Pathophysiology

Mr Henry Wilson is a 54 year old bank manager who presents to the Emergency Department with a sudden onset of shortness of breath and left sided chest pain whilst watching the evening news. The pain has been constant for one (1) hr.

He has no relevant past history and he is taking no regular medications. He is 160 cm tall and weighs 95kg.

You are the Registered Nurse caring for Mr Wilson on arrival.

Mr Wilson states he has left sided chest pain. The pain is not exacerbated by deep breathing, coughing or movement. He is diaphoretic and has a pain score: 8/10. His vital signs are Temp: 37.2, HR: 84, BP: 150/90 mmHg, RR: 18, SaO2: 95% in RA. Glasgow Coma Score (GCS): 15. He is treated in the Emergency Department and a 12 lead ECG is done (results below).

The medical officer has inserted an IV cannula.

The medical officer orders the following to be commenced immediately and then re-review.

Oxygen Therapy

Blood pathology to be collected, including FBC, EUC, LFT, BSL and cardiac markers.

Medications: Morphine 2.5 mg IVI for pain

Aspirin 300mg stat

Clopedigrol 600mg

Anginine

X-Ray: Mobile chest.

The results of Mr Wilsons cardiac markers have been processed by pathology and are as listed below:

CK-MB: 1.0mcg/L

Troponin I: 2.0mcg/L

Assessment Task:

As a guide in no more than 1000 words (using your criteria sheet), apply the ABCDE framework and critically analyse the clinical indicators in the case study and their significance. In particular, apply your knowledge in interpreting the attached 12 lead ECG to determine care priorities for Mr Wilson. Then identify and discuss the most important nursing interventions (at least two priority interventions) relevant to Mr Wilsons needs and the rationales for these as you assess him. Your paper should demonstrate an understanding of the pathophysiology and treatment ordered by the medical officer (i.e oxygen, ECG, medical tests, medications) and your nursing responsibilities associated with this treatment. Discuss 2 of the 4 medications identified. Please remember to write this paper in a formal/analytical style.

 

 

 

Short Answer Test (SAT)

Marking criteria and standards: Assessment 3 – Short Answer Test (SAT) by use of ABCDE components protocol

A-Airway: Is the airway complete or partially patent?

Assessment– The patient responds with a patent voice. This indicates that there is a partial obstruction in the airway. The patient voice has changed to a noisy breathing with an increased effort in breathing. There are also sighs of reduced levels of consciousness characterised by snoring.

Intervention: use a head-tilt and chin-lift manoeuvre in order to help open the patient’s airway. Airway suctions by use of proper equipments is recommended.

Pathophysiology:  studies of multiple individual airways during either contraction to closure or relaxation in real time, is an important study in airway as well as changes in airway size with changes in lung volume. It is notable that obstruction in the airway that are no treated can rapidly lead to cardiac arrest (Corkin, et al. 2012).

B – Breathing: Is the breathing adequate?

Assessment: In all settings, it is possible to decide on the respiratory rate, thoracic wall movements inspection of the symmetry and use of auxiliary respiratory muscles, needs to be conducted. Pressing the chest is crucial on independent dullness or resonance determination. Cyanosis, swollen neck veins, and lateralization of the trachea can be recognized.

Intervention: Conduct lung auscultation by use of a stethoscope through the application of an ox meter pulse .It there no sufficient breathing it is advisable to perform assisted ventilation by giving rescue breaths. A bag mask can also be used.

C-Circulation: is the circulation adequate?

Assessment: there is change in color, sweating, as well as reduced consciousness level indicating signs of decreased perfusion.

Intervention: Approaching the problems indicated by performing a heart auscultation. Monitoring of the blood pressure as well as measurements (Corkin, et al. 2012). The patient should be place in a supine position and uplifting the patient’s legs. After that intravenous results should be collected as soon as possible and infusion of saline.

Mr Henry Wilson is a 54 year old bank manager who presents to the Emergency Department with a sudden onset of shortness of breath and left sided chest pain whilst watching the evening news. The pain has been constant for one (1) hr.

He has no relevant past history and he is taking no regular medications. He is 160 cm tall and weighs 95kg.

You are the Registered Nurse caring for Mr Wilson on arrival.

