Nursing Essay 2022

Running head: NURSING
NURSING
Name of the Student
Name of the University
Author Note

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Introduction- Nurses play an important role in the recovery of the patient. This essay
mainly focusses on a particular case study where a new graduate nurse have to provide care
for a patient named Mrs. Kennedy who was admitted in hospital due to pneumonia but later
the nurse came to know that Mrs. Kennedy actually had coronary heart disease. Later, her
condition worsens with rise in heart rate and respiration rate and decrease in oxygen
concentration and blood pressure. This essay thus deals with a reflection based on the case
study scenario and how the nurse will provide accurate care to her patient. It will also reflect
all the pathophysiological problems that will help in the proper diagnosis of Mrs. Kennedy.
Discussion- Mrs. Kennedy is a 56year old patient hospitalized due to pneumonia.
According to the previous notes, it is focused that she lives alone in a rented flat and her son
lives in abroad. She is depressed due to her loneliness. She is also a retired woman and hence
has no such work to do at home. According to the previous medical history, Mrs. Kennedy
had ischemic heart disease, hypertension and onset of coronary heart disease. Six years ago,
she also had coronary artery bypass graft surgery. She went through percutaneous
transluminal coronary angioplasty two years back along with stenting to her right coronary
artery as well as posterior descending artery. Mrs. Kennedy was found to be a chain smoker
till she was diagnosed with coronary artery disease. According to previous observations in the
hospital, Mrs. Kennedy had pulse rate of 74bpm and blood pressure 165/90 mm/Hg. She had
a respiratory rate of 14/minute and SpO2 98%. I went through all these reports before onset
of my care procedure. Half an hour later when I went to administer her medicine I observed
that she was diaphoretic. On questioning her she replied that she was not feeling well and her
chest pain started. I again checked all the necessaries and found that her pulse increased to
116bpm and respiratory rate to 26/min. her blood pressure came down to 105/70 mmHg and
SpO2 to 92%. She had a breathing difficulty and also a cool sensation. According to my
examination her heart rate and respiratory rate increased gradually whereas blood pressure
and SpO2 decreased significantly. Heart rate generally increases due to occurrence of atrial
fibrillation. Vascular pathophysiology results in the increase of heart rate. It has thus emerged
as an risk factor for patients like Mrs. Kennedy suffering from hypertension, coronary artery
disease as well as myocardial infarction (Zoni-Berisso, Lercari, Carazza & Domenicucci,
2014). Respiratory rate is a major symptom for numerous diseases but physicians do not pay
much attention to it. Respiratory rate may increase due to pain, anxiety or other situations. It
mainly occurs when the acid level is high and hence the breathing rate increases in order to
blow off carbon dioxide (Jensen, Suadicani, Hein & Gyntelberg, 2013). It can be well

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explained by the term tachypnea . High respiratory rate marks the risk of occurrence of
myocardial infarction in patients already suffering from coronary heart disease. Many
evidences show the relation of decreased blood pressure with coronary heart disease (Xie et
al., 2016). Low blood pressures generally results due to insufficient flow of blood to body
organs which mainly leads to strokes, heart attacks as well as kidney failures(). On the other
hand, decrease oxygen saturation level or SpO2 is an independent risk factor for arrhythmia.
According to Jiang (2013), healthy heart tolerates hypoxia better and hence should have
oxygen saturation from 93% to 98%. All the symptoms thus conclude that Mrs. Kennedy is at
major risk of coronary heart disease and should be treated immediately. Cold sensation and
difficulty in breathing may result in cardiogenic shock. Therefore, all the treatment will be
related to the diagnosis of cardiogenic shock which is the main risk factor or Mrs. Kennedy.
Nurses should first immediately call the supervised physician and accompany them in
their treatment procedure. After the physician completes their checkup and prescribed
medications, nurse’s role comes into account. Mrs. Kennedy was suffering from acute pain
hence the nurse should monitor and review the location as well as the nature if the pain. In
addition they should also monitor her vital signs like blood pressure, pulse, respiration after
every two hours (Pegram & Bloomfield, 2013). They should also instruct Mrs. Kennedy to
report them whenever she is having chest pain. It is the duty of the nurses to create a calming
atmosphere for the patient and make the patient comfortable (Slatyer, Williams & Michael,
2015). Administering medications in the correct route is another important criterion which
should be kept in mind. This is because there were various incidences that cause deterioration
in patient’s health due to administration of drug through wrong route (Bibby, 2019).
Intolerance activity must be followed and the nurses should record the blood pressure, rhythm
before and after the activity. They should convince Mrs. Kennedy to take more rests and not
to think about her ill health. Rest helps in the process of recover a lot. The nurses should also
educate Mrs. Kennedy about the various stages of treatment that the doctor prescribed to do.
They should also take care about the diet that should be followed by Mrs. Kennedy. Her diet
should be such that it is easily digestible and does not contain caffeine (Kennedy, Lavie &
Blair, 2018). They should help in carrying out the ECG examination, chest radiograph. As
Mrs. Kennedy is suffering from risk of impaired tissue perfusion due to her lowering of blood
pressure level, hence the nurses should assess her change in consciousness. They should
inspect occurrence cold skin, cyanosis (Cavalcante, Brunori, Lopes, Silva & Herdman, 2015).
As she is already suffering from cold skin and breathing difficulty, therefore nurses should

