HS2006 Acute Care Management: A Detailed Case Study of Rob's Condition

This case study details the acute care management of a 17-year-old patient, Rob, presenting with chest pain suspected to be induced by cocaine use. The case begins with an overview of Rob's condition, including his history of smoking and alcohol use, followed by a thorough A-E assessment covering airway, breathing, circulation, disability, and exposure. The assessment reveals bradypnea, hypertension, and irregular heartbeat, prompting continuous ECG monitoring and further investigation into potential cardiac issues. The study also discusses the pathophysiology of cocaine-induced chest pain and emphasizes the importance of stabilizing vital signs and monitoring the patient for potential arrhythmias. The goal of the A-E assessment is to guide the care plan, including medication and further diagnostic tests like ECHO, to ensure Rob's health improvement. The case highlights the critical role of nurses and medical experts in providing effective care and monitoring for improved long-term recovery.

HS2006 Acute Care Management
HS2006 ACUTE CARE MANAGEMENT
INTRODUCTION
In this project, I will be writing a care study to discuss the recognised assessment tool that will identify my patient’s condition
regarding acute care management. I will be examining my patient, who had intermittent chest pain due to consumption of cocaine. I
will include the critical care, NEWS and the A to E assessment performed on the patient. The NMC code (2015) explains the
importance of always keeping individuals’ privacy rights. The study will shed in - depth light on extended patient condition, nursing
management goals and significant working scenarios for improved healthcare condition.
A pseudonym will replace the participant’s name to maintain confidentiality. The name Rob will be used instead. Firstly, it will be
discussing their care plan whilst using the A-E assessment tool that has been taught to use when working with any patient. Rob
was experiencing acute respiratory difficulties and hypertension, needing immediate care.
PATIENT OVERVIEW
Rob is a 17-year-old boy experiencing frequent and rapid chest pains; therefore, he was brought to the emergency department.
Upon admission, Rob was bradypnoeic (12 breaths/min) and reported difficulty breathing. He was immediately admitted to the

HS2006 Acute Care Management
paediatric ward, and his A-E was performed. Rob had been highlighted as a smoker before his arrival, smoking an estimate of 10
cigarettes a day, and he was a regular user of alcohol as well.
During his initial assessment, Rob was accompanied by his mother to support him.
The following observations were made:
Rob self - ventilating in room air; temperature: apyrexial (36.3°C); BP was hypertensive (126/85mmHg) which according to Freitag
and Vasan, (2003) does not fall within the standard parameter for his age. Hence the patient was questioned about his normal
range of BP, to which he responded by agreeing that it is higher than his usual. Furthermore, his skin had a pink colour in
appearance and was well perfused peripherally and centrally.
Being overweight may be the cause of chest pain and high BP (Vasan and et.al., 2022). Fatty deposits which build up in the
arteries that supply blood to the heart. As a result of this, the arteries are narrowed and the blood flow to the hart is reduced. This
causes chest pain. Being overweight may also be the reason behind High BP in Rob’s case. When a person is overweight, the
heart has to work harder so that the blood is pumped throughout the body. This puts strain on the arteries thus raising the blood
pressure.
The main concern of the patient assessment is mainly because of Rob’s heartbeat, which is unstable due to the suspected use of
cocaine, affecting his heartbeat and blood pressure. Therefore, continuous ECG checks were performed along with frequent
observations, and continuous cardiac monitoring. Also as per the history of patient it was made assumed that the Rob has a
suspected use of cocaine and as a result he had suffered from severe chest pain.
Rob further explained how he has episodes of chest pains that burn in the centre and left side, which radiates upwards. This occurs
several times a day and lasts up to 1-2 hours per occasion. He has a reduced appetite, is sweaty while having episodes of pains

HS2006 Acute Care Management
and feels tightness across the chest; Rob described this as “his heart feeling weird”, and he thought as “his heart may be speeding
up”. This is a concern as he may be at the risk of deteriorating.
As per Huangand et.al., (2020) patient needs to be given effective care by nurses and medical experts, and further be
prescribed medical care and standards for improved longer term healthy recovery. Therefore, the performance of A-E assessment
has been implemented to ensure these are met.
A-E Assessment:
The A-E assessment is a critical assessment to achieve improvement in the patient by determining the severity of the patient’s
condition and to see if they need to start any further treatment (Toki and Ono, 2020). This assessment consists of the airway,
breathing, circulation, disability, and exposure. This is a nursing technique utilised when you are reviewing a patient, whether you
are administering medication, performing observations, or even introducing yourself to the patient.
The patient’s results were:
 Airway- The aim of the airway assessment is to ensure that the anatomical function is achieved if the airway is blocked or
obstructed which is to be identified though nose, mouth, and bronchi (Cathala and costa, 2019). When Rob was suffering
from chest pain and became Bradypnoeic, it clearly shows that the airway was obstructed. This will enable to get breathing
assessment done by best medical experts and doctors, nurses for further extended timely nursing care being given
(Bergersen, Brooke Stevens-Green and Rosellini, 2022.) noted that Angina is a type of chest pain which usually occurs
when there is an obstruction in the flow of blood towards the heart This is a potential diagnosis and may be the cause of
shortness of breath. The pain feels like tightness or pressure in the chest which further spreads around the body. This is a
major reason that would be counted for the Bradypnea

