Mr. Frank Jura is a 54 year old male, currently admitted to the cardiac unit in response to an exacerbation of his unstable angina. Mr. Jura also presents with uncontrolled Type II diabetes, hypertension, and is currently obese.
As a pregraduate PN student on the unit, you are assigned to Mr. Jura’s care for the duration of your shift. You have negotiated the plan of care with your RN preceptor (who is also assigned to Mr. Jura), and divided the responsibilities of his care for the remainder of the 12-hour shift.
After completing your AM vitals, you notice that Mr. Jura’s blood pressure has been hovering just above high-normal range (around 145/90) as long as he has been admitted. Curious at this trend, you examine his medication administration record and note that he is currently prescribed the following cardiac related medications/treatments:
You inform your preceptor of your findings regarding his elevated blood pressure. In response, your preceptor states:
“Ah well, the poor guy is probably nervous….you know, being in the hospital and all. I’ll just pop a PRN Ativan into his AM meds and that should help with his elevated blood pressure.”
Select one case study from the above listing, and complete the assignment focusing upon the following:
1. Deconstruct the case narrative, exploring the scenario from both the nursing, health and psychosocial perspectives.
2. Generate relevant and timely actions and recommendations to assist the patient (and their family) in the situation to obtain the highest level of wellness possible.
3. Discuss your process of finding, retrieving, and analyzing best practice information to develop care plan for the patient and their family in the given case narrative.
4. Include discussion of at least one College of Nurses of Ontario Practice Standard or Guideline (http://www.cno.org/learn-about-standards-guidelines/publications-list/standards-and- guidelines/), and how the Standard or Guideline is relevant to the case scenario.
In nursing profession, professionals are liable for a holistic well being of the care user. While ensuring the holistic well being of the patient, nurse should understand the patient’s current needs and should prioritize these needs based on the urgency. In this context, diagnosing patient’s each symptom and vital signs are crucial for improving the overall health issues of the patient (Carpenito, 2012). The nurse is liable to act as a communication bridge between the patient and the doctor, she needs to communicate thoroughly with the patient for identifying patient’s health needs and convey it to the multidisciplinary care team for the patient, for developing suitable care plan for the patient, which maximizes the positive health outcomes of the patient (Hamm et al., 2011). In this assignment, a particular patient’s case would be demonstrated and analyzed for identifying his care needs and providing recommendation for his well being through a systematic manner. Holistic Care Plan For A Patient With Unstable Angina Essay Paper
In this case scenario, the key focus is a 54 years old male, named Mr. Frank Jura, who have been admitted to the cardiac unit, upon experiencing an exacerbation of an unstable angina. In addition, by reviewing his previous health history, it has been revealed that he is also experiencing with uncontrolled type II diabetes, hypertension and obesity. In addition, through his admission in the health care centre, it has been revealed that his blood pressure was slightly high from the normal range, i.e. 145/90 mmHg. Thus, he needs continuous monitoring for his condition (Hamm et al., 2011). Although the practice nurse has suggested that the high blood pressure might be due to anxiety and stress in the hospital environment.
Therefore, analyzing Mr. Jura’s case, it has been revealed that the patient has several issues, which are needed to be prioritized in an urgent basis. On the other hand, it has also been revealed that each of his symptoms and previous health history has a strong association. For instance, Mr. Jura’s history of Type II diabetes, hypertension and obesity are the key risk factors for elevating the risk of cardiovascular complications, including short or long term angina, stroke and myocardial infarction (Lilley et al., 2011). Moreover, in response to his constant high blood pressure, the practice nurse depicted that he may be anxious and stress in the hospital environment; however stress and depression are also consequences of type II diabetes, hypertension and obesity. Therefore, to ensure Mr. Jura’s holistic well being, it is important to mitigate his health issues from the root, prioritizing his previous health history, i.e. type II diabetes, obesity and hypertension.
