Case Study: Systematic Approach to Chest Pain Assessment

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This case study focuses on the systematic approach to chest pain assessment, including initial assessment, plan of care, and patient-centered goals. It provides an overview of the case study, describes the assessment process, and discusses the development of a care plan. The case study also includes information on the patient's medical history, social life, and family medical history, as well as interventions and goals for treatment. The outcomes of the care plan are measured to ensure effectiveness.

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CASE STUDY

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TABLE OF CONTENTS
INTRODUCTION...........................................................................................................................1
Overview of the case study..........................................................................................................1
PART 1............................................................................................................................................1
Description of initial assessment of Peter including a detailed description of your systematic
approach to chest pain assessment...............................................................................................1
PART 2............................................................................................................................................3
Development of plan of care........................................................................................................3
CONCLUSION................................................................................................................................6
REREFENCES................................................................................................................................7
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INTRODUCTION
Evidence based care plan can be defined as a set of standard terms that are being recorded
in order to find or identify patient’s circumstances, outcomes, events as well as interventions that
can provide sufficient details to support clinical care, outcome research, decision support as well
as quality improvement (McLachlan and et al., 2019). Evidence based care plan is one of the
most important things which is required to be focused on in order to provide nurses or healthcare
professionals with clinical information and best practices that are required to bring improvement
within outcomes in order to reduce errors by standardizing care. It further helps in bringing
improvement within healthcare practices as well as on overall health of the population in order to
enhance their overall quality of life. This assignment will lay emphasis on case study of Peter
Stanhope who is suffering from chest pain. This assignment will further focus on detailed
description of systematic approach to chest pain assessment, short- term and long- term patient
centred goals, interventions to achieve required goals, ways in which outcome can be measured
and rationale for each intervention to be implemented.
Overview of the case study
Mr. Peter Stanhope is a Caucasian male who is 42 years old who has been admitted into
emergency department with one day history of central chest pain. He has a past medical history
of hypercholesterolemia and Gastro oesophageal reflux disease (Webster and et al., 2017). He
has also undergone two main surgeries that are: laparoscopic cholecystectomy and vertebral
laminectomy. From his family medical history, it was observed that he has a medical history of
hypertension and Acute Coronary Syndrome.
PART 1
Description of initial assessment of Peter including a detailed description of your systematic
approach to chest pain assessment
Pain is one of the most subjective things which is required to be measured and assessed by
the healthcare professionals. Before assessing overall pain assessment, it is important to assess
current condition of the patient. There are various kinds of methods that can be used for
assessment of the patient. One of the most commonly used patient assessment methods is A-G
method. It is a structured and systematic approach used for assessment of patients. It is one of the
most useful assessment practises that can be used in both emergency situations as well as in
nursing practises. This method is completely based upon ABCDE approach. This method
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requires nursing skills so that all kinds of critically ill or deteriorating patients can receive care.
This method is most commonly used in both primary and secondary care settings. It has a fixed
procedure for all kinds of situations. It is useful for systematic baseline patient assessment.
A- G method covers: airway, breathing, circulation, disability, exposure, further
information and goals. Before performing this method, it is important for nurses to explain what
they are going to do to their patients and ask for their consent. This method can be used for
assessment of Mr. Peter Stanhope’s condition after asking for his consent to perform this
assessment. Main elements of this assessment that will be focused on while performing A-G
method on Mr. Peter Stanhope are as follows:
Airway: It is a passage between lips and trachea. It is important to have a clear airway because
any kind of obstruction in it can be life threatening. From Mr. Peter Stanhope assessment it was
observed that he was facing difficulty in breathing because of which it can be said that he had
airway obstruction.
Breathing: Any kind of abnormal findings within breathing assessment can be cause because of
any kind of chronic respiratory disease etc. Mr. Peter Stanhope was faxing difficulty in beating
and was having shortness of breath. Patient was also having asymmetrical rise and fall of the
chest.
Circulation: Any kind of abnormal findings in circulation assessment can be caused due to any
kind of cardiac disease. Mr. Peter was looking pale, was suffering from severe chest pain. His
heart rate was also abnormal.
