Nursing Practice and Decision Making - Case Study Example

? Nursing Practice and decision making Nursing Practice and decision making Mr. Singh arrived to the hospital under normal conditions, however, the chest pain he experienced required further assessment to be carried out. Such assessment included anamnesis morbid and anamnesis vitae and more in depth descriptions of the chief complaint, which was a sudden onset of chest pain. As there are several etiological factors to chest pain which include cardiac, pulmonary or digestive system malfunctions, the above mentioned parameters such as history of disease and lifestyle have to be considered in order to see which system is affected more and is the root cause of the chest pain. After examination of all systems, mainly focusing on the cardiac system, the results showed that the ECG, boy temperature, respiratory rate, 02 saturation and blood glucose were all normal. Hence, a blood analysis was also carried out and all the parameters were normal except for the Troponin I levels which were slightly above normal. In addition, his blood pressure was high at approximately 160/100. These parameters also need to be considered when making the therapeutic plan for Mr. Singh. In addition, Mr. Singh had also been suffering from depression and anxiety which are also matters that will be discussed in detail in the following sections of the paper (Goldberg & Fawcett, 2012). The paper will analyze the case of Mr. Singh in detail, paying attention to his history and the symptoms he presents. In addition to the management of symptoms, the paper will also analyze the psychosocial factors affecting Mr. Singh and the approaches that can be taken in alleviating them in order to improve the prognosis of the patient (Ryan, 2013). Firstly data collection has to be carried out which enables the physician to gain insight on the disease of the patient (Rogers, A., & Pilgrim, 2010). Judging by the status in which the patient came to the hospital which was anxious and unsteady, the physician or nurse performing the clinical assessment must first calm the patient down the patient, ensuring that he is not under pressure (Edwards & Elwyn, 2009). The information must be obtained in a steady and unhurried manner, as this might alter the response of the patient or further worsen his anxiety (Rogers, A., & Pilgrim, 2010). Once the patient is relaxed, the chief complaint must be assessed, followed by anamnesis morbid. In this case, the patient stated that he had never felt a pain of this nature before, suggesting that this could be the onset or acute phase of a particular illness (Rogers, A., & Pilgrim, 2010). Therefore, it is necessary to assess the life history of the patient in order to reveal the underlying causes of this pain (Edwards & Elwyn, 2009). In the review of Mr. Singh, there were indications that he was susceptible to cardiovascular diseases. The risk factors that were obtained from the assessment of Mr. Singh include hypertension, which was previously diagnosed and presently at 160/100. Mr. Singh was also a smoker who was suffering from depression and anxiety (Goldberg & Fawcett, 2012). In addition to these factors, Mr. Singh also had been previously diagnosed with hyperlipidemia and type II diabetes which made him susceptible to diabetic heart disease. Due to the fact that the parameters were normal except for his blood pressure and the sense that he was at risk of developing cardiac disease, Mr. Singh had to undergo several addition tests to determine his cardiac function. There is need for shared decision making as Mr. Singh did not present any major signs or symptoms upon his visit to the hospital (Thomson, Kinnersley & Barry, 2012). Other further complications in Mr. Singh’s situation will also be analyzed in the following sections when analyzing the psychosocial issues involved. After clinical assessment, Mr. Singh was diagnosed with Acute Coronary Syndrome, and was referred to the call of medical team for admission. There are several stages that are involved in the assessment of Acute Coronary Syndrome, which is the reason why Mr. Singh was admitted to the acute medical admission ward in order to create an appropriate treatment strategy for his condition (Godolphin, 2009). Patients with Acute Coronary Syndrome are classified into two categories which are ST segment elevation myocardial infarction (STEMI) or non STEMI (Gallagher, 2012). His Tropinin test results only indicated a slight increase hence a second test result had to be carried out in order to determine the category of ACS presented by Mr. Singh. The second blood analysis reveled that he had experienced a non ST elevated myocardial infarction (Gallagher, 2012). This showed that there was a need to implement preventative measures for recurrent ischemic occurrences. The fact that he been diagnosed with non STEMI-ACS, also shows the need for further assessment of risks of further ischemia occurring and risks of hemorrhage also had to be assessed (Gallagher, 2012). Such assessments help to determine the approaches to be used in treatment. For example, individuals with a higher risk of developing