HS2006 Acute Care Management
Complementary, As Rob has smoking habit and he smoke 10 cigarettes a day, it may directly impact towards the respiratory
system and can cause the breathing issue. This is because, the substances of the smoke get deposited on the lung tissue
which further reduces the capacity of lung to diffuse oxygen (Makhmudova, 2022.)In the same way, due to excessive smoking
the user will develop the risk of developing bacterial pneumonia and other lung infection which may have a direct impact on the
breathing of the patient i.e. Rob. This shows that with the habit of smoking and blocking of lungs, the Airway would be affected
(Anzalone and et.al., 2019).
Breathing-.
RCUK (2016) recommend the; look, listen and feel approach which is one of the important aspects which provides a
comprehensive assessment of breathing. Rob displayed some signs of increased effort in breathing and respiratory distress. This
can be observed from the movement of his chest wall which moved in, instead of moving out.
Additionally, Rob remained displaying bradypnoea under which its breathing slowed down to12 breaths per minute. Also
while undertaking the breathing assignment, a smell was found which showed that the Rob may have consumed alcohol. The
symptoms remain as initial assessment.
Also, CRT < 2 seconds, which, according to Fleming, S. et al. (2016) a safe CRT test should not be used to rule out serious
illness in children. Inversely, a prolonged CRT may be considered borderline abnormal as it indicates risk of shock. Thus,
continuous monitoriosation proceeded by applying cutaneous pressure to the fingertip for 5 seconds. (Jevon, P., Gallier, H., 2020)
Circulation- Robs skin was pink toned, well-perfused, and warm to touch. Upon auscultation Rob’s heart beat felt irregular which
according to is defined as arrhythmia (Darmawahyun and et.al, 2022).. The Heart rhythm problem arise when the electrical signal

HS2006 Acute Care Management
which make coordination in heart beat would not work properly. The main symptoms of arrhythmia are beating of heart to be too
fast or too slow or irregular. Symptoms also include chest pain, fainting, dizziness, fluttering in chest. Chest pain is also counted as
one of its symptoms which would further lead to irregularity in pulse count. All these correspond to Rob’s current symptoms.
Due to the circulation assessment, collectively with the nurse, SN decided to perform an ECG, which is monitored because it
records the electrical signals of heartbeat, and any cardiac disturbance can also be identified.
Disability- This assessment focus on the main causes of reduced consciousness. AVPU has been used to identify the level of
consciousness The AVPU scale (an acronym from "alert, verbal, pain, unresponsive") is a system by which health
care professional can measure and record a patient's level of consciousness. Usage of drug may result in
confusion and unconsciousness. This makes the AVPU assessment extremely important at this stage (Smith et
al, 2017). Also patient was suffering from hypertension where this lowered responsive attitude towards patient
ideal response, it has been also ideally analysed that patient has to be further taken specific care regarding
medical conditions.
The patients ACVPU status would have to be assessed, standing for alert, confusion, response to voice, painful stimuli and
unconscious. The Glasgow Coma Scale is used for analysing consciousness within patient, where eye opening
and verbal responses can be analysed. As patient has been under cocaine addiction, GCS was used as it
enabled to analyse the papillary changes being experienced in patient. The CGS score is 4, where patient was
experiencing less consciousness within physical abilities and was not showing responses due to chest pain,
hypertension. The patient had pain. The patient was also suffering from nausea and vomiting. The drugs have
an adverse effect on gastrointestinal and central nervous system which results in stimulation of pathways and