Disability: It involves evolution of central nervous system. It is based on AVPUC in which a
stand for alert, v stands for verbal stimulus, p stands for painful stimulus, u stands for
unresponsiveness, c stands for confusion. Mr. peter was alert, his verbal and painful stimulus
were active, he was nor unresponsive and was nor confused either. But he had an alcohol
addiction.
Exposure: In this patient is assessed for skin rashes, wounds, pressure injury, signs of infection,
bruises, skin changes. Mr. Peter was suffering pale has undergone two surgeries.
Further information: All per the additional information of Mr. Peter he was addicted to
smoking and drinking alcohol, he had medical history of Gastro oesophageal reflux disease
(GORD) & hypercholesterolemia as well as he hasd a known family medical histoy of
hypertension.
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Goals: The main short-term goal was to reduce chest pain suffered by Mr. peter and bring it
down below a scale of 3. Long term goal was to bring improvement within his physical activity,
diet so that his quality of life can be improved. Mr. peter will be kept under observation for 48
hours and will be monitored continuously.
In order to assess pain, there are various kinds of methods. PQRST is one of the most
commonly used pain assessment method that can be used to assess chest pain of Peter Stanhope.
This method can be used by nurses or health care professionals of Peter Stanhope to
appropriately report his chest pain by using PQRST assessment method (Frisch and et al., 2019).
PQRST stands for: provocation or palliation, quality or quantity, region or radiation, severity
scale and timing. In provocation questions like what patient was doing when the pain started or
what caused it are asked to the patient. In Quality what the pain feels like, like sharp, burning
and many more. In region location where the pain is felt by the patient is focused on or whether
it travels or moves around. In severity, severity of the pain is rated on the scale of 0 to 10 and last
in timing at what time pain started or how long it lasted is asked. On the basis of these questions
documentation of patient’s pain assessment is done. On the basis of this documentation all the
interventions that are required to be focused on or are required to be provided to the patient are
focused on.
In order to understand and assess Mr. Peter Stanhope’s chest pain a proper and systematic
approach was taken (Roche, Gardner and Jack, 2017). First of all, using PQRST method his
current condition was understood. Then information related to his medical history, social life,
family medical history, his current medications were obtained. On the basis of this information
few medical tests were conducted in order to understand and analyses his current chest pain
situation. Test such as blood test, chest X- ray and ECG was conducted so that further
examination can be done and further decision making can be done.
According to the case study of Mr. Peter Stanhope suffered from a chest pain at the central
area of his chest because of which he was admitted in the emergency department of the hospital.
After getting admitted to emergency department a systematic approach was taken in order to
assess his chest pain. He was an overweight man of 105 Kg of weight. When medical history of
peter was assessed then it was observed that he was suffering from Gastro oesophageal reflux
disease (GORD) and hypercholesterolemia and because of which he was on medications and was
taking Ranitidine and Lipitor medicines for his medical problems. This medical problem and his
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weight clearly explained that he was an overweight person with high cholesterol problem. Not
only this he also had a family medical history of hypertension (Sweeney and et al., 2020). On
analysing detailed history of his social life and any kind of addictions then it was observed that
he was a chain tobacco smoker who used to smoke 15/day and was smoking from past 10 years.
He was also a social drinker who used to drink approximately 6-8 standard drinks per week.
After all of these assessments he was admitted to Cardiology Observation Unit so that
appropriate care can be provided to Peter. After getting admitting to cardiology observation
department it was observed that he had difficulty in breathing and was experiencing extreme
shortness of breath. He was looking quite pale and he had continuously held his left- hand palm
on his chest and was showing facial grimacing (Tyrer and et al., 2017). In order to further
understand his condition and appropriate reason behind his chest pain his chest X- ray was done,
blood test was done and ECG test was conducted. From the results it was observed that his chest
X- ray was quite normal but his ECG reports was not normal. This ECG report clearly explained
that there was a needs and requirement to treat peter and provide appropriate treatment to him.
These test results and appropriate information helped in understanding and analysing his chest
pain and ways in which it can be treated. Interventions that are required to be focused on can also
be understood.
