Healthcare Institutions: Nursing Acutely ill Patient - Essay Example

? Nursing Acutely ill patient Health s and health providers should always ensure that strategies are in the right place in order to manage the patients who are in bad shape or those who are recovering from a critical illness. The best strategy to employ is to empower the practitioners caring for the patients with the recommended knowledge, competence, and skills in order to recognize and effectively manage them. Acute illness courses offer most healthcare practitioners with various experiences that assist in promoting opportunities for the learning students to improve their skills and knowledge in caring for the vulnerable patients. This work is mainly going to discuss the management of patients admitted in Accident and Emergency departments suffering from Angina. It also focuses on the treatment, pathophysiology, monitoring, and reassurance. Angina can also be referred to as Angina Pectoris1. Angina is condition causes a severe pain in the chest that often spreads to the arms, shoulders and neck. This condition is mainly caused by inadequate blood supply to the heart muscles. Angina is discomfort or chest pain that is caused when the heart section is deprived of oxygen2. It is also subjected to a symptom of heart disease like the Coronary artery disease. There are three main types of angina. They include, variant angina, stable and unstable angina. Variant angina is a type of angina that occurs when one is at rest or during sleeping hours3. It is very easy to treat using medication. This type of angina in not common and occurs free of atherosclerosis that might be there incidentally. 4Some researchers state that variant angina occurs because of coronary artery muscle contraction. Stable angina is the most common type of angina that takes place the heart is overworked. It is easy to predict when it can occur, for instance, when carrying out some activities. Stable angina can be relieved either by rest or through angina medications5. The last type of angina, unstable angina, follows an unpredictable pattern unlike stable angina. It can occur during an activity or when at rest. It is rather complex because it cannot be relieved by both medication and rest. Its occurrence may indicate an impending heart attack. 6The symptoms of angina include; sensation of heaviness or pressing pain on the chest under sternum, the breast bone. The pain is mainly experienced in the arms, neck, jaw regions and shoulder. Physical exertion normally increases the condition because angina occurs only when the heart requires excess oxygen beyond the available oxygen from the blood that nourishes the heart. The main causes of angina are extreme temperatures, smoking cigarette, emotional stress, heavy meals and alcohol. Some of the causes of angina are very serious and threatens life. Musculoskeletal is one of the most common causes of chest pain that are common in patients under forty years. Some of the causes of chest discomfort include respiratory causes such as pleurisy and pulmonary embolism, the digestive causes such as esophageal spasm and heartburn7. The worst condition that threatens life is the cardiac chest pain. Cardiac chest pain sums to 18% of the chest pain cases combined. Chest pain reports sums up to 40% of the admissions in emergency hospitals out of which, 5% visits the Accident and Emergency departments. It is very important to differentiate between non-cardiac and cardiac pain in the admissions of chest pain in a hospital, even though, it can be hard to be sure about the nature8. Early assessment helps to know if there is a heart disease within a patient while early treatment increases the survival chances of the patient. It is therefore important to do early assessment and early treatment in order to discover the presence of a heart disease and increase the patient’s survival chances respectively. According to various statistics, the incidences of Coronary Heart Disease have been increasing for the last decades; though there were, low death rates. The coronary heart disease is one of the common causes of mortality in the industrialized world today. For instance, in the United Kingdom, 2.6 million people, representing 4.6% of the total population of people live with CHD. Additionally, 2 million people suffer from angina, a known symptom of coronary artery disease, in the UK. This means that the main cause of deaths in the UK is the CHD. This paper is mainly going to focus on the nursing involvement and care of a patient admitted in emergency and accident department with chest pain. It will put emphasis on the nature of the pain and the adaptation of the patient’s physiology. This will definitely enable us to understand the cardiac pain related problems and the management from the perspective of the nurse. Admitting a patient experiencing chest pain moving towards his arms, shoulder, neck or throat, in the A&E department, the patient is likely to suffer from angina. Angina pectoris is pain caused because of lack supply of both oxygen and blood to the heart muscles embolism, atherosclerosis or spasm. They may possibly lack a medical history, though there are many conditions that may lead to chest pain. As presented before, this condition is mainly common in people under the age of 48 and it can be either heart related or non-heart related condition. The cause of chest discomforts can also originate from organs in the chest, abdomen, spinal cord, or muscular distension. Whenever a patient appears in the emergency department experiencing chest pain, the