recurrent ischemic attacks should receive an anticoagulant and antiplatelet therapy. Mr. Singh was also discovered to be smelling of smoke by his nurse which he claimed to do to help relax (Ross, Clarke & Kettles, 2013). However, his condition requires the cessation of smoking in order to preserve his vascular structure and reduce the possibility of any rupture leading to hemorrhage and ischemia (American Heart Association, 2013). His condition also requires for the reduction of lipids in his blood content, hence he has to alter his lifestyle in order to cater for this procedure. In addition, Mr. Singh’s history showed that he had already been diagnosed with hyperlipidemia which is why intervention has to be carried out immediately. The processes that can be taken to reduce lipids in blood will be stated in the following sections of the paper. Mr. Singh has also stated to the nurse his family problems which means that he is under a lot of stress which can exaggerate his high blood pressure and further increase worsen his condition (Ross, Clarke & Kettles, 2013). Hence, therapeutic measures have to be taken top help calm down his psychological state. The measures to be taken will also be discussed further on in the paper. There is need for rennin and angiotensin in order to reduce the chances of ischemic attacks. All the above mentioned parameters show the necessity for shared decision making in order to make the appropriate strategies as there are also psychosocial factors involved (Stiggelbout et al., 2013). The following section will analyze the therapeutic measures that can be utilized to preserve and improve the health of Mr. Singh. Firstly it will analyze the treatment approaches to Mr. Singh’s condition. Firstly he needs to improve the strength of his vascular system and a majority of the procedures involved in achieving this process require a change in lifestyle of the patient (O’Connor & Edwards, 2009). Therefore, the decision should not be made by the doctor alone but the together with the patient to make an appropriate strategy. The nurse has already discovered that Mr. Singh is having family problems which could be one of the reasons why he smokes as he mentioned that it helps him to relax. Therefore, the nurse is very influential in the alleviation of a patient’s psychological problems due to the fact that she has more contact with the patient than any other medical practitioner. She can use this to get more insight on the patient’s life and together they can formulate a plan that can help reduce the depression and anxiety of the patient. Shared decision making has been found to improve the quality of patient care by many researches in psychological disorders, particularly depression (Barry & Edgman-Levitan, 2012). Firstly the nurse will inform Mr. Singh of his treatment options and together they will try to decide which one suits him better. The nurse’s duty in this instance is to inform and educate the patient on all the available treatment options and give him an understanding of the options in order to choose which one he will be able to follow. In fact, in such cases it has been found beneficial for the doctor to play the role of a guide and allow the patient to make the decision by himself. On the other hand, the doctor also needs to work with the nurse in order to gain more insight on the condition of the patient. This will allow the doctor to provide the patient with better treatment options for alleviating his depression. As this is the underlying cause of the patient’s smoking, treating him for this disorder will make the process of quitting smoking easier for the patient (American Heart Association, 2013). Depression also has an influence on Mr. Singh’s blood pressure which is moderately high (Stage 2) (Godolphin, 2009). Therapeutic intervention is also necessary for treating his hyperlipidemia as it is also a risk factor for recurrent ischemia in patients with Acute Coronary Syndrome (O’Connor & Edwards, 2009). Firstly this can be reduced by monitoring and regulating the patient’s diet. Reducing high fat and sugar content has also been discovered to reduce hyperlipidemia. The dietary plan can be created with the help of the patient. Considering the fact that he had been previously diagnosed with hyperlipidemia, the doctors need to know if the patient already followed a strict diet plan and whether or not there were any improve. In addition the patient should be encouraged to take regular exercise as this helps in treating his condition. Shared decision making has also been widely used in the treatment of both hypertension and hyperlipidemia (Barry & Edgman-Levitan, 2012). Lifestyle is one of the main modifications that can be carried out to reduce high levels of lipids in blood. Apart from dietary changes patients are also offered some herbal supplements which have been known to help with hyperlidemia (Fleurence, 2012). The presentation of Mr. Singh’s symptoms shows the interaction of different systems in the pathogenesis of his condition (Ryan, 2013). The neural system can be seen to influence the cardiovascular system in the sense of hypertension and Acute