Identify your first five nursing priorities for Andrew. These priorities should be identified in order of clinical urgency and may include further assessments and/or interventions that can be initiated and conducted by a Registered Nurse.
Order Description
these are some text to use
Berman, A., & Snyder, S. ( 2012). Kozier and Erb’s Fundamentals of Nursing. Melbourne: Pearson Education.
Farrell, M., & Dempsey, J. (2014). Smeltzer & Bare’s textbook of medical and surgical nursing (3rd ed). Sydney: Lippincott Williams & Wilkins.
Lewis, P., & Foley, D. (2014). Weber and Kelley’s health assessment in nursing (2nd ed). Sydney: Lippincott Williams and Wilkins.
Bullock, S. & Hales, M. (2013). Principles of pathophysiology. Frenchs Forest: Pearson.
Case study
Andrew Taylor is a 48 year old high school PE teacher who is due for discharge from the orthopaedic ward following a left knee reconstruction 3 days ago. You are going through his discharge instructions with him when you notice that he seems distracted and looks pale. He tells you that he has been experiencing central chest pain and an uncomfortable tightness in his chest since he woke this morning. Further assessment reveals that he is diaphoretic with cool peripheries, his respiratory rate is 18, heart rate 115, BP 105/60 and SpO2 97% on room air.
This assessment task requires you to submit a report in which you discuss your initial assessment and management of Andrew. In addition to a brief introduction and conclusion, your report should address the following:
• Chest pain is a very serious clinical manifestation and should always be considered to be caused by myocardial ischaemia until proven otherwise. Discuss how you would use the PQRST mnemonic to conduct a systematic assessment of Andrew’s chest pain. This discussion should incorporate any relevant information already provided in the case study and any additional information you would seek as part of your assessment.
PQRST mnemonic – what is PQRST? Why is it useful in chest pain assessment? What do you assess for each stage? What does the case study tell us about each stage? What additional information do you need.
• Identify your first five nursing priorities for Andrew. These priorities should be identified in order of clinical urgency and may include further assessments and/or interventions that can be initiated and conducted by a Registered Nurse.
After you have assessed the chest pain, what would you do next? Intervention – something that you do for the patient to improve their condition. Sitting up, administer medications, patient education, wound dressing etc. assessment – something that you do to obtain additional objective or subjective assessment. Vital signs, BGL, additional history, GCS etc.., what order will you do them and why? Clinical urgency (ABCDE)
• Acute Coronary Syndrome (ACS) is a term used to identify a group of conditions caused by common underlying pathophysiology. For each of the priorities you have identified, provide a rationale that explains how it will address or is linked to the underlying pathophysiology of ACS.
Subheading are good and recommended
Point form and tables are not
Use appropriate terminlology
Heart attack – mycocardial infaction
Bloodstream – intravasucular compartment
Shock- what type of shock
Septic – sepsis septic shock
You must support your discussion with a MINIMUM of 12 recent (less than 7 years old) and credible sources. Credible sources include the following:
• peer reviewed journal articles
• text-books, evidence summaries
• best practice guidelines,
• government documents
• health facility clinical guidelines, pathways and policies/procedures
• websites containing content aimed at health professionals. (edu, org, edu)
Prescribed text(s)
Berman, A., & Snyder, S. ( 2012). Kozier and Erb’s Fundamentals of Nursing. Melbourne: Pearson Education.
Farrell, M., & Dempsey, J. (2014). Smeltzer & Bare’s textbook of medical and surgical nursing (3rd ed). Sydney: Lippincott Williams & Wilkins.
Lewis, P., & Foley, D. (2014). Weber and Kelley’s health assessment in nursing (2nd ed). Sydney: Lippincott Williams and Wilkins.
Bullock, S. & Hales, M. (2013). Principles of pathophysiology. Frenchs Forest: Pearson.
Rationale
This assessment tasks addresses the following subject learning outcomes:
• be able to collect, interpret and document subjective and objective assessment data in the acutely ill person
• be able to link the underlying pathophysiology of selected acute health challenges to their clinical manifestations .
• be able to apply theoretical knowledge, critical thinking, problem solving and the use of best evidence to the planning and implementation of safe and appropriate nursing interventions for people experiencing selected acute health challenges
Marking criteria
Explains Systematic Chest Pain Assessment using the PQRST Mnemonic
In your report, you have: Provided an accurate and detailed discussion of the use of the PQRST mnemonic to assess chest pain, with all of the relevant assessment data from the case study identified and explained. And identified all of the additional assessment data you would need to obtain and clearly explained how you would obtain this information.
Minimising cardiac workload – restricted activity, strict adherence to noise/light levels, rest periods, number of visitors at a time, analgesia, strict fluid balance.
Close monitoring – care of the puncture site (fem/rad), cardiac rhythm monitoring, peripheral IV Access x2, regular blood pathology sampling, watching for complications (ACS, angio, anti- coegs, GTN infusion) daily 12 lead ECG, daily review by cardiologist
Identifies and Prioritises First Five Nursing Assessments or Interventions
In your report, you have: Clearly identified five safe and appropriate nursing assessments or interventions And Prioritised nursing care in accordance with current best practice And Consistently provided rationales that include clear justification of your reasons for prioritising care in this order.
Linking Nursing Priorities to the Underlying Pathophysiology of ACS
In your report, you have: Provided comprehensive and accurate rationales that consistently make substantial links between the selected assessments or interventions and the underlying pathophysiology of the patient’s condition.
Explains the Pathophysiology of Acute Coronary Syndrome
In your report, you have: Provided an in-depth and accurate discussion of all of the relevant disruptions to normal physiology that occur in ACS. All aspects of the discussion are specific to the patient in the case study, with clear links made to the abnormal assessment findings.
Use of Evidence to Support the Discussion.
An extensive range of current and highly appropriate sources have been located, evaluated and integrated to substantially support the discussion.
Academic Writing and Presentation
The report adheres to all of the presentation requirements stated in the Subject Outline There is use of formal language and correct
Nursing terminology throughout And The content is logically and succinctly structured to create a coherent and integrated report And There are no mistakes in grammar, spelling or punctuation.
Referencing
All sources are explicitly acknowledged in-text. And/or APA guidelines for in-text referencing and the reference list are consistently adhered to. And/or All sourcescited-in text match those cited in the reference list.
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