Nursing Consultation and Decision-Making in Acute Coronary Syndrome - Essay Example

Advanced nursing consultation and decision making in Acute Coronary Syndrome (ACS A case study Introduction This is a case study that involved the diagnosis and treatment of a 42 year Old Mr. Ali Bahmani. His wife brought the patient to the clinic. His wife explained that Mr. Ali had complained of having heavy chest pain and pressure. The patient had indicated that the pain that radiated to the left arm. He felt it when he was resting and watching TV in the evening with a limitation of the daily activity. I immediately suspected that it was an acute coronary syndrome. The wife indicated that Mr. Ali had complained of nausea when they were in the house. When I was notified of their case, I immediately ushered them into the emergency section of the clinic for further diagnosis and treatment that could save the patient. Acute Coronary syndrome is treatable only when it is diagnosed quickly (Cunningham, 2004). In advanced nursing consultation and decision making, reflection is an integral part of training (RCN, 2010). It is an active procedure of viewing your own experience so as to review it later. In this case study, I used Driscoll’s reflection model (1994) due to its easy format of 3 questions. The first question is ‘what?’, which will trigger such questions as “what did I see”, what was my reaction to the patient condition? The second part the question would be ‘so what?’ which guided the analysis of the events I did in diagnosing and treating Mr. Ali. Some of the questions that would be asked include what were the effects of what I did or failed to doing. In addition, ‘Now what?’ is the final part of the model. It deals with the proposed actions that follow the events. The questions are used to assist the nurses in their procedure of handling the patient. They are also perfect since they initiate a thoughtful reflection process by motivating deeper analysis that leads to the formation of a future action plan. Background Advanced Nurse Practitioner focuses much on the patient ensuring that they are safe from danger. Advanced Nurse Practitioner has high demand currently. However, Advanced Nurse Practitioner needs to be highly skilled so that they can understand their roles and environments. Evaluation of Advanced Nurse Practitioner roles is a complicated process. However, their main aim is focusing on the patients health and needs. An Advanced Nurse Practitioner (ANP) is a highly qualified nurse with postgraduate education and experience that prepares them for highly specialized roles (White, 2010). According to the Royal College of Nursing (2012), nurses who were initially registered to perform certain roles are diversifying their areas of practice and working at advanced levels. This has been an improvement in the health service nowadays (White, 2010), which has enhanced positive health outcomes and promoted service delivery. When nurses work at an advanced level, they are able to make autonomous decisions (Overbaugh, 2009, p. 47). The ANPs are responsible for making decision on what form of treatment and health care patients require. This is based on their advanced knowledge and skills in nursing (RCN, 2010) ANP screen patients to know the risk factors and symptoms associated with certain diseases (White, 2010). They then make differential diagnosis by utilization of acquired and learnt decision making skills (Tate, 2007). The Royal College of Nursing (2012) notes that the ANP is the initial person of contact with the patient. He or she deals with the issues brought by the patient. It is their duty to know the history of the health of the patients using important process such as the hypothetic – deductive theory. They are able to offer diagnosis to the patients through the interpretation of lab results. The ANP also order for a therapeutically plan of care where necessary. Shared Decision Making is a process in which patients are encouraged to participate in selecting appropriate treatments or management options (Aqua, NHS, 2012). Aim My aim is to assist all patients by raising their health conditions. I will also apply my skills in assisting the patients who have Acute Coronary Syndrome. This is possible by studying a patient case study. In this case study, the heart physiology, pathophysiology is described. The consultation and framework used will also aim at improving the health condition of the patient. in this case, we will dwell on illness model, the three function model (Beaumont, 2012), Helman’s Folk model (Tate, 2007), Scott and Davies (Beaumont, 2012). Perfect decisions should be made to ensure that the patient’s condition is maintained. The decision making process should be descriptive, normative and prescriptive (Thompson & Dowding, 2002). Normal Heart Physiology The heart is a specialized fist shaped organ located in the thorax, between the lungs and above the diaphragm, lying behind the sternum and being surrounded by the pericardium and weighing normally about 250-300 grams (Porth, 2010). The aorta, the superior and inferior vena cava the pulmonary artery and vein ensure that the heart is served with blood. This is by the smooth blood flow in and out of the heart (Preston and Wilson, 2012) and the heart receives deoxygenated blood from the body via the veins, pumping it first to the lungs for oxygenation, and then on to the body via the arteries. The heart is divided into four chambers, the left and right atria and the left and right ventricles which lie beneath them. Four valves (the tricuspid, the mitral, the pulmonary and the aortic) control the flow of blood to and from the heart. Just like any other muscle the heart requires a good blood supply (White 2010). This comes via the coronary arteries (Porth, 2010). Which must be functioning properly if the heart is to do its work properly (Woo & Schneider, 2009). Heart Pathophysiology: ACS Occurrence and Altered Physiology The altered physiology of chest pain will be looked at as it is the main symptom of ACS. According to Green and Hill (2014), two pain syndromes result from stimulation of visceral or somatic afferent pain fibres. Somatic pain fibres innervate the skin layer, dermis and parietal pleura. These pain fibres are organized in dermatome patterns and they enter the spinal cord at certain levels. Internal body organs contain the visceral pain fibres. They enter the spinal cord at dermatome patterns. Pain associated with somatic nerve fibres is unique in that it can be easily traced. It is normally felt as a sharp sensation. Pain associated with visceral nerve fibres is hard to trace and is not exactly localized (Green & Hill, n.d. 2014). As a result it is common for patients to find difficulties in explaining what is aching and feeling pain. It is common for patients to mistake its origin too. This is because it normally is referred to another area in the body which corresponds to a bordering somatic nerve (Woo & Schneider, 2009). In our case, Mr. Bahmani expressed pain on the left arm. This is an example of a misinterpretation of its origin. Acute Coronary Syndrome occurs in different forms which depend upon the effect of the blockage of the coronary artery on the affected part of the heart muscle and the cause (White 2010). The condition varies in severity from unstable angina to myocardial infarction (M.I.). In the case of an M.I. the case is complicated since in some cases, the smaller branches of the coronary artery are blocked. However, it may be sudden or take a long time. The artery also can suddenly get blocked. There are several types of M.I. which are designated according to the tracing obtained from an electrocardiogram (E.C.G.). The two main types are where there is non-ST elevation (NSTEMI). The next type is where ST elevation is present (STEMI). In the case of unstable angina the blockage to the artery is only partial, although blood flow is reduced (White 2010). The word ‘infarction’ refers to the death of the tissue because of the absence of blood flow beyond the blockage. This is also referred to as a coronary thrombosis or heart attack (Porth, chapter 20, 2010). The degree of infarction is determined by the position of the occlusion which establishes the area at risk. It also is determined by the acuteness and period of myocardial ischemia (Hamm, 2014). In unstable angina where the patients experiences pain at rest around 10% of them have an occluded culprit artery at the moment of presentation (Hamm, 2014). What? On approaching Mr. Ali, he was sweating and breathing deeply. This was evident through the movements of his chest while he was breathing in and out. I calmly introduced myself after which I noted that he immediately held his chest and shut his eyes tightly, an indication of pain (Overbaugh, 2009, p. 44). According to Eldarir & Abd el Hamid (2013), the right method of evaluation is significant in achieving correct result and making the right judgment. The observations on physical examination recorded at the time of admission are indicated in table 1. Table 1: Respiratory Rate (Breaths/minute)/ Normal Respiratory Rate (12 to 16 breaths/minute) 16 breaths/minute Blood Pressure (mmHg) (Normal ambulatory BP during the day is 135/ Read More