Mr Wilson states he has left sided chest pain. The pain is not exacerbated by deep breathing, coughing or movement. He is diaphoretic and has a pain score: 8/10. His vital signs are Temp: 37.2, HR: 84, BP: 150/90 mmHg, RR: 18, SaO2: 95% in RA. Glasgow Coma Score (GCS): 15. He is treated in the Emergency Department and a 12 lead ECG is done (results below).

The medical officer has inserted an IV cannula.

The medical officer orders the following to be commenced immediately and then re-review.

Oxygen Therapy

Blood pathology to be collected, including FBC, EUC, LFT, BSL and cardiac markers.

Medications: Morphine 2.5 mg IVI for pain

Aspirin 300mg stat

Clopedigrol 600mg

Anginine

X-Ray: Mobile chest.

The results of Mr Wilsons cardiac markers have been processed by pathology and are as listed below:

CK-MB: 1.0mcg/L

Troponin I: 2.0mcg/L

Assessment Task:

As a guide in no more than 1000 words (using your criteria sheet), apply the ABCDE framework and critically analyse the clinical indicators in the case study and their significance. In particular, apply your knowledge in interpreting the attached 12 lead ECG to determine care priorities for Mr Wilson. Then identify and discuss the most important nursing interventions (at least two priority interventions) relevant to Mr Wilsons needs and the rationales for these as you assess him. Your paper should demonstrate an understanding of the pathophysiology and treatment ordered by the medical officer (i.e oxygen, ECG, medical tests, medications) and your nursing responsibilities associated with this treatment. Discuss 2 of the 4 medications identified. Please remember to write this paper in a formal/analytical style.

 

 

 

Short Answer Test (SAT)

Marking criteria and standards: Assessment 3 – Short Answer Test (SAT) by use of ABCDE components protocol

A-Airway: Is the airway complete or partially patent?

Assessment– The patient responds with a patent voice. This indicates that there is a partial obstruction in the airway. The patient voice has changed to a noisy breathing with an increased effort in breathing. There are also sighs of reduced levels of consciousness characterised by snoring.

Intervention: use a head-tilt and chin-lift manoeuvre in order to help open the patient’s airway. Airway suctions by use of proper equipments is recommended.

Pathophysiology:  studies of multiple individual airways during either contraction to closure or relaxation in real time, is an important study in airway as well as changes in airway size with changes in lung volume. It is notable that obstruction in the airway that are no treated can rapidly lead to cardiac arrest (Corkin, et al. 2012).

B – Breathing: Is the breathing adequate?

Assessment: In all settings, it is possible to decide on the respiratory rate, thoracic wall movements inspection of the symmetry and use of auxiliary respiratory muscles, needs to be conducted. Pressing the chest is crucial on independent dullness or resonance determination. Cyanosis, swollen neck veins, and lateralization of the trachea can be recognized.

Intervention: Conduct lung auscultation by use of a stethoscope through the application of an ox meter pulse .It there no sufficient breathing it is advisable to perform assisted ventilation by giving rescue breaths. A bag mask can also be used.

C-Circulation: is the circulation adequate?

Assessment: there is change in color, sweating, as well as reduced consciousness level indicating signs of decreased perfusion.

Intervention: Approaching the problems indicated by performing a heart auscultation. Monitoring of the blood pressure as well as measurements (Corkin, et al. 2012). The patient should be place in a supine position and uplifting the patient’s legs. After that intravenous results should be collected as soon as possible and infusion of saline.

Pathophysiology: A critical study of the capillary refill time and pulse velocity is important in order to define more on breathing disorders. It can be done in any setting. On the other hand inspection of the patient’s skin gives clues on circulatory problems.

D-Disability what is the strength of consciousness?

Assessment: A rapid assessment of the blood is important to determine the level of the patient’s consciousness. It can be done through the use of AVPU method. In this case the patient gets grades on alertness, responsiveness of the voice, pain responsive and general unresponsive in all the three areas.

Intervention: On the other hand, the Glasgow Coma Score can be used. An inspection on the Limb actions is important in order to estimate possible signs of lateralization. There should be efforts to stabilize the cerebral conditions of the airway which is an immediate treatment for patients (Corkin, et al. 2012).