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take more care of her. They should also measure their fluid intake and outtake and assess her
weight daily. She already had a weight of 88kgs hence should be given healthy diet. This is
because she had a huge body mass index and needs special protection in her diet (Phelan et
al, 2015). Increase in body mass index (BMI) helps in increasing the risk of cardiovascular
diseases more. She is already having all the symptoms related to cardiogenic shock and hence
her weight should be maintained in order to reduce the occurrence of more risk factors. Rise
in weight increases the risk of cardiogenic shock by many folds (Chatterjee et al., 2017). The
nurse should keep oxygen cylinder ready beside the bed of Mrs. Kennedy as her oxygen
saturation is decreasing rapidly. Nurse is also responsible in auscultating the lungs for areas
of reduced ventilation. They should monitor the oxygen saturation with the help of pulse
oximetry (Ewer, Granelli, Manzoni, Luna & Martin, 2013). The patient should be able to
make Mrs. Kennedy in a comfortable position and hence it is advised according to the
nursing guidelines that such patients’ bed must be kept elevated. They should also keep the
mechanical ventilator ready if the oxygen therapy proves to be ineffective. Mrs. Kennedy
needs assistance when she is coughing and also in urination. The nurses should examine her
urine regularly in order to get more evidences regarding occurrence of cardiogenic shock.
Mrs. Kennedy should be restricted from fluids and sodium as it increases the preload. The
nurse should administer the prescribed medicines on time without any delay. Hence, nurses
should remember their ABC of nursing practice and take care maintaining all the three. ABC
of nursing practice refers to Airway, Breathing and Circulation (Winkens, Ponds, Pouwels,
Eilander & van Heugten, 2014). This is referred to be the primary care plan for the nurses.
The above interventions do follow the ABC and hence should be carried out as discussed in
order to provide the necessary treatment to Mrs. Kennedy. Maintaining the airway system
will help her to overcome from her breathing problem. Checking the blood pressure and heart
rate within definite intervals helps the nurse to monitor the changes occurring in Mrs.
Kennedy’s body and will in turn help in the future diagnostic procedure. Administration of
medication through correct rout helps in correct form of treatment as wrong route
administration may lead to deterioration in her health. Preparation of mechanical ventilation
will help the nurse in case of emergency. Checking the food and controlling her diet will help
elimination of some inches and provide surety that Mrs. Kennedy is having a healthy diet
plan. This will help her from the future risk of many diseases like diabetes mellitus. As Mrs.
Kennedy’s nurse, I learned how to take care of a cardiovascular patient. I am just a nurse
graduate and had not dealt with much patients before. She will be my first patient whose
condition is critical and needs effective care treatment and constant monitoring. I learned

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about all the emergency measure and how and where to use it. I gained knowledge why it is
necessary to monitor all the vitals constantly in case of such patients having a risk of
cardiogenic shock. I heard various malpractice stories and how wrong route of administration
of medications affected the health of patients. Being new to the nursing profession, gaining
knowledge from all the patients care plan is very necessary for my growth as a nurse. Every
patient’s story is different. Disease is different and hence care plan is also different. Hence,
for the nurses it is a challenge to make all the patients comfortable and provided with their
best care plan possible. Communication with the patient is very important. Otherwise patient
might feel uncomfortable and might stop taking the treatment. All this should be kept on
mind before starting the assigned care plan for my patient, Mrs. Kennedy.
Mrs. Kennedy is a retired woman and lives alone in her house. She seemed to be very
depressed as when asked about her son whereabout she became teary eyed. Her son lives
alone and rarely comes to meet her. She is suffering from depression as well anxiety. Due to
this two it affected her health more. Knowing the fact that she is alone worries her and the
only measure found to stop that worry and depression is by smoking daily. She was a chain
smoker for the last thirty years and just left smoking after she was diagnosed with the
coronary heart disease. According to (Hare, Toukhsati, Johansson & Jaarsma, 2013)
depression and coronary heart disease are related bidirectionally. Depression may contribute
to sudden cardiac death to patients like Mrs. Kennedy who are already at a risk of cardiogenic
shock.it results in increase of all the cardiac mortality. Depression also helps in the
contribution to living a unhealthy lifestyle. Smoking is an example of such unhealthy
lifestyle. Depression makes people smoke and drink because according to many these two
helps in overpowering themselves from depression (Kuo & Chiang, 2013). Depression is also
related to cardiovascular diseases pathophysiologically. In cardiovascular patients, who are
also depressed, hyperactivity of noradrenaline secretion leads the main role in relating the
two. In depressed patients, sympathetic outflow bis increased through negative stress effects
of catecholamines on the heart as well as blood vessels. On the other hand, norepinephrine as
well as low serotonin level is also related to myocardial infarction and depression (Kuo &
Chiang, 2013). Anxiety is also related to cardiovascular disease. They are associated with the
onset and advancement of cardiovascular problems mainly cardiogenic shock. This is mainly
due to autonomic dysfunction, inflammation, endothelial dysfunction and development of
more platelet aggregation (Tully, Cosh & Baune, 2013).

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Conclusion- According to all the vital signs of Mrs. Kennedy it is hence confirmed
that she is at risk of cardiogenic shock. Her significant increase of heart rate and respiratory
rate and decrease of blood pressure and oxygen saturation helped me in coming to the above
conclusion. As a nurse all the required measures are taken in order to avoid any worse
situation and help in her recovery process. The treatments like monitoring the vital signs after
every regular interval, comforting her , keeping the oxygen cylinder ready and cleaning her
airway will help her in recovery from the current situation and will reduce the risk of
occurrence of cardiogenic shock. However, it is also seen that Mrs. Kennedy is also suffering
from depression and anxiety and hence requires proper attention and more care from the
nurse.

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