nurse should determine whether the patient is at risk of getting an acute coronary syndrome in case the pain persists9. To carry out this task, the nurse needs to do a cardiovascular examination that involves, physical examination, assessing the physical symptoms and ECG and its interpretations. When carrying out a physical examination, the nurse can also use a risk factor profiling in order to assess the condition of the patient and determine the risk of the patient, for instance, whether high, low or medium. The risk factors that may cause an acute coronary syndrome are non-modifiable and modifiable basis10. For example, modifiable basis includes, Diabetes Mellitus, hypertension, smoking, obesity and inactive lifestyle. Smoking, according to several studies, increases risk in coronary heart infection. Smoking also increases the formation blood clots and blood pressure. Coffee also causes coronary heart disease when taken in plenty because it raises the risk of MI. Unstable angina results from the alteration of physiology. In a patient who spent most of the time smoking, the smoking act and anxiety can cause the hypertensive episodes that can affect the coronary artery. Immune response to the injury is the gathering or collection of the low-density lipoproteins and macrophage blood cells in the section. Therefore, after the process of healing, the smooth muscle covers the injury or lesion. The process, however, might reoccur and might enlarge the size of the lesion. As a result, the artery wall may be destroyed at the same point. Acute pain comes from the nociception that match the central nervous system and the peripheral afferent action released by stimuli that is capable of damaging a tissue. The production of bradikinin, prostaglandins, carbon dioxide, potassium, adenosine and lactic acid explains best the origin of the pain physiologically. The release of these substances makes the heart excited since it consists of sympathetic efferent fibers. 11Bradikinin and prostaglandins are the most pain producing substances because they work together. For example, the release of prostaglandins enhances the action of bradikinin directly to the nerve terminals. This action depolarizes the nociceptors, which are the primary sensory neurons. Nociceptors obtain impulses and direct them to the dorsal roots and the afferent sensory neurons to the C-fiber that synapse on the neurons the in the dorsal horn of the spinal cord. The ascending nerve axons, goes to the contralateral spinothalamic tracts from the dorsal horn and synapse the neurons found in the thalamus perceives visceral pain. These reactions are the main reasons behind a severe chest pain in patients with diagnosed with unstable angina. The somatosensory cortex helps in detecting the physical pain within a patient while the limbic system determines emotional response. 12Unstable angina is a symptom of an introduction of myocardial infarction in the future. It is a type of acute coronary disease. The unstable angina symptoms are not easy to detect or predict like the stable one. The symptoms are unpredictable and random. The symptoms of the unstable angina are due to the rupture of a plaque. For instance, when there is partial blockage of the artery, the pain produced takes approximately twenty to thirty minutes. The management of chest pain patients in the Accident and Emergency department calls for or relies on early detection of the condition. It is also important to know the procedure of pain management of the condition and a good referral after detecting the condition. When the patient is admitted, it is important to perform an Electrocardiogram (ECG) in order to detect and record the important signs13. Electrocardiogram also assists in collecting data concerning the chest pain and managing the pain appropriately. 14The nurse should decide how to collect the information about chest pain and its characteristics during the process of assessment because there are different types of chest pain diagnosis. During assessment, the doctor can know the history and the duration of pain thus enabling him to decide which step to start with. In order to gather information about the pain, the nurse should ask the patient when he started feeling the pain, the duration it takes and the frequency in case there are. It is also important to know whether the patient had had pain in the history or even he had known of a family member with such a problem. The nurse should also know the exact position where the pain accumulates during assessment. This will assist the nurse to know whether pain is gastric, hepatic, muscular or cardiac. Patients experiencing a lot of pain in the central part of their chest that moves or extends to the neck, arm, or shoulder with ultimate exacerbation when adjusting his position, is likely to have the cardiac chest pain. The changes in the body do not affect Cardiac chest pain. The patient should state whether he had had cases of chest pain before and the difference between the past and present pain in there was. The patient should also be able to tell whether the pain is superficial or deep. Cardiac chest pain is deep and respiration do not affect it in any way. The collection of the information about the chest pain as experienced by the patient is done when performing the ECG. The electrocardiogram is an effective diagnostic tool that enables the nurses and doctors to sketch the heart. Additionally, an ECG can give non-invasive, quick and accurate measurements of the heart’s electronic activity. Diagnosis of various heart conditions is done after interpreting the information got by performing ECG. ECG is capable of detecting hypertrophy that might have been reset due to pericarditis, heart attack or angina. Most patients who visit the A&E departments are often brought by ambulance because they cannot walk to the emergency department due to sharp pain they experience. The first step to take is to perform is 12 lead ECG because it can provide a good view of the chest pain that the patient had suffered. The privacy of the patient should be maintained during the procedure of performing ECG. It is also important to affirm the patient of the procedure and steps taken and making him comfortable. 