Pathophysiology: In particular, a study to determine when the patient is only pain responsive or unresponsive, and on airway patency needs to be done. Some the recommended ways to determine it so far includes placing the patient in the revival position, where personnel qualified are able to secure the airway. Evaluation of Papillary light reflexes and blood glucose level is also an important area to put focus on.A way to control a decrease in the consciousness A caused by low blood glucose can be outlined. The two ways includes oral or glucose (Corkin, et al. 2012).

E-Examination: any clues to explain the patient’s condition?

Assessment; There are signsof trauma, bleeding, rashes on the skin reactions, needle marks, etc, which must be observed, must be observed.

Intervention: Bearing the patient dignity in mind, clothes should be removed to give room to a thorough physical examination. Body temperature estimation can be done by feeling the skin or using a thermometer.

In conclusion the 12 lead ECG provided in the case study is a graphic representation of the electric activates of the heart on a two plane platform of Mr. Henry. The QT interval in the ECG measurements is done from the beginning of the QRS which is located at the end of the T wave. This is usually inversely related to heart rate. The patients age and sex is highly influence its outcome (Corkin, et al. 2012).The QTC is an implication of the QT that has been corrected for heartbeat. In the case of the ECG provided Qt intervals represents the heart beats ,they might also prolong end  if it exceeds 1 and half of the R-R intervals in the heart beat rates that ranges from 60 to 100 beats in one minute. There are no signs of a prolonged QT interval in this case because the patient has not been using any kind of drug. Once there is shortened QT interval it is an indication that Mr. Henry may be related to presence of hypocalcaemia or thyrotoxicosis (Corkin, et al. 2012).

References

.

Corkin, D., Clarke, S., & Liggett, L. (2012). Care planning in children and young people’s nursing. Chichester, West Sussex, UK: Wiley-Blackwell

A critical study of the capillary refill time and pulse velocity is important in order to define more on breathing disorders. It can be done in any setting. On the other hand inspection of the patient’s skin gives clues on circulatory problems.

D-Disability what is the strength of consciousness?

Assessment: A rapid assessment of the blood is important to determine the level of the patient’s consciousness. It can be done through the use of AVPU method. In this case the patient gets grades on alertness, responsiveness of the voice, pain responsive and general unresponsive in all the three areas.

Intervention: On the other hand, the Glasgow Coma Score can be used. An inspection on the Limb actions is important in order to estimate possible signs of lateralization. There should be efforts to stabilize the cerebral conditions of the airway which is an immediate treatment for patients (Corkin, et al. 2012).

Pathophysiology: In particular, a study to determine when the patient is only pain responsive or unresponsive, and on airway patency needs to be done. Some the recommended ways to determine it so far includes placing the patient in the revival position, where personnel qualified are able to secure the airway. Evaluation of Papillary light reflexes and blood glucose level is also an important area to put focus on.A way to control a decrease in the consciousness A caused by low blood glucose can be outlined. The two ways includes oral or glucose (Corkin, et al. 2012).

E-Examination: any clues to explain the patient’s condition?

Assessment; There are signsof trauma, bleeding, rashes on the skin reactions, needle marks, etc, which must be observed, must be observed.

Intervention: Bearing the patient dignity in mind, clothes should be removed to give room to a thorough physical examination. Body temperature estimation can be done by feeling the skin or using a thermometer.

In conclusion the 12 lead ECG provided in the case study is a graphic representation of the electric activates of the heart on a two plane platform of Mr. Henry. The QT interval in the ECG measurements is done from the beginning of the QRS which is located at the end of the T wave. This is usually inversely related to heart rate. The patients age and sex is highly influence its outcome (Corkin, et al. 2012).The QTC is an implication of the QT that has been corrected for heartbeat. In the case of the ECG provided Qt intervals represents the heart beats ,they might also prolong end  if it exceeds 1 and half of the R-R intervals in the heart beat rates that ranges from 60 to 100 beats in one minute. There are no signs of a prolonged QT interval in this case because the patient has not been using any kind of drug. Once there is shortened QT interval it is an indication that Mr. Henry may be related to presence of hypocalcaemia or thyrotoxicosis (Corkin, et al. 2012).

References

.

Corkin, D., Clarke, S., & Liggett, L. (2012). Care planning in children and young people’s nursing. Chichester, West Sussex, UK: Wiley-Blackwell

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