Evolution of the Nursing Process Report
Added on 2020-05-08
11 Pages3300 Words64 Views
Disease and DisordersHealthcare and Research
|
|
|
Running head: NURSINGNursingName of the student:Name of the University:Author’s note
1NURSINGNursing/collaborative interventions to manage patient’s clinical priority: This report critically presents an evaluation of nursing and collaborative interventionsimplemented for the management of the clinical condition of Mr. A, 80 year old male who wasadmitted to the CCU with complicated angina and unexpected pulmonary edema. A patientadmitted in CCU goes through the stage of triage, diagnosis, treatment, observation, dischargeand follow up. In relation to the problem of chest pain in patient, the first clinical priority was toassess chest pain in patient and then determine the medications needed as per hospital protocol toreduce chest pain. The PQRST method was employed for the assessment of chest pain by thenurse. The first step taken by nurse was to conduct positioning to give a comfortable position topatient. During this step, it is necessary for nurse to inquire about how chest pain is relieved. Ifpatients get pain relied due to change in body position, then it is an indication that pain is notischemic in nature, however if it is relieved by giving GTN, then it is an indication of ischemicpain (Boden et al., 2015). According to Drahnak & Custer (2015), main aim of positioning is toprovide physical comfort to patient during and utility of prone positioning is mainly realized inimproving oxygenation rate in patient. In case of angina, nurses also instruct patient to leave allactivities and rest in bed in semi-fowler’s position. After positioning, the most important nursing action is for chest pain management is toassess the severity and level of pain. Use of pain assessment tools help to quantify the severity ofchest pain and determine the best medication and treatment needed in patients to provided painrelief (Purser, Warfield, & Richardson, 2014). The nurse assessed the level of pain in Mr. A bythe PQRST method. The PQRST pain assessment tool is an effective tool that supports a nurseaccurately in reporting about pain in patient. It mainly inquires patient about precipitating factors
2NURSING(P), quality of pain (Q), Region of pain (R), severity or duration (S) and timing (T) (Lisi &BCPP, 2015).The main advantage of the PQRST pain assessment method is that the mnemonicsused in the tool help nurses to get cues regarding the elements to be considered during painassessment method. For instance, the question about onset of pain can give idea about patient’sability to cope with pain and respond to treatment (Althaus, Arránz Becker, & Neugebauer,2014)... The cause of pain helps to identify the mechanism behind the pain. In addition, the siteand radiation informs nurses and clinician about patient diagnosis and future course of treatment(Linl et al., 2011). Hence, in short PQRST is the most common and effective approach to collectself-report of pain from patients (Swift, 2017).This process of pain assessment by PQRSThelped the nurse and clinician in the case study to start the treatment. ECG is a pathophysiological approach to assessment of chest pain and it is mainlyperformed in patients requiring medical attention for chest discomfort and myocardial ischemia.The benefits performing ECG during ongoing chest pain is that it can help to identify about theischemic nature of pain. For instance, chest pain caused by ischemia will show changes inischemic ST-T waves or else the ST-T changes will be absent (Hamilton-Craig et al., 2014).Apart from PQRST, collaborative pain assessment was also done by conducting ECG on Mr. Aand ECG mainly showed horizontal and downward depression in ST segment. This form ofabnormality in ST segment is mainly caused by myocardial infarction (Reinstadler et al., 2015).Hence, the use of non-invasive cardiac investigation by ECG was an effective step used byclinician to assess symptoms of mycocardial ischemia in patients like Mr. A with chest pain(Radico et al., 2014). In response to assessment regarding severity and cause of pain in patients, the first nursingintervention implemented for Mr. A was to administer one dose of 600 mcg of GTN sublingually
3NURSINGto relieve pain patients. GTN is a glyceryl trinitrate tablets that is given to provide relief frompain caused by angina or to prevent an expected heart attack. This medication is mainly given topatients during the first sign of chest pain and the medication starts acting within five minutes asit is absorbed quickly into the bloodstream (Thompson, 2016). It relieves pain mainly by theaction of relaxing the blood vessel and reducing the workload on the hearts. The widening of theheart arteries lead to increase in flow of blood to the heart muscles and consequent relieves chestpain. Another evidence showed that GTN have a direct relaxant effect as they act on vascularsmooth muscles and dilates coronary vessels to improve oxygen supply to the myocardium. Itaffirmed that all patients with stable angina must be prescribed short-acting nitrates for acutesymptomatic pain. The only reported side effects with this drug are headache and hypotension(Docherty, Jackson, & Gardner, 2016). A systematic review and meta-analysis of the effectiveness of antianginal drugs as add-on therapy in patients with stable angina revealed that when short acting nitrates cannot controlsymptoms of stable angina in patient, then prophylaxis using beta-blocker should be started. Thispoints out to the alternative options for patients with stable angina if GTN does not work. Thecombination of beta-blocker or calcium channel blocker along with other class of medicationslike Ranolazine was found to give positive clinical outcomes in patient (Belsey et al., 2015).Alternative medication option was also taken for Mr. A as nursing reassessment of bloodpressure and pain showed no improvement in symptoms. Pain score was 7/10 and blood pressureremained elevated. The normal hospital procotol is that if pain does not subside after first dose,then nurse can give another dose after 5 minutes. The same was done by the nurse, however asthe second dose also did not worked, the nurse had to collaborate with the clinician and ask for
End of preview
Want to access all the pages? Upload your documents or become a member.
Related Documents
Comprehensive Chest Assessmentslg...
|5
|994
|16
(Doc) Nursing Sample Assignmentlg...
|7
|1539
|64
Nursing Interventions Analysis 2022lg...
|10
|962
|20
Patient Handover: Nursing Care Plan for a Patient with Hypertension, Ischemic Heart Disease and GERDlg...
|5
|1171
|210
Nursing Decision Making and Practicelg...
|10
|2084
|390
Nursing: Primary Diagnosis and Nursing Problemslg...
|4
|557
|87