15The practitioners or doctors are expected to place electrodes in a good place in order to trace the heart perfectly without mistakes. Misplacing of the electrode can change the ST segment or can result into missing of the ST elevations. In addition, misplacement can make waves mimicking ventricular. The processes of placing electrodes, preparation of the skin and recording procedures should follow appropriate guidelines in order to reduce risks. The electrodes attached to the skin surface records the depolarization of the heart muscles during every heart beat over a given period of time. It is also very important to monitor observations in chest pain. It helps to know whether the patient is in pain and how he reacts towards the activities carried. A patient can suffer a slight tachycardia that contributes 101 beats after every minute. Anxiety can also activate the reaction of tachycardia though some patient normally do not show the signs of stress anxiety and therefore corporate throughout the activities. The doctor or nurse should check blood pressure of the patient and whether or not there is oxygen saturation. Also they should check blood sugar levels and the temperature of the patient. In the case of patients who suffer from chest pain with dyspnea, the administration of oxygen should only be done when the level of oxygen reduces below 94% in order to aim at an SpO2 of 94% to 98%. The doctors should use NICE guidelines carefully in order to carry out their activities without problems or complications. Establishment of pain score for the patients requires application of a reliable pain scale, which is easily understood by both the patient and the nurse. The most preferred pain concentration measurement tool is a simple tool such as an arithmetic rating pain scale that rates from 0 to 10. It is important for the nurse to explain how the scale should be used so as to avoid confusion and misinterpretation. For example, while reading the scale, number 10 represents unbearable pain whereas 5 represents a constant pain that is manageable. Zero on the other hand represents no pain at all16. Some authors such as Cox states that nurses should record and assess pain intensity and the characteristics of the sick preceding intervention. Cox explained that this act is necessary because it assists to appraise the outcome. In the preparation and ECG performance, nurses or health practitioners should work on collecting information about the medical history of the patient, the characteristics of pain he experiences and assessment of risks. The aim of gathering this information is to show the ECG and present it to the doctor. When the patients' results come from the pathology, the patient can be found with unstable angina, or any other type of angina. The doctor can prescribe treatment for the patient which include analgesics and antiplatelet drugs. A patient with unstable angina can be given a prescription as follows: 1 milligram of sublingiual glycerin trinitrate and 300 milligrams of Aspirin. The antiplatelet drugs perform two main functions which include, reduction of platelet aggregation and hindering the formation of thrombus. In the case of ischemic, the first prescription is a dose of aspirin, 300 milligrams followed by a daily consumption of 75 milligrams as a long term treatment. Controlling pain in the patient is a priority for the health practitioner or nurse because it enables the patient to cooperate thus making work easier. The patient can express that he is in pain in various ways. A patient with chest pain can express his feeling verbally or by his reactions such as facial expression. Additionally, one can tell that a patient is in pain when he constantly touches his chest. Observation of the patient’s behavior is important because it can help to tell whether the patient is in pain or not. Facial expression and fatigue are the key signs that can tell if someone is in pain. It is important to treat pain since it disrupts the normal condition or function of an individual. Excessive pain interferes with someones daily activities and reduces the normal functions of an individual. One way of treating pain is through pharmacological management. Pharmacological control or management helps to attain and maintain the recommended pain control method with no or very little effects if any. 17On the other hand, Glycerine trinitrate (GTN) is a well known drug used to treat the coronary artery spasm, myocardial infarction and angina. Dilating blood vessels reduces the resistances of the flow of blood. Wide blood vessels on the other hand decreases the blood volume that flows back to the heart, thus enabling the heart to lessen the rate at which it consumes oxygen and the workload. As I described in the above text, angina is caused by a little supply of oxygen to the heart. Prescription of GTN helps to reduce the amount of oxygen required.It also assists in improving the amount