Plans of Care for Chung: Urgent Risk Area, Mental Health Concern, Legal/Ethical/Professional Issues

This case study outlines plans of care for Chung, a patient with chest pain and suicidal ideation. The first priority is to identify the possibility of myocardial infarction, followed by management of the mental health concerns. Legal and ethical issues related to confidentiality and coercion are also considered. Nursing interventions and rationales are provided throughout.

2.4.2 Case Study: Plans of Care
1a).Urgent Risk area.
The first priority in dealing with Chung’s case is to identify the possibility of myocardial
infarction. Chest pain is treated as an emergency concern (Roche, Gardner & Jack, 2017).This
would be a cardiac evaluation precaution to allow early risk stratification of myocardial
infarction following the vital signs of chest pain accurately (Ayerbe, González, Gallo, Coleman,
Wragg, & Robson, 2016)).Identification of the urgent area is important owing that cardiac arrest
is a life threatening condition hence requires urgent interventions (Steadman, 2010)
1b).Nursing Intervention and Rationale
Following the warning signs on possible cardiac arrest, I would immediately asses for the
characteristics of chest pain (PQRST) (Burman, Zakariassen, & Hunskaar, 2014), respiration and
heart rate with each episode of chest pain. Causes of chest pain are many .An increase in chest
pain happens as the body compensate to pain, which can lead to other serious complications
Barnett, Prior, Kadam, & Jordan, 2017). I would obtain full description about the client’s
medical history and details about the location, duration, and intensity of his symptoms and assist
the client to quantify pain by comparing it to other experiences.
The rationale of this intervention is that pain is a subjective experience and must be described by
the client. It provides baselines for comparison to help in determining effectiveness of therapy,
resolution and progression of problem (Wilcox et al.,2015).I would also put into practice the
consideration that some chest pain are non-cardiac (Campbell et al.,2017).

2a).Mental health concern
The mental health concern in regards to the case client would be the possible harm to self. This is
due to the risk factors upon assessment. The client admits the thought of harming himself
(suicidal ideation) and would have higher access to means of carrying out the plan since the
client is a doctor by occupation (De Choudhury, Kiciman, Dredze, Coppersmith & Kumar,
2016). The other area of concern would be depression due to anxiety.
2b).Nursing intervention for the mental health concern and rationale
The risk of suicide or harm to self requires nurse intervention. Management of risks factors is a
major intervention I would use. This will aim to reduce the risk behaviors such as the
hopelessness, self-rejection and the suicidal ideation that influences the client to carry out the
plan. The client also should be given leave at work to minimize access higher means of carrying
out the suicidal plan (Tighe, Nicholas, Shand, & Christensen, 2018).
3).Legal. Ethical or professional issues of consideration
Working in mental health setting as a nurse present challenges dealing with legal and ethical
issues. In my client’s case deciding on whether to maintain the right to confidentiality versus
disclosure to enable intervention by mental health team present an ethical dilemma (Hiriscau,
Stingelin-Giles, Stadler ,Schmeck, Reiter-Theil,2014) Mental Health Act provision requires
detention for risk of suicide in order to reduce risk versus the clint’s right to consent
treatment(autonomy) options present legal issue (Weimand, Sällström, Hall-Lord, & Hedelin,
2013). Chung’s self determination to harm -self versus my responsibility to prevent no harm or
to ‘no harm’ poses an ethical consideration. (Attri et al.,2015). The decision whether to use
coercion in practice when there is risk or not will be shaped by professional code of conducts

shown in professional virtues of dignity, integrity and compassion (Nursing & Midwifery
Council ,2015).
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