PART 2
Development of plan of care
Nursing care plan is a kind of plan that helps nurses to understand ways in which
treatment to a patient for their current condition. In order to develop an effective care plan for
Mr. Peter Stanhope cheat pain treatment it is important to develop patient centred goals that are
required to be focused on (Wechkunanukul, Grantham and Clark, 2017). Then in order to
achieve those goals interventions will be developed so that those can be achieved. Then after
development of goals and interventions Ways in which goals or outcomes can be measured is
determined. This helps in development of an appropriate and accurate care plan for Peter for his
chest pain.
Development of short- term and long- term patient centred goals
Here are few short- term and long- term goals that are required to be achieved in order to
provide excellent care to Mr. Peter. Some of the major patient centred goals that are required to
be achieved are as follows. Short- term goals will help in bringing improvement within overall
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chest pain condition of Mr. Peter till the time he is under observation of 2 days. Whereas long-
term goals will help in providing a support or maintaining physical and psychosocial health of
the patient.
Short- term patient centred goals are as follows:
To reduce chest pain scaling rating to less than three on the scale of 0 to 10 within a time
period of 3 days.
To maintain as well as normalize Sinus Rhythm during 2 days of hospitalization time period.
To provide medications in order to bring ECG back to normal and reduce central chest pain.
Long- term of rehabilitation patient centred goals are as follows:
To bring improvement within physical health of the patient within a duration of 3 to 6
months of time period.
To maintain as well as improve psychological and emotional health of the patient and also
help the patient so that he can reduce his addition for tobacco smoking and alcohol
simultaneously.
Interventions to achieve the required goals
There are various kinds of multi- disciplinary interventions that can help the health care
professionals to achieve their desired short- term and long- term patient centred goals in a much
better manner. It has been observed that multi- disciplinary interventions not only help in
bringing improvement within patient current condition but is also helps in bringing improvement
within overall quality of life (Mulder and et al., 2019). Some of the interventions that would help
nurses to bring improvement within Mr. Peter Stanhope’s central chest pain are as follows:
Nurse will be monitoring overall condition of Mr. Peter’s chest pain condition in every 6
hours and will also be monitoring condition of the patient every hour. This will help nurses to
focus on reduction of central chest pain suffered by the patient.
Nurses and health care professionals will also focus on educating the patient so that they can
report any kind of changes within their condition i.e. if there is increase in chest pain or chest
discomfort then he should immediately report it to the health care professionals or the nurses.
Medications of the patients will also be checked and reviewed in every 6 hours in order to
understand whether there is any kind of relief in his chest pain or not. This will help in
reducing scalability of the patient’s chest pain.
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Patient can also be given nutritional education so that he can bring changes within his diet
and physical lifestyle. Providing diet will help the patient to reduce his cholesterol level.
Other than this, educating about physical health will help nurses to generate awareness
among the patient so that he can reduce his smoking and drinking addiction. This will help in
bringing improvement within physical health of the patient.
Patient can be refereed to a psychotherapist who will help the patient to reduce his drinking
and smoking addition and will also help him to bring changes within his life style.
Psychotherapist will help the patient to focus on good things, on their future self, and reduce
attraction for negative things such as smoking, alcohol drinking. This psychological
intervention will help in achieving long term patient centred goal of bringing improvement
within overall psychological health of the patient.
Ways in which goals or outcomes can be measured
It is extremely important to measure outcomes of all kinds of interventions or treatment
that are being provided to the patient. Measurement of these goals or outcomes helps the nurses
or healthcare professionals to understand the extent till which health issues suffered by the
patient has been cured (Gay and Olympia, 2018). There are various ways that can help the nurses
to monitor or measure overall achievement of the goals and outcome of the interventions. Some
of the most common Ways in which goals or outcomes can be measured are as follows:
In every 6 hours review from the patient upon his current pain will also be taken so that
current medicines effect can be analysed. Not only this his ECG and blood test will be
repeated in every 6 hours. Results of the ECG and blood test will help the nurses or heath
care professionals to analyse and measure improvement within overall condition of Mr.
perter and also check whether ECG of the patient has been improved or not. All the ECG
reading of the patient will also be compared in order to analyse whether it has been improved
or not.
Regular blood pressure and pulse rate of the patient would also be measured. This would help
the health care professionals and nurses to check whether the overall condition of the patient
is being improvement. Measurement of pulse rate will also provide an indication to the
nurses and doctors that whether their heart is beating in a regular manner or not.