Mr. Jura’s medication chart includes Ramipril, metropolol and Hydrochlorothiazide which are used for treating his high blood pressure; Transderm nitropatch and Nitrospray, which are administered for controlling angina or chest pain. Therefore, it has been revealed that Mr. Jure has been administered with medications for treating his continuous high blood pressure, but it has been also revealed that no medication or therapies are provided to Mr. Jura for controlling his high blood sugar, type II diabetes as well as obesity (Potter & Perry, 2014). Therefore, these would be the key focus in Mr. Jura’s holistic care plan, along with the current symptoms. In addition to that, his alleviated blood pressure is also indicating stress and anxiety, which also increases the risk of chronic depressive symptoms to be developed soon. In this context, psychological and emotional interventions should also be included in the holistic care plan for Mr. Jura (Barr et al., 2011).
According to the case scenario, the following goals have been developed to meet Mr. Jura’s current health care needs:
To achieve these goals, co-operation of patient, patient’s family and the members of multidisciplinary team is crucial and it is the initial step in the procedure (Sattelmair et al., 2011). In addition, while implementing the goals in the therapeutic plan, each goal should be assessed on the basis of SMART criteria, i.e. whether the goal is specific, measurable, attainable, realistic and time-specific or not. Development of potential goals helps to meet the expected therapeutic outcomes through a systematic way (Hamm et al., 2011).
According to the pre-existing literatures and evidence based processes, the following resources can be recommended for Mr. Jura’s well being:
According to the “College of Nurses of Ontario Practice Standard or Guideline” establishing nurse-patient relationship is crucial for ensuring patient’s well being and a nurse should demonstrate the standard by establishing a positive nurse-patient relationship, which is related to Mr. Jura’s case scenario (College of Nurses of Ontario, 2015).
Conclusion and Reflection
In conclusion, demonstrating and analyzing Mr. Jura’s case, it has been revealed that nurses’ responsibility is to maintain standards in practice, while promoting the maximum well being of the patient. In addition, the case study assignment helped to understand the importance of holistic diagnosis and assessment for identifying the key causes of illness (Hamm et al., 2011). I would use the acquired knowledge in further practical cases, for improving the relationship with the patient, by identifying the patient’s needs in logical and empathic way. From Mr. Jura’s case, it has also been revealed that dealing with CVD patients, it is important to monitor patient’s vital signs thoroughly, as these can fluctuate significantly, thus, nurse should be aware of any kinds of patient’s altered symptoms. In addition, CVD patients also need mental and emotional support to cope with the chronic disorder, which should be promoted by the nurse (Barr et al., 2013).
Reference List
Barr, J., Fraser, G. L., Puntillo, K., Ely, E. W., Gélinas, C., Dasta, J. F., … & Coursin, D. B. (2013). Clinical practice guidelines for the management of pain, agitation, and delirium in adult patients in the intensive care unit. Critical care medicine, 41(1), 263-306.
Blais, K. (2015). Professional nursing practice: Concepts and perspectives. Pearson. Medlineplus.gov, U. (2017). Unstable angina: MedlinePlus Medical Encyclopedia. Medlineplus.gov. Retrieved 4 June 2017, from https://medlineplus.gov/ency/article/000201.htm
Carpenito, L. J. (2012). Handbook of Nursing Diagnosis (14 ed.). New York: Wolters Kluwer Health.
College of Nurses of Ontario. (2015). Practice Standards: Medication. Retrieved from https://www.cno.org/en/learn-about-standards-guidelines/standards-and-guidelines/
Hamm, C. W., Bassand, J. P., Agewall, S., Bax, J., Boersma, E., Bueno, H., … & Ohman, M. (2011). ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. European heart journal, 32(23), 2999-3054.
Lilley, L., Harrington, S., Snyder, J., Swart, B., & Savoca, D. (2011). Pharmacology for Canadian Health Care Practice. Toronto: Mosby Elsevier.
Lunney, M. (Ed.). (2013). Critical thinking to achieve positive health outcomes: Nursing case studies and analyses. John Wiley & Sons. Holistic Care Plan For A Patient With Unstable Angina Essay Paper