Critical Care Nursing and Myocardial Infarction
Added on 2020-03-16
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Running head: BACHELOR NURSING ASSIGNMENTBachelor nursing assignmentName of the StudentName of the UniversityAuthor note
1BACHELOR NURSING ASSIGNMENTMr Jack, a 52-year-old man had a sudden attack of chest pain in the early morning thatradiated to his neck and left arm. He was sweating profusely and was rushed to the emergencydepartment in the hospital. On admissions, he was conscious, however, hypertensive,tachyarrhythmia with ST elevation and mild dyspnoea and oxygen saturation levels at 91%. Thiscase study is relevant to myocardial infarction (MI), a medical emergency that on delay intreatment can ultimately lead to death. The significance of this case study is that it provides anin-depth investigation of MI based on evidence and help to investigate the underlying aspects ofthe disease to manage the complex clinical situation. Concisely, this case study gives scope forthe critical assessment, development of collaborative interventions that help to manage theclinical priority and responses of the patient. In the given case study, Jack had a sudden chest pain early morning that radiated to hisneck and left arm and was sweating profusely. His past medical history reported DiabetesMellitus (DM), an alcoholic and smoker. He is obese with a BMI of 30.2 and weighs 83 kg. Ongeneral survey, it was found that his blood pressure was high (170/92), tachyarrhythmiccondition (110-115), mild dyspnoea, ST elevation, and 91% O2 saturation levels that depictsvariation in the vital parameters, mild activities in BP. The skin was clammy, face was pale, andcool with chest pain that radiated to neck and left arm. On assessment, ECG showed changes,CPKMB, and Trop T test shows positive results confirming that Jack is suffering from MI. Taking the complex condition of Jack into consideration, the main clinical priority is thepain management so that his myocardial injury pain reduces on a pain scale of 1 to 10.According to ACCF/AHA/SCAI guideline, there is smaller branch of coronary artery blockageand there is loss of blood and oxygen supply that causes chest pain (Levine et al., 2015).Therefore, pain management is the main priority as MI damages the heart muscle. As Jack is
2BACHELOR NURSING ASSIGNMENTgetting anxious about his condition, there is also activity intolerance due to alteration in the BPwith activities and heart rate that need improvement in his activity level after treatment (Smyth etal., 2016). Based on the clinical priority, the planning is to manage chest pain that follows MI andrisk management, as there might be decreased cardiac output secondary to MI. There is also needto explain and educate Jack regarding his MI condition that can reduce his anxiety and fear. Dueto the imbalances in the heart and BP, there is activity intolerance and so, Jack’s activity levelneeds to be improved after the treatment regimen. He is also a smoker and alcoholic andtherefore, he should be taught to quit as it can complicate MI condition. The main clinical priority is to relieve the chest pain and nursing goals involve thecontrol of chest pain with proper medicine administration within period. This is evidenced byJack’s variations in BP, pulse and chest pain. Therefore, there should be careful monitoring anddocumentation of the vital parameters like pain, verbal and non-verbal cues (conscious level,crying, moaning, clutching of chest and restlessness), heart rate changes or BP (Morton et al.,2017). There is variation in behaviour and appearance in MI patients that can pose a challenge inthe nursing assessment. The rationale for this intervention is that in the given case study, Jack isfocused on his pain that is making him anxious that also act as precipitating factor for painelevation. Anxiety increases respiration level and there is stress induced catecholaminesreleaseincreasing BP and heart rate. Pain being subjective data requires patient description for thedetermination of therapy effectiveness, problem progression and resolution (Roest et al., 2014).Therefore, the nurse should obtain a full description of the intensity (pain scale 1 to 10), location,characteristics and duration. There is also a need for reviewing of past medical and familyhistory to manage the further risk damage that might interfere with the pain relief and
3BACHELOR NURSING ASSIGNMENTdiagnostics. The patient need to be instructed to perform relaxation techniques like slow anddeep breathing exercises, visualization, distraction behaviours and provide required assistance(O'Gara et al., 2013). Administration of supplemental oxygen is important so that there isincrease in oxygen amount for the myocardial uptake relieving discomfort as his oxygensaturation levels were 91%. Beta blockers (second-line pain control agents) (atenolol(Tenormin), propranolol (Inderal), metaprolol (Lopressor) can be administered for thesympathetic stimulation blocking and reduction of systolic BP, heart rate and myocardial oxygendemand (Vanhoutte & Gao, 2013). There should also be checking of the vital signs before and after the administration ofnarcotic medications as respiratory depression and hypotension can occur. These conditions canfurther increase the myocardial damage in the presence of ventricular insufficiency. Along withthe pain management, Jack should be instructed about immediate pain reporting by providinghim a calm and quiet environment through confident approach. This would help to decrease theexternal stimuli that may aggravate cardiac anxiety and strain limiting his coping abilities andcurrent situation adjustment (Bates & Menees, 2012). There is insufficient physiological energy that results in activity intolerance to perform adesired activity. This is related to imbalances in myocardial oxygen supply and demand andpresence of necrotic or ischemic myocardial tissues. There should be proper documentation ofthe heart rate, rhythm, BP changes or shortness of breath before and after the performance ofactivities. This would help to determine the response of Jack towards the activity and indicationof deprivation of myocardial oxygen (Nakajima, 2015). This would assist in altering the activitylevel, bed rest, medication regimen or in the supplemental oxygen use. Jack should be instructedto take rest for limiting the activity based on pain level or cardiac response. This would help to
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