (Takx et al. 2015). Nitroglycerin promotes dilation of cardiac vessels and restores the cardiac requirement of
oxygen. The therapeutic use of morphine as pain reliever in myocardial infarction has not gained promising results due to dosage
errors. High dosage of morphine is associated with various side-effects when used as a pain reliever. The patient’s symptoms of
increased dizziness and difficulty in breathing post administration of morphine suggest as possible signs of overdose of morphine
(Parodi et al. 2015). Ticagrelor administration is associated with side-effects even in normal dosage administered. Severe nose
bleeding observed in the patient was a negative response due to side-effects. Shallow breathing rates observed post administration
may also be an effect of overdose of ticagrelor (Gaaubert et al. 2014). Monitoring the patient’s conditions and assessing the diagnostic
reports, the dosage administration of morphine and ticagrelor required critical concern in the patient’s case. Severity of the patient
condition post drug treatment was the turning point of my understanding.
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