HS2006 Acute Care Management
thus nausea and vomiting. As response of CGS score is 4,the patient medical condition specifies that patient
need specific care for improvising hypertension and recover.
Patient was non responsive, and ideally not able to respond properly which shows that respiration was not proper. Pulmonary
changes were seen in body, as patient was experiencing extreme weakness and low efficiency in breathing levels (Misirlioglu, and
et.al,., 2021)..
The PEWS score of the patient was calculated. The CRT indicated a low risk PEWS Score while heart rate and respioratory rate
showed a high risk PEWS score.
Exposure - This assessment assesses the patient for any skin rashes, wounds, pressure injury (NHS improvement, 2018), signs of
infection and bruises. In case of Rob with respect to exposure, he got rashes. Afebrile. 36.3°C. As he had taken drugs, we
inspected the patient’s skin for evidence of any rashes. It is important to inspect skin when the drugs have been taken as these
have been known to cause allergic reactions in some young people (Monfre, Batchelor and Skar, 2022). Fluids is essential where
because of lack of hydration, due to lack of drugs and alcohol has been significantly growing (Labrague, 2021).
.
 G – Goal is to stabilize vital signs for improvement of patient health condition.
This shows that the giving drug as per the patient need does not only limit up to its dose but its impact towards the
patient body is also monitored with the help of making an analysis using ECG, BP and other diagnostic method. With the
help of monitoring only the dose of Fondaparinux has stopped after its 3 rd dose. Also the 6Rs have been implemented in
order to make monitoring of Rob.
Goal:

HS2006 Acute Care Management
The goal of the A-E assessment is to make plan for Rob to monitor him on CCM as the differentials included acute
coronary syndrome. He had daily troponins and ECGs while Aspirin, Clopidogrel and Fondaparinux as medications. Rob
could not leave as he was at risk of arrhythmias. It was also suggested that ECHO should also be done to see the heart’s
rhythm and see how the blood moves through the heart.
SUMMARY:
In case of Rob who was facing the problem of shortness of breath, need an acute treatment under which the performance of
ECG is necessary but at the same time it can be noted that performing 12 Lead ECG are just irrelevant and not necessary.
PATHOPHYSIOLOGY
Pathophysiology theories are the studies that investigate the cause of disease and reaction to the body because of such conditions
(Harrison et al., 2021). As per the views of Kadom, Alvarado and Medina, (2018) Pathophysiology can be defied as physiology of
the abnormal state specifically the functional changes that is accompanied with a particular disease or the syndrome. This means it
is the coverage of pathology with physiology which include the study of disordered physiological process that are either associated
with a diseases or may lead to cause or result from such syndrome.
As cocaine is a fast-acting drug, the effects are pretty immediate and can be very dangerous; it has several effects on the
heart and blood vessels, including blood pressure, heart rhythm disturbance and inflammation of the heart muscle. Research that
has been shown by Zampi (2020) suggest that the rhythmical changes cocaine can make on ECG show the transient Brugada
pattern after recreational Cocaine use this is common in young cocaine abusers. Brugada syndrome is most frequently reported in
adolescents who do not have obvious heart problems. It is hard to isolate one standard ECG finding specific to cocaine use;
however, increased QRS voltage, common rhythm changes and conduction to disturbance is the most typical usage. With the

HS2006 Acute Care Management
consumption of cocaine, the human body is impacted especially the respiratory as well as nervous system. Usage of cocaine
causes stroke and heart disease as well as convulsions and seizures. This may also lead to affect the heart rate as it increases
along with increase in body temperature, blood pressure. It may also lead to cause severe chest pain. Overdoes of cocaine may
alter the chemistry f brain and reduces the reaction time.
NURSING MANAGEMENT
Nursing care to be given to hypertensive patient experiencing chest pain will be taken by managing chest
pain, providing adequate oxygen and also enhancing patient comfortableness. In the present case, the priority
within nursing management is to improve patient breathing and treat the side effects due to drugs. Also to
provide better psychological care, therapies to patient for improving psychological conditions towards improvised
functioning. Medication being given, for improvising BP levels and to create further specific patient recovery
where it has to be reduced. The airway, breathing, circulation, disability and exposure is effective model which
will enable to identify patient breathing issues and his respiratory levels.
For managing the BP, Ramipril and Lisinopril can be prescribed to the patient. Ramipril will help in lowering
the BP and prevent future heart problems. However, it has been found that Lisinopril has been found to be
associated with severe risks. According to Allemand and Flückiger (2022), Ramipril has comparatively less side
effects on younger patients. Hence, Rob will be prescribed Ramipril as it will be more suitable in his case.
Regular monitoring of BP will be done, where administering antihypertensive medications will be done by
providing oxygen when saturations are low will enable BP to lower down. nurses will be taking care that proper
body rest along with medication is taken care properly.