of oxygen supplied to the heart18. Due to the fact that GTN reduces the required oxygen and improves the supply to the heart, it helps in reducing pain, therefore, making it a suitable and applicable means of treating angina. Even though GTN is an important drug in the treatment of angina, it also has various effects. For example, it causes headaches, tachycardia, postural hypotension and dizziness. The GTN dose should be taken as directed by the doctor or physician. Due to severe headaches it causes, diamorphine can be used to relieve the pain. In addition, when ACS is diagnosed, diamorphine can be recommended as a painkiller. Diamorphine is a strong or powerful opioid analgesic , which works by connecting opioid receptors. Opioid receptors are present in the central and peripheral nervous system. Through attaching the opioid receptors, opioid analgesics helps to stop the feeling of ache or pain in the brain. Additionally, it works to reduce most functions of the body. This explains why relaxation is one of the effects of diamorphine. Other effects of diamorphine on patients include impaired coordination, relief of anxiety and reduced alertness. Diamorphine is a common drug that is extensively used in cases of acute chest pain. It is preferred in this condition because it causes less nausea and hypotension than morphine. However, some physicians claim that morphine is good at relieving pain compared to diamorphione. The prescription of a diamorphine should be written manually and the administration should be rechecked by another nurse since it is a controlled drug. Diamorphine is not very important in the emergency department due to the presence of GTN19. Recommendations should be followed strictly in order to ensure there is a valid procedure of drug administration. The recommendations to be followed are as follows: a nurse should go through the prescriptions and ensure that there is the patient's name, date of birth and the address, name of the drug prescribed, and the dose. In the period when chest pain persists after offering GTN, the doctor can decide to repeat the prescription at an interval of five minutes. The patient is not expected to show irritating symptoms. In case three doses of the prescribed medicine fail to work or relieve angina, the patient should seek further medical attention. After medical administration, the patient should be visited after 3-5 minutes to confirm whether the concentration of pain has reduced. Moreover, the patient is checked to ensure that observations were reliable. After a few minutes, the patient will be asked to rate the level of pain again by the use of numerical ranking pain scale. If the pain reduces, the patient is considered to respond positively to the medication provided thus proving that there is possibility of survival. In case the pain retains or increases, the patient at this stage requires further medical attention. According to the information provided, it is apparent that the responsibility of nurses in an incident of chest pain in the Accident and Emergency Department consists of several activities. For instance, nurses perform the assessment of patients as stated in the NICE guidelines so as to take a quick action when identification of Acute Coronary Disease is made. In case the diagnosis is made, the first and foremost steps that should be followed include ECG, the type of pains experienced, the kind of observations made and the risk factors. Furthermore, in order to achieve an optimal prognosis, pain management and close monitoring of the patient is required. The management of pain is vital because it helps to prevent extra myocardium hypoxia. It is also a major intervention in the A&E department. In conclusion, I can admit that these experiences have taught me a lot of lessons that will help me to employ what I have learnt in a practical work. This work has enabled me to know that pain can be identified in various different ways depending on the patient’s reaction. In pain management, I realized that the nurse is expected to institute a successful communication channel with the sick so as to obtain all the required information that would assist in deciding what prescription or method to take in pain management. This paper moreover, shows the significance of comprehending or understanding physiology and anatomy. According to the paper, nurses only do what has been told by the doctor. However, treatment mainly relies on addressing what is wrong with the patient’s normal physiology. It is therefore important for the nurses understand both pathology and physiology. Understanding of pathology and physiology helps the nurses to offer a framework to encourage a healthier and safer practice. Lastly, I learned that patients suffering from angina can be helped using medical prescription depending on the type of angina. Reference list D Dugdale, “Electrocardiogram (ECG)”, in MedlinePlus. July 2012, viewed 9 December 2012. “Electrocardiogram (ECG or EKG)”, in MedicineNet, Inc. November 2012, viewed 9 December 2012. B Wedro, “Electrocardiogram (ECG, EKG)”, in eMedicineHealth. Viewed 9 December 2012. “Electrocardiogram (ECG or EKG)”, in Mayo Foundation for Medical Education and Research (MFMER). October 2012, Viewed 9 December 2012. “GTN sublingual tablets (glyceryl trinitrate)”, in NetDoctor. November 2011, Viewed 9 December 2012. “Glyceryl trinitrate for angina”, in Patients.Co.Uk. Viewed 9 december 2012. J Simpson, “”The use of glyceryl trinitrate (GTN) in the treatment of chronic anal fissure in children”. 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