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Assignment on Integrated Nursing Practice

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Added on  2020-04-07

Assignment on Integrated Nursing Practice

   Added on 2020-04-07

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Running Head: Integrated nursing practiceIntegrated nursing practiceName of the StudentName of the UniversityAuthor Note
Assignment on Integrated Nursing Practice_1
1INTEGRATED NURSING PRACTICEIntroductionThe assignment deals with the case study of Frank James; 72-year-old man has beenadmitted due to acute exacerbation of his chronic heart failure. Based on the cardiogenic shockpresented in the case study, the essay discusses the signs and symptoms as associated with theABCDE pneumonic. The pathophysiology of the cardiogenic shock and the highlighted signsand symptoms are discussed critically. Shock is the state of inadequate oxygen delivery to vitalorgans of the body and insufficient perfusion throughout the body. It is the life-threateningsituation and requires immediate assessment and treatment (Thiele et al., 2015). Part AIn the given case study, when Frank James was admitted with an acute exacerbation ofhis chronic heart failure. Observation showed he was mildly diaphoretic, slightly short of breathand complained of nausea. In the last three weeks the patient had experienced pain radiating tohis back every hour, which is relieved with sublingual nitroglycerin (GTN). The patient hasfamily history of heart disease. He was under medication of aspirin, atenolol, isosorbide, andlisinopril. On the next morning the patient complained of shortness of breath and restlessnesswith a chest pain score of 2/10 that is radiating to his left arm. Upon chest X ray, it was foundthat his cardiac condition was worsening with pulmonary oedema. On examination, he isconfused, sweating, pale and centrally cyanosed.The common causative factors of cardiogenic shock are myocardial infarction,Cardiomyopathy, Valve disease, Structural defects and Cardiac arrthymias. The common causeof the cardiogenic shock is the failure of heart to pump which is the intrinsic factor (Thiele et al.,
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2INTEGRATED NURSING PRACTICE2015). The cardiogenic shock is manifested as increase or decrease in heart rate, increase inrespiratory rate followed by dyspnoea, decrease in blood pressure and increase in urine outputfollowed by oligouria. Initially there is an increase in temperature and then normal (Ostadal etal., 2017). Similar symptoms were observed in the case of Mr Frank where his blood pressure keptdecreasing after admission (from 156/98mmHg to 96/50mmHg). There was an increase in heartrate from 124 to 128bpm. Respiratory rate was found to increase from 30bpm to 36bpm. Thepatient temperature was 37°C and U/O 20mls/hr for the past 2 hours. The patient’s skin wasfound to be sweating, and pale.Using the ABCDE approach the chosen condition is discussed explaining thepathophysiology of the signs and symptoms. ABCDE stands for Airway, Breathing, Circulation,Disability and Exposure.The patient’s airway assessment showed signs of cardiogenic shock- dyspnoea. Theassessment includes listening to the signs of airway obstruction. Pulmonary edema is caused bythe back flow, increasing the airway resistance which was the cause of “bat wings” in chest xray. The management includes ensuring that the airway is maintained. The aim of managementshould be to increase the oxygen saturation to 99%. Pulmonary congestion and edema is causedby the acute increase in the left arterial pressure. Oxygen can be given through facemask ormechanical ventilation (Vital et al., 2013).Pulmonary edema leads to profuse sweating asobserved in patient.Breathing assessment includes checking the rate and pattern, depth of respiration, colourof patient, symmetry of chest movement and use of accessory muscles. In case of frank the
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