HS2006 Acute Care Management
Lifestyle changes will be next priority as these will focus not only on hypertension but also the overall
health of the patient in the chosen case. Hypertension management includes dietary interventions such as
reducing salt, increasing potassium and avoidance of alcohol, and managing diet control. Also light physical
exercises and stress management will be focused on by nurses for improving physical strength along with
mental stress reduction. Lifestyle change will also be needed for controlling the blood pressure.
As the patient has been found to be consuming drugs, it is another priority while undertaking nursing
management. The nurses will take care of patient by given him rehabilitation therapies and counselling. Nurses
will be giving cognitive behavioural therapy, where stages will be focused on making list, recording unproductive
thoughts being found in patient behaviour and creating replacement thoughts, noticing and replacing with proper
medication will be done. Within therapies patent counselling will be done, by properly harnessing significant care
to reduce hypertension and addiction from cocaine. The cognitive behavioural therapy, will be conducted to
improvise further improvement in care standards for patients and also ideally taking specific steps for improvising
patient condition.
The nurses care priority is to further provide best treatment to patient, improve his breathing levels and reduce
BP level by giving proper medication and therapies to improvise long term complications. There has to be further
changes in lifestyle developed, where nurses have to be specific regarding various new medicines to be give
and therapies for removing alcohol addiction. It can be analysed that further extended care, nursing
management was done by observing proper medication and including healthy diet. Lifestyle habits, and proper

HS2006 Acute Care Management
nutrition rich food has been taken care for patient effective care delivery and also nurses will be taking specific
care about medicines for improving patient physical recovery. Bed rest will be taken care for patient, as this will
enable proper recovery to be improved on further within longer time period.
Nurses management was effective, and care was given in timely manner by utilising best care strategies,
keeping check on responses and his recovery period which vitally enabled to get significant improvement being
seen in his overall health. It has been also analysed that better medical care, nursing specific care being given
enabled to vitally take care of further improvement goals for extended timely betterment. Also fluid balance was
taken care, so that hydration is maintained and further improved care vitally develop best expertise for effective
recovery. Also patient care was given further care by primitively providing best food, medical standards and
monitoring prior focus on health conditions based on specific key competencies.
Reflection of Professional Experience
During this experience, my main learning point was how cocaine could deteriorate and affect blood pressure and heart rate. The
reason behind use of A to E assessment, the benefits and importance of it—also, written up easily for any handovers, as it explains
all the importance the next nurse would need to know for their shift. I am confident with using the ECG, as I am not familiar and
could identify a normal cardiac rhythm and an abnormal rhythm. This will inform my future nursing practice as I am more aware of
the heart and the effects drugs could have on it, how each factor can go from being stable within the age range to not, and the
causes of why it is like that. I also checked the NEWS chart to see if my patient's observations were within the expected parameter.

HS2006 Acute Care Management
This experience allowed me to improve my assessment skills as I can now care for a patient from admission to discharge and
during the recovery process. My nursing skills were improved slowly, as I was able to conduct effective timely assessment for
improvising patient health condition diversely (Ribeiro, 2021).
I could efficiently interact with the patients by using the knowledge that I developed from the Acute Care Module as I was aware of
the pathophysiology of conditions such as side effects of drugs, high blood pressure and chest pain. (City, University of London,
2021) I was also aware of best nursing care, which has to be given to patient and ideally analyse specific conditions within medical
aspects for optimising faster recovery. I was not efficient at checking BP levels and heartbeat of patient where this hampered my
performance. I further aim to improvise my medical nursing knowledge and diversify specific aspects regarding timely improvement
of patient condition.
I was able to be an effective listener and provide advice as well as support to the patient. By listening to the patient’s concerns I
was also able to provide emotional and moral support when needed to the patient as well as his mother. Through this I could build
the relationship of trust with the patient. This proved to be highly beneficial during the process of recovery. This is because, as the
patient trusted me, he was cooperative and followed the instructions. I now aim to learn new nursing principles, assess medical
professional knowledge productively and gain expertise from my senior doctors.
During care delivery to this patient, I ensured to follow NMC principles. For example, I was able to identify all the needs of the
patient and prioritize them and provide care accordingly. I also learnt and worked efficiently with the multi - disciplinary team such
as therapists, heart specialist, rehabilitation experts, counsellors and nutritionist. This helped me a lot in developing communication
skills.

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CONCLUSION
To conclude, the care that Rob received was adequate. Throughout the remainder of his stay, he continued with daily ECG and
was on continuous cardiac monitoring (Healthline, 2020). He got daily troponin. However, doctors reduced it as he did not need
such a hefty dose. His MRI was not done as a covid patient had used it. Therefore,it was not in use for a while. He was asked to
transfer to a cardiology ward that he got moved over to once the bed was accessible for him. Hehad mild tachycardia, which he
needed his outstanding blood done as part of the myocarditis screen. Lastly, he is continuing with aspirin and clopidogrel. Ensuring
that the nursing care was done correctly and escalating concerns were appropriate allowed us to confirm that he received the best
quality of care. Making sure communication between the MDT was done correctly allowed Rob to receive adequate care.

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