Coronary Syndrome. The symptoms of the patient show that there is also need for social intervention in the therapeutic methods (Fleurence, 2012). Firstly, the nurse should be the first form of social support during the patient’s stay in the ward. The patient is experiencing neglect from his wife and children and has also lost his job which means he is in need of social support (Kon, 2010). Since the patient has very little contact with family, the hospital staff and nurses have the ability to help the patient with his condition and support him through this stressful period in his life (Fleurence, 2012). In addition, the patient can be introduced to support groups of patients experiencing similar problems which can help him as these people share similar problems and are able to provide empathetic advice and support (Fleurence, 2012). Improving the emotional status of the patient will in turn help him gain control of his life and spend less time contemplating on his situation with his family (Glassman & Gaffney, 2012). Engagement in other social activities could also help Mr. Singh improve his psychological status and create a better life for himself as he has already lost his job. Treatment for Mr. Singh should not be restricted to curing his Acute Coronary Syndrome but should also be extended to his social life as this also affects his physiological well being. There are also additional means to promote the mental health of the patient. This is also a procedure which can utilize shared decision making as it involves measures which are related to improving living conditions (Barry & Edgman-Levitan, 2012). Involving members of the patient’s family can help in creating a suitable environment for the patient whereby he feels less neglected and is able to turn to someone for support (Clancy, 2012). The doctors can interact with the patient and find out information about his closest relative or someone in his community who he frequently relates to, and this individual can included in the treatment process (Clancy, 2012). This intervention will also help in treating his hypertensive and stress disorders. The fact that the patient was also diagnosed of bipolar diseases emphasizes on the need of the patient to be around people for communication purposes (Cai et al., 2012). This can help him cope with his mood swings and can also prevent any further complications developing. For example, patients presenting similar symptoms to those of Mr. Singh frequently become suicidal, hence, they must be constantly monitored and require more attention in order for them not to engage deep in their thoughts and end up harming themselves (Craven & Jensen, 2013). In summation, Mr. Singh presents psychological symptoms that are in need of urgent intervention as they can cause further complication to his Acute Coronary Syndrome (Craven & Jensen, 2013). These symptoms require a therapeutic plan that involves the doctors, nurses and the patient as each is required to provide his or her input on the methods taken (Fleurence, 2012). The approach that should be taken towards treating this patient is person centered care, and his family members should be also involved in the process (Craven & Jensen, 2013). This is due to the fact that most of the concerns presented by the patient such as smoking for relaxation, depression and anxiety can be treated by therapy and social support. The patient stated that his wife and children have neglected him; hence if the possibility of reconciliation is not an option, other family members should be there to support the patient. The nurse is the one who maintains the most contact with the patient; hence she should obtain information to present to the doctor in order for him to devise the best treatment plan. Patient centered treatment is also necessary as changes in lifestyle can help in improving the patient’s cardiac symptoms and increase in lipid contents in the blood. The patient should also be encouraged to spend less time in isolation and interact more with the community as this will help him relieve stress from his family problems and job loss and try to progress forward in his life. The nurse has the most important role in the treatment of this patient as she is there for moral, psychological and medical support. Word Count: 2386 References American Heart Association. (2013). Smoking and Cardiovascular Disease (Heart Disease). Barry, M. J., & Edgman-Levitan, S. (2012). Shared decision making—the pinnacle of patient-centered care. New England Journal of Medicine, 366(9), 780-781. Cai, Y., Kuang, W., Guo, T., Yan, L., Zhu, J., & Chen, H. (2012). [Clinical characteristics and cognitive function of unipolar and bipolar depression]. Zhong nan da xue xue bao. Yi xue ban= Journal of Central South University. Medical sciences, 37(11), 1152-1155. Clancy, C. M. (2012). Patient?centered outcomes research and nurse practitioners’ role in shared decision making. Journal of the American Academy of Nurse Practitioners, 24(1), 59-61. Craven, R. F., Hirnle, C. J., & Jensen, S. (2013). Fundamentals of Nursing: Human Health and Function. 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