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NURS3002: Therapeutic & Professional Relationship

   

Added on  2021-04-24

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NURS3002 2018Assignment 3 Template Standards for PracticeStudent Name:Student ID: Date: Submission Due DateDate Submitted:Topic Availability:Class no:Standard 1: Thinks critically and analyses nursing practiceWhile in clinical PEP, I had to deliver care to a patient suffering from myocardialinfarction (MI) as per the required standards of nursing practice. Mr J was a 49-year-oldmale of Hispanic origin who was admitted to the Coronary Care Unit at 9 am. The patientpresented to the Emergency Department at around 7 am as he was having left sided chestpain since the past two hours before presenting to the healthcare setting. The patient haddescribed the pain to be crushing in nature, and he was suffering from shortness of breath,sweating and sense of impending doom. An Electrocardiograph (ECG) was carried out thatshowed significant changes as ST elevations in leads I, aVL, V2, V3, V4, V5 and V6.These changes denote Anterolateral Myocardial Infarction. Laboratory investigations donereported a normal full blood count, and normal levels of sodium, potassium, creatinine,chloride, urea, liver enzymes and urates. Further, the triglyceride and cholesterol levels ofthe patient were significantly elevated. The cardiac enzyme level was elevated minimallyat the initial level; however, it rose after five hours. The patient was a slim built and tall individual with 77 kg weight and 180cm height. Hehad suffered a stroke one and a half years ago and thus was a known case of hypertension.He was reported to have an attending medical clinic for care support. His parents wereknown to be hypertensive. An assessment was carried out to understand the social historyof the patient; the revealed that he is a professor at the city university, teaching sociology.Although the patient was a non-alcoholic, he was a regular smoker. He smokes 5-6 rolls ofcigarette per day. He is married with two children and has a peaceful social life.

NURS3002 2018Assignment 3 Template Standards for PracticeAt this juncture, it was thought appropriate to carry out a thorough nursing assessment ofthe patient that would help in collecting information about the patient’s psychological,physiological, spiritual and sociological status. According to Butcher et al. (2018, p. 352),nursing assessment is considered to be the first step in the comprehensive nursing process,aimed at laying the path for patient-centred care. Objective data for the patient was firstcollected that revealed the vital signs of the patient to be as follows- BP: 138/92 of Hg, thetemperature of 36 degrees Celsius, pulse rate of 62 per minute and respiratory rate of 23per minute. The patient’s skin was warm and there was the absence of cyanosis. Thepatient was oriented to people and place, and alert when he was brought into the unit. Arespiratory system assessment indicated that air entry was normal bilaterally and the lungfields were clear. Assessment of the cardiovascular system revealed that there were novisible heaves, thrills or pulsation. S1 and S2 could be heard. Assessment of the GI tractindicated that the patient has no difficulties in swallowing and no mass was felt in theabdomen that was non-tender and soft when palpated. the musculoskeletal systemassessment identified that the patient had normal muscle tone and gait. The power on theleft side was 5/5, and that on the right side was 3/5. This was the residual effect of thestroke suffered earlier (Giger 2016, pp. 35-36). A nurse is required to understand the pathophysiology of acute conditions so that the careplan can be outlined ideally. It the present case, it was ensured that a knowledge ofmyocardial infarction was brought into focus. Acute Myocardial Infarction (MI) results dueto thrombotic occlusion of the coronary artery, thereby leading to irreversible necrosis andcell injury. The condition is commonly known as a heart attack (Reed, Rossi & Cannon2017, p. 197). The important risk factors for such condition include smoking, diabetes andhigh blood pressure (Ibrahim, Riddell & Devireddy 2014, p. 342). Anterolateral MI is aresult of thrombotic occlusion occurring in the left anterior descending artery and occlusion

NURS3002 2018Assignment 3 Template Standards for Practiceoccurring in the coronary branches. According to the World Health Organization standardsfor detection of MI, the three factors that are to be considered are a patient history ofprolonged and severe chest pain, serial enzymes levels and electrocardiography (Chava &Dauerman 2018, p. 213). Most cases of heart attacks take place between 4 am, and 10 amdue to higher level of blood adrenaline that is released from the adrenal glands at themorning hours. The augmented adrenaline is a contributing factor for rupture of thecholesterol plaques (Nakashima et al. 2017, p. 362). The patient, in the present case, experienced shortness of breath, sense of impending doomand profuse sweating and chest pain at the initial phase of myocardial infarction.According to Ibrahim, Riddell and Devireddy (2014, p. 343) chest pain is the hallmark ofacute MI. The pain that the patient suffered at the initial stage was due to the blockage ofcoronary artery that supplies blood to the heart. Injury to heart muscle is due to the heartmuscle’s deprivation of oxygen and blood, which leads to the sensation of chest pressureand chest pain (Ibanez et al. 2017, p. 120). Shortness of breath is due to the reduction ofcardiac output, while the profuse sweating is due to sympathetic activation. Further, thesense of impending doom is a result of adrenaline release together with othercatecholamines.Standard 2: Engages in therapeutic and professional relationship[sCritical care nursing is a specialized nursing field that has the focus on the care of unstableand critically ill patients following surgery, extensive injury or life-threatening diseases.Critical care nurses are to work in diverse environments where they are entailed to deliverpatient-centred appropriate care (Blais 2015, pp. 157-158). According to Morton et al.(2017, p. 1056), critical care nurses are to engage in therapeutic and professional

NURS3002 2018Assignment 3 Template Standards for Practicerelationships that encompass collegial generosity in relation to mutual trust and respect ifrelationships with the care context. A nurse is supposed to maintain the boundariesbetween personal and professional relationships. In the present case, an attempt was madeto establish a successful therapeutic relationship with the patient. In introduction was givento the patient and the patient’s name was used while talking to him. Since a handshake wasnot feasible due to the patient’s condition, it seemed appropriate to hold his hand as a warmgesture. The patient’s privacy was maintained when he was brought into the critical careunit that ensured a safe environment. While carrying out the assessments, active listeningwas an appropriate approach as the patient felt the importance of the nurse’s attempt tounderstand his concerns. Eye contact was maintained with the patient and smiling atintervals made the patient comfortable. Eye contact and smiles are crucial to engage thepatient in a conversation (Urden, Stacy & Lough 2015, p. 34). Speaking calmly and slowlywas also imperative, as the communication was two-way (Adam 2017, p.89). Maintainingprofessional boundaries is crucial while incorporating caring behaviours. The patient’spreference for handholding was assessed prior to engaging in such acts. As opined by Blais (2015, p.163) nurses are to communicate effectively with patients in arespectful manner. The dignity, values, culture, rights and beliefs of the patients are to beconsidered while delivering care that is culturally sensitive. The patient in the present casewas of Hispanic background for whom culturally sensitive care was to be given. Evidencepoints out that people of the Hispanic origin face major issues while obtaining care. Asignificant barrier from the nurse’s end is unfamiliarity with linguistic and culturalsubtleties. To address this concern for the patient under care, an interpreter was appointedwho has professional in working with Hispanic patients. Professional interpreters ensurethat the communication between patient and care provider is culturally appropriate (Adam2017, p. 65). In addition, challenges emerge from cultural mistrust together with the

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