Assignment on Carol Jones - Consider the patient situation

Scenario 1: Carol Jones
Consider the patient
situation
Carol Jones, 45 years old, is away on an interstate business trip and presented to a GP clinic on the outskirts of the Flinders
Ranges in South Australia. Her main concern is feeling breathless and nauseated. She also complains of occasional chest
pain which goes away when she rests. Her BP is 170/93 mmHg and she is mildly tachycardic. The GP on duty reassures her
and suggests she follow up with her regular GP upon her return home. However, as Carol is leaving the clinic she suddenly
experiences an episode of breathlessness. You, the Practice Nurse on duty, witness this and notice that Carol is pale. When
you check her pulse, it is 160 bpm and irregular.
Collect Cues: Review the existing documentation;
Social History
Carol Jones is a consultant engineer specialising in concrete structures for bridge construction. This requires her to travel
interstate frequently for long periods visiting construction sites. Carol has recently separated and has 5 children ranging from
6 to 18 years of age who reside with their father when Carol is away. Carol’s busy lifestyle precludes her from daily exercise
and much of her dietary intake when she is away is ‘on the run’ takeaway fast-food and alcohol – she states that she has ‘a
beer at lunch and a couple of glasses of wine in the evening to help me relax after a hectic day’. Carol is a non-smoker and
denies any use of recreational drugs.
Recall:
Before you continue with this assignment you should recall and apply your existing knowledge to the above situation to ensure
you have a broad understanding of what is/may be occurring.
Process information Interpret:
In the following table, list the data that you consider to be normal/abnormal (not included in word count)
Normal (Subjective & Objective Data) Abnormal (Subjective & Objective)
Objective Objective
Breathlessness
Nausea

Scenario 1: Carol Jones
Subjective Mild tachycardia
Subjective
Blood Pressure 170/93 mm/Hg (Normal BP: 160/80 mm/Hg)
Pulse rate 160 beats per minute (Normal: 60-100 bpm)
Relate & Infer: (250 words)
 Relate: cluster cues by identifying relationships between them.
• Infer: make deductions as to why a cue, or a cluster of cues may be considered abnormal in this context. Justify by
referring to appropriate anatomy, physiology and pathophysiology.
Refer to Levett-Jones (2018) Clinical Reasoning p7.
•Based on your interpretation of all the information/cues presented, form and justify an overall opinion on what may
be happening
The patient is experiencing sudden episodes of breathlessness and feels nauseated most of the time. She complains of chest
pain, which goes away after she takes rest. According to a study conducted by Simon et al. (2013), episodes of sudden
breathlessness can be an indicator of chronic heart failure or chronic pulmonary disease. Sudden episodes of breathlessness
along with occasional chest pain that goes away while resting can indicate irregular or decreased blood flow in the coronary
arteries. Upon primary inspection of the vital signs, it has been observed that the patient’s blood pressure reading is 173/93
mm/Hg. The normal blood pressure of a human being of 45 years old should be around 120/80 mm/Hg (Currie et al. 2018). As
the systolic pressure of the patient is between 160-180 mm/Hg and diastolic pressure is slightly lower than 100 mm/Hg, it is
evident that the patient is having higher blood pressure, which highly elevated than the normal levels. The blood pressure of
173/93 mm/Hg is indicator of hypertension stage 2. Stage 2 hypertension is more severe form of hypertension, in which the
health care professionals might recommend lifestyle changes to the patient and prescribe medications to address the issue

Scenario 1: Carol Jones
(Yano et al. 2018).
Moreover, the patient has pulse rate of around 160 beats per minute and irregular, which is highly elevated than normal
maximum levels of 100 beats per minute while resting (Hart 2015). The patient is observed to be pale with mild tachycardia.
Analysing all the cues it can be inferred that the patient is suffering from acute coronary syndrome and requires immediate
medical attention.
Predict: (100 words)
Explain what may happen to your patient if no action is taken
Acute coronary syndrome is a life-threatening condition which can prove to be fatal if left untreated. In this condition, the blood
supply to the heart is not sufficient, leading to a condition called tachycardia (Sanchis-Gomar et al. 2016). Tachycardia is the
medical condition where the heart beats goes above 100 beats per minute to meet up the deficit in the heart caused by
interruptions in coronary arteries (Nursing Times 2017). If left untreated, acute coronary syndrome shows several
complications including arrhythmias (electrical dysfunction), mechanical dysfunctions such as heart failure, papillary muscle
dysfunction or myocardial rupture, thrombotic complications and inflammatory complications such as pericarditis (MSD
Manual Professional Edition 2019).
Identify the
Problem/s
List in order of priority at least two key nursing problems (not included in word count)
1. The patient is experiencing anxiety due to increased risk of myocardial infarction or coronary syndrome evident by
episodes of breathlessness, chest pain, and pale face.
2. The patient has increased cardiac output evidenced by hypertension stage 2, mild tachycardia, and chest pain.
Establish Goal &
Take Action
For your (ONE) highest priority nursing problem: (300 words)
 Establish one goal
 List the related FOUR (4) actions you would undertake to achieve that goal. Your actions should include ONE (1) skill
only from the following list; 1) 12 Lead ECG and interpretation, 2) Venipuncture and sample handling, 3) Oxygen
therapy, 4) Pulse oximetry.