Potential Myocardial Infarction And Priority Problems Discussion Paper
Nursing Case Study
1. Analyses the following case study carefully and answer the questions
X, a 47 year old construction worker with a 36- pack/ year smoking history, is admitted to your floor with a diagnosis of r/o myocardial infarction. He has significant male- pattern obesity. (“beer- belly”, high Waist to Hip Ratio {WHR}), a barrel chest and reports a dietary history of high- fat food. His wife brought him to the ED as he complained of unrelieved “indigestion”. His admission vital signs were BP-202/124, PR- 96/min, RR- 18/min and T- 36.8 C. X was put on O2 2lt/ nasal cannula, an IV of D5W and he was given sublingual nifedipine in the ED. He was admitted to Dr. Graham’s service. He tells you he is fine in a loud and angry voice and demands a cigarette.
a) Revise whether these vital signs are reasonable for a man this age? If not, what concerns you ? State reasons.
b) Plan 5 priority problems associated with the care of a patient like X.
c) Propose 3 relevant nursing diagnoses for a cardiac patient like X.
d) Explain what laboratory tests may be ordered to investigate X’s condition?.
e) You call Dr. Graham’s resident who prescribes 10mg Morphine sulphate IV push q1hr prn for pain (burning). Explain the reasons for this order.
f) Analyse what special precautions you should follow when administering Morphine sulphate as IV push.
2. Explain briefly the importance of the following nursing interventions.
a) Subcutaneous administration of insulin
b) Administration of oral glycaemics
c) Blood Glucose Level Monitoring
d) Mid-stream specimen of urine
e) 24-hour urine collection/bladder washout
f) Removal of IDC
g) Contraceptives
h) Catheter specimen of urine
i) Glasgow coma scale/neurological observations
3. Provide examples of bioethical issues in nursing.
4. Formulate the two most important things you must do after you have given a client medication.
5. Propose the importance of not being judgemental in the nursing profession.
a) Building on your knowledge, provide examples of two situations where you would advocate for your patient. Identify and address potential conflicts of interest.
6. Demonstrate the best way to go about dealing with conflict between the clients’ wishes and the wishes of their family?
7. Explain social justice principles in relation to the health care system.
Analyzing X’s Vital Signs And Concerns For His Age
B.P- 202/124, which indicates a high blood pressure, which is a matter of concern for a patient of his age and can signify heart disease.
R.R- 18/min, which indicates normal breathing.
T- 36.7 degree, which indicates that he was not febrile.
b) Priority problems associated with the case study are as follows:-
i. Obesity in Mr. X due to the consumption of fatty foods, which can enhance heart problems.
ii. X had been a chain smoker, which can lead to diseases like COPD and can bring about complications in heart diseases.
iii. X was suffering from myocardial infarction.
iv. He was having a high blood pressure, which is a matter of concern of his age.
c) i. Pain, squeezing and heavy sensation in the chest, decreased cardiac output.
ii. Respiratory distress due to inefficient clearing of the airway due to accumulation of the secretions.
iii. Tissue perfusion is decreased, nausea, vomiting, chest pain, sweating, indigestion.
d) Laboratory tests, that may be ordered to investigate X’s condition-
i. Electrocardiogram, for the physical assessment.
ii. Determination of the cardiac markers- there are certain enzymes that lea out of the myocardial cells through the damaged cell membrane of the cardiac muscles. These markers are released into the blood stream. Potential Myocardial Infarction And Priority Problems Discussion Paper
The commonly used markers are the MB subtype of the enzyme Creatine kinase and the cardiac troponins. Enzymes like SGOT and LDH are also used as cardiac markers.
i. Chest radiograph can also be used to determine MI.
ii. Histopathological diagnosis can show the condition of the damaged heart muscles.
iii. Coronary angiogram to determine obstruction in the heart vessels.
e) Intravenous morphine Sulphate is used in the case of chest pain of uncertain etiology. Morphine reduces the B.P. It slows down the heart rate, thus relieving anxiety. It also helps to lessen the myocardial oxygen demands, depresses the respiration and decreases the oxygenation.
f) Each patient should be assessed prior to the application of the doses and should be monitored regularly for the development of the risks. Proper dose regimen should be followed as different formulations of this drug are not bioequivalent. In case of the elderly patients, the doses should be reduced to half of the normal daily dose for the adults. Patients should not consume alcohol while taking this drug (Motov et al. 2015).
2. a) The intravenous administration of insulin glucose followed by the subcutaneous insulin therapy helps in improving the life quality of the patient and helps them in the long term survival. Insulin and glucose plays an important role in ischemic reperfusion metabolism. A rise in the availability of the glycolytic substrate increases the synthesis of anaerobic adenosine triphosphate. It helps to reduce the post ischemic cardiac dysfunction.
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b) It helps to lower the blood glucose level. Glycemics can be used to manage the patients with Type 2 diabetes patient. It can improve the glycemic control and helps to prevent macrovascular and the microvascular complications (Hsia et al.2012) They act by regulating the ATP-dependant potassium channels in the pancreatic beta cells. They stimulate the release of insulin from the beta cells and thus help in controlling the glucose level.
