Case Study Assessment

Case Study Assessment

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Case Study Assessment

Question 1

The case involves an adult woman aged 69 years old woman, who complains for severe sub sternal chest pain that radiates to the neck, jaw and left arm. She also seemed anxious and pale. The primary survey involved checking on operation of various body components of the patient. This includes airway, breathing, circulation, disability, and glucose. According to the survey, the patient airway is clear. There were no signs of noisy breathing or obstruction. The results rule out the possibility for respiratory related problems. The patient’s breathing is at RR 28 breaths/min, while the normal adult respiratory rate is recorded form 16 to 20 breaths/min. The patient also had labored breathing which indicates struggle while breathing. The patients’ oxygen saturation is at 92% while the normal oxygen saturation for an adult is 95% and above (Chabek, 2016). The patient also produces bilateral basal crackles and crepitations, which is regarded as a sign of deteriorating heart failure. The whole analysis demonstrates respiratory failure which needs immediate attention. The best nursing strategy is to supply the patient with more oxygen to increase the oxygen saturation in the body and to reduce the breathing problem. This will be done by supplying the patient with 6ml Hudson mask which will assist in supplying the required level of oxygen to the patient (Moser & Mann, 2002).

The circulation evaluation demonstrates that the patient has a heart rate of 120 bpm which considerably high when compared to normal adult heart rate which is supposed to range from 60 to 100 bpm. The patient blood pressure is at BP 90/50mmHg, which is considerably low compared to normal blood pressure for adults which is supposed to be 120/80 (systolic/diastolic) this shows that the patient still low blood pressure despite the high struggle that raises the heart rate. The patient Jugular Venous Pressure is elevated by 4cm, which is a sign of venous hypertension. The patient peripheral pulse rate shifts between rapid and faint which demonstrates uncontrollable change in the pumping system. The capillary were found to be refilled after 4 secs, with extremities that include mottled, clammy, and cool. This is a sign of peripheral vascular disease. She had a bilateral ankle oedema which is a sign of congested heart and hence a sign of heart failure, and 3rd heart sound which demonstrates heart failure. The patient temperature was at 37.5oC which is slightly above the normal temperatures of 37oC. The best nursing strategy to enhance blood circulation would include massage and exercising the limbs. However, the cause of the problem may not be easily resolved by the nursing strategies but advanced medical interventions. The other nursing strategy is connecting the patient to a cardiac monitor to keep track of the change in the heart rate.

The patient in disability survey demonstrated that she was restless and anxious, though she was oriented in place, time and person with Glasgow Coma Scale of 15/15 showing she was filly conscious. However, she demonstrated a pain scale of 5/15 which demonstrated that she was in considerable pain that could be the major cause of the anxiety. In this case, nurses needed to employ strategies to reduce pain by administering hem with pain killers based on the physicians’ directions.

Exposure demonstrated no bruising, fluids demonstrated that the patient had I.V inserted through there was no fluids in progress. This shows that the patient had received previous medication which the nurse need to know about to avoid over dosage. The glucose level was BGL 4.0 mmol/L which is within a normal range of 4.0 -7.8 mmol/L. Therefore there are no nursing strategies required on this aspect (Moser & Mann, 2002).

Question 2

The patient was diagnosed with acute anterior ST elevation myocardiac infarction (STEMI). This can be affirmed by the EGC analysis where the ST elevation is clearly seen as well as J points. ST-segment elevation myocardial infarction (STEMI) is a form of heart attack where in a coronary artery is blocked completely and the biggest part of the heart muscle is not able to receive blood. This condition is demonstrated by the primary analysis where high heart rate, high respiration rate, low oxygen supply, low blood pressure, changing pulmonary pulse, and bilateral ankle oedema. All these signs demonstrate serious signs of heart fail, where the heart cannot pump enough blood to address the needs of the body. This results to oxygen shortage in the body, low blood pulse and oedema among others. The presence pulmonary vascular congestion based on the X-ray results demonstrates the main reason for poor blood supply in different parts of the body (Mosern & Mann, 2002).

The second diagnosis is the onset of cardiogenic shock, this is demonstrated by transthoracic echocardiogram result that demonstrates hypokinetic left ventricular and septal wall. Cardiogenic shock refers to a condition where in the heart suddenly cannot pump adequate blood to address the needs of the body, a condition that is normally initiated by a severe heart attack. The patient also has high cardiac enzymes where by the level of high sensitivity troponin T is recorded at 88ng/l with the normal value being 0-14 ng/L. These enzymes are only found in high concentration to a patient who has hypertrophic cardiomyopathy. The patient also has 5 years history of hypertension which is a sign that some blood vessels in the heart were thinning or their diameters were decreasing as a result of increase in mass quantity of the vessels. The arterial blood gas analysis demonstrates deficiency in various gases which include the PaO2, HCO3, BE and excess of Lactate. This demonstrates a problem in blood air circulation in the body and hence poor heart functionality (Khalid & Dhakam, 2008).

Question 3

The first drug administered to the patient is aspirin. Aspirin is used to handle heart condition by decreasing inflammation which is a plaque build-up component that can easily cause heart attack. Aspirin blocks the cyclooxygenase enzymes action, reducing the production of prostaglandins, the chemicals which enhance the response of inflammation.BY inhibiting prostaglandins, aspirin assist in preventing any form of blood clot in the blood vessels and hence reducing the chances of death (Bermingham et al, 2014).

Aspirin in this case is focused at reducing angina or chest pain and also easing the heart muscles in their functionality can therefore be monitored by frequent check of the pain and also by the ECG system result. Improvement should be seen by the reduction of the patient pain and hence her level of anxiety and also by improvement of the patient’s heat pace.

Aspirin works well in handling heart related problems. However, aspirin also demonstrate a wide range of side effects that include rashes, itching, hives, chest tightness, breathing difficulties, confusion, drowsiness, vomiting, and severe stomach upset among others. In this regard, the nurses should monitor the patient for any abnormal changes particularly changes like chest tightness, breathing difficulties and other changes that are highly related to the patient current medical condition. The patient loss of consciousness will be another sign to show aspirin advanced effects (Bermingham et al, 2014).

References

Bermingham, M. et al. (2014). Aspirin use in heart failure: is low dose therapy associated with mortality and morbidity benefits in a large community population? Circ Heart Failure, 7, 237-238.

Chabek, E. (2016). Normal vital sign. Retrieved from < http://emedicine.medscape.com/article/2172054-overview>

Khalid, L., & Dhakam, S.H. (2008). A review of cardiogenic shock in acute myocardinal infarction. Current Cardiology Reviews, 4(1), 34-40.

Moser, D. K., & Mann, D. L. (2002). Improving outcomes in heart failure it’s not unusual beyond usual care. Circulation, 105, 2810-812