Rationale for each intervention to be implemented
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Patient’s current condition monitoring: it is important to monitor current condition of chest pain
health issue patient within a fixed and continuous time interval. This monitoring of patient’s
condition helps the nurses to understand what is the current condition of the patient. Whether the
medicines are being effective and bringing improvement within reduction of chest pain or not
( Roche, Gardner and Jack, 2017). Not only this it is also important to monitor because if all of a
sudden chest pain of the patient increases or there is any kind of complication within patient’s
health issue then it can be easily tacked and maintained.
Medications: Medicines are extremely important in order to reduce chest pain of the patient. It
helps in bringing improvement within the overall condition of the patient by reducing pain in the
central chest and providing relief to the patient.
ECG and blood test: repeat teat of ECG and blood test helps in identifying whether overall
condition of the patient is being improved or not. It also helps in identifying whether there is a
need and requirement to bring changes within the intervention like medicines for overall
improvement or not.
Education: It is another important intervention which is required to be focused on. It is important
to provide education to the patient about their medical conditions, ways in which they can help
the nurses or health care professions in improving their condition ( Roche, Gardner and Jack,
2017). This also helps the nurses to make their patients understand, what kind of changes or
issues felt by the patients then they should report to the nurses.
Referral to a psychologist: In this case psychologist plays a vital role as they will help the patient
to reduce his addiction of smoking and drinking so that his overall quality of life can be
improved. Which will further help him in bringing improvement within his high cholesterol
condition.
Changes within diet or physical lifestyle: Diet or physical lifestyle has always been an important
intervention that can help a patient to enhance their overall health. Bringing changes within diet
and physical lifestyle helps the patient to improve his heart condition, reduce future chances of
chest pain and also helps in bringing improvement within current health condition.
Implementation of these interventions are important as these interventions helps in
enhancing overall health condition of the patient as well as also helps in enhancing overall
effectivity of the treatment which is being provided to the patient.
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CONCLUSION
From the above assignment it has been summarized that there are various causes such as
family medical history, current medical history, social lifestyle and many more that contributes
in health issue which is being faced or suffered by the patients. It has been analysed that before
providing any kind of treatment to the patient is important to apply a systematic approach
towards the heath issue which is being faced by the patient so that in depth analysis of that issue
can be done. This assessment helps in development of care plan for the patient with both long-
term and short- term goals that are required to be achieved. Not only this it has also been
analysed that correct assessment of health issue helps in providing correct and appropriate
interventions to the patient.
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REREFENCES
Books and Journals
Frisch, S.O., and et al., 2019. Using Predictive Machine Learning Modeling for the Nursing
Triage of Acute Chest Pain at the Emergency Department. Circulation, 140(Suppl_1),
pp.A14879-A14879.
Gay, T. and Olympia, R.P., 2018. Distress in My Chest: The Approach to a Student Presenting
With “Chest Pain”. NASN School Nurse. 33(6). pp.366-371.
McLachlan, A., and et al., 2019. The development and rst six years of a nurse-led chest pain
clinic.
Mulder, R., and et al., 2019. An RCT of brief cognitive therapy versus treatment as usual in
patients with non-cardiac chest pain. International journal of cardiology. 289. pp.6-11.
Roche, T.E., Gardner, G. and Jack, L., 2017. The effectiveness of emergency nurse practitioner
service in the management of patients presenting to rural hospitals with chest pain: a
multisite prospective longitudinal nested cohort study. BMC health services
research. 17(1). p.445.
Sweeney, M., and et al., 2020. The impact of an acute chest pain pathway on the investigation
and management of cardiac chest pain. Future Healthcare Journal. 7(1). p.53.
Tyrer, P., and et al., 2017. Clinical and cost-effectiveness of adapted cognitive behaviour therapy
for non-cardiac chest pain: a multicentre, randomised controlled trial. Open heart. 4(1).
p.e000582.
Webster, R., and et al., 2017. The acceptability and feasibility of an anxiety reduction
intervention for emergency department patients with non-cardiac chest
pain. Psychology, health & medicine. 22(1). pp.1-11.
Wechkunanukul, K., Grantham, H. and Clark, R.A., 2017. Global review of delay time in
seeking medical care for chest pain: An integrative literature review. Australian Critical
Care. 30(1). pp.13-20.
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