Priority Problems And Relevant Nursing Diagnoses
c) Blood glucose level monitoring would help the caregiver to get a regular knowledge about the glucose level in the blood and would help to choose the medicines and the required doses to manage the complications.
d) A mid stream specimen of urine test is generally done in order to confirm the diagnosis of a urine infection and to decide what antibiotic should be taken. In this case the urine is taken from the middle of the bladder.
e) This method is used to measure proteins, hormones , minerals and other chemical compounds present in the urine. It can be used to determine kidney diseases like diabetic nephropathy, neprotic syndrome, polycystic ovarian diseases and many more (Yismow et al.2012). Potential Myocardial Infarction And Priority Problems Discussion Paper
f) After an indwelling catheter is being introduced in to the patient’s bladder, Urinary catheters should be removed in due time from a patient’s bladder as it can lead to complications like infections, encrustation or bladder neck damage (Yismow et al.2012).
g) Contraceptives are generally taken to prevent unwanted pregnancy. Contraceptive drugs are also used to prevent certain complications other than preventing pregnancy. Some contraceptive drugs are used to treat PCOS diseases in woman. Some hormonal birth control helps to regulate menstruation cycle, reduce acne (Khalili et al. 2012).
h) It is normally done for the bacteriological examination of the urine sample, if the patient is suspected with an infection. It can be used to determine the clinical conditions like the bacteriuria which is unavoidable in patients with catheters (Yismow et al.2012).
i) The Glasgow comma scale is used to determine the neurological dysfunction in patients and is used to follow up the progressive level of the consciousness (Rhodes et al. 2012). It is an important tool to assist the patients suffering from trauma , the BTI victims.
3. Suicide- the argument still exists whether or not people have the right to die according to their wishes, especially in case of the terminally ill patients (Johnstone 2015).
- The right to say no.
- Lying to patients
- Resources utilization
- Personal belief and empirical knowledge.
4. i) It is essential to keep a follow up of the patient to monitor any progress or deterioration.
ii) To keep a watch for the adherence of the client to medication.
5. Nurses should not be judgmental. Nurses should provide appropriate care to the patients in spite of their limits and should show empathy and understanding to the patient. The nurse’s patients come from different walks of their life and suffer from various problems, hence they need to be non judgmental.
a) In some cases a patient might not want to stick to the medications and want a switch in the mode of treatment. In such a case a conflict of interest would definitely arise between the nurse and the patient. In such cases discussions are required.
Conflict of interest may arise between the patients regarding the tools and the techniques use to provide an appropriate care. In such cases it is required to make everything clear to the family of the patient.
6. The best way to deal with the conflicts between the clients wishes is to discuss thoroughly about the pros and cons of the treatment. If required, specific examples can be given to the client and the families, regarding other patients and help them in deciding the appropriate care.
7. There are four principles of social justice that is equity, access, rights and participation. The social justice principles are generally applied to eliminate the inequality in terms of health and to provide appropriate health care to the different classes of people (Rhodes et al.2012). The social justice principle in health care can be explained as-
Participation- In making plans, taking decisions and implementing the plans in community health.
Equity- Equal and fair distribution of the resources irrespective of discrimination.
Access- the availability of a large range of health benefits.
Rights- Equal right for everyone irrespective of the economic status.
References
Hsia, E., Seggelke, S., Gibbs, J., Hawkins, R.M., Cohlmia, E., Rasouli, N., Wang, C., Kam, I. and Draznin, B., 2012. Subcutaneous administration of glargine to diabetic patients receiving insulin infusion prevents rebound hyperglycemia. The Journal of Clinical Endocrinology & Metabolism, 97(9), pp.3132-3137.
Johnstone, M.J., 2015. Bioethics: a nursing perspective. Elsevier Health Sciences.
Khalili, H., Higuchi, L.M., Ananthakrishnan, A.N., Richter, J.M., Feskanich, D., Fuchs, C.C. and Chan, A.T., 2012. Oral contraceptives, reproductive factors and risk of inflammatory bowel disease. Gut, pp.gutjnl-2012.
Motov, S., Rockoff, B., Cohen, V., Pushkar, I., Likourezos, A., McKay, C., Soleyman-Zomalan, E., Homel, P., Terentiev, V. and Fromm, C., 2015. Intravenous subdissociative-dose ketamine versus morphine for analgesia in the emergency department: a randomized controlled trial. Annals of emergency medicine, 66(3), pp.222-229.
Rhodes, R., Battin, M. and Silvers, A. eds., 2012. Medicine and social justice: essays on the distribution of health care. Oxford University Press.
Sievenpiper, J.L., Chiavaroli, L., De Souza, R.J., Mirrahimi, A., Cozma, A.I., Ha, V., Wang, D.D., Matthew, E.Y., Carleton, A.J., Beyene, J. and Di Buono, M., 2012. ‘Catalytic’doses of fructose may benefit glycaemic control without harming cardiometabolic risk factors: a small meta-analysis of randomised controlled feeding trials. British Journal of Nutrition, 108(3), pp.418-423.
Voight, B.F., Peloso, G.M., Orho-Melander, M., Frikke-Schmidt, R., Barbalic, M., Jensen, M.K., Hindy, G., Hólm, H., Ding, E.L., Johnson, T. and Schunkert, H., 2012. Plasma HDL cholesterol and risk of myocardial infarction: a mendelian randomisation study. The Lancet, 380(9841), pp.572-580.
Yismaw, G., Asrat, D., Woldeamanuel, Y. and Unakal, C.G., 2012. Urinary Tract Infection: Bacterial etiologies, drug resistance profile and associated risk factors in diabetic patients. European Journal of Experimental Biology, 2(4), pp.889-898. Potential Myocardial Infarction And Priority Problems Discussion Paper
