Nurses play a very important role in managing a patient from the moment of his admission up to making a discharge plan. Each part of the nursing process is vital to the wellbeing of the person he is taking care of. Clinical reasoning is always essential in each part of the nursing process from assessment, setting up goals and intervention. Effective nursing management is done when a nurse looks for the early and right cues at the right patient and implementing it at the right time. This essay will delve deeper into the case of Rob Geis, a patient who was suffering from angina, given his history and the signs and symptoms he experienced up to the time when his condition worsened to Myocardial Infarction. This essay will also look into how the nurse should provide effective nursing care to the patient with this condition.
Etiology and Pathophysiology of Angina
Angina is pain felt in the chest area as a result of lack of inadequate supply to the myocardium (Better Health Channel, 2013) Atherosclerosis or the hardening and narrowing of arteries caused by the build-up of plaques, the insufficient supply of oxygen and its increasing demand are some of the factors that can cause ischemia in the myocardium (Lewis et al., 2012). When there is a total blockage of the coronary arteries for a few minutes, the myocardium cannot receive oxygen and glucose for aerobic metabolism thus anaerobic metabolism occurs (Lewis et al., 2012). The lactic acid builds up and stimulates the nerve fibres in the myocardium resulting to chest pain (Lewis et al., 2012). The cells are repaired and the aerobic metabolism and the contractility of the arteries are restored when there is return of blood flow (Lewis et al., 2012)
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....). New South Wales: Elsevier Australia.
MedlinePlus. (2010). Atenolol. Retrieved April 4, 2014, from http://www.nlm.nih.gov/medlineplus/druginfo/meds/a684031.html
Rull, G. (2011). Cardiogenic Shock. Retrieved April, 2014, from http://www.patient.co.uk/doctor/Cardiogenic-Shock.htm
Smeltzer, S., Bare, B., Farrell, M., & Dempsey, J. (2011). Smeltzer & Bare's Textbook of Medical-Surgical Nursing (2nd Australian and New Zealand edition ed. Vol. 1): Lippincott Williams & Wilkins Pty Ltd.
WebMD. (2012). Electrocardiogram. Retrieved April 1, 2014, from http://www.webmd.com/heart-disease/electrocardiogram
Williams, B. R., Lewis, D. R., Burgio, K. L., & Goode, P. S. (2012). Next-of-Kin's Perceptions of How Hospital Nursing Staff Support Family Presence Before, During, and After the Death of a Loved One. Journal of Hospice and Palliative Nursing, 14(8), 541-550.
Which of the following is used to distinguish the diagnosis of MI (Myocardial Infarction) from that of Unstable angina?
Hinkle, J., Cheever, K., & , (2012). Textbook of medical-surgical nursing. (13 ed., pp. 586-588). Philadelphia: Wolters Kluwer Health
This essay will demonstrate an understanding of the clinical reasoning cycle which describes the procedure by which nurses gather prompts, process the data, come to an understanding of a patient’s problem, design and implement interventions, assess results, and reflect on and learn from the process (Hoffman, 2007; Kraischsk & Anthony, 2001; Laurie et al., 2001). The clinical reasoning cycle consists of five main stages, it comprises of; considering the persons condition, collecting indications and data, processing the information, recognizing problems/issues and detailing the assessment (Levett-Jones 2013). Throughout this essay these five main parts of the clinical reasoning cycle will be discussed and put into context. The first step of
Nurses are both blessed and cursed to be with patients from the very first moments of life until their final breath. With those last breaths, each patient leaves someone behind. How do nurses handle the loss and grief that comes along with patients dying? How do they help the families and loved ones of deceased patients? Each person, no matter their background, must grieve the death of a loved one, but there is no right way to grieve and no two people will have the same reaction to death. It is the duty of nurses to respect the wishes and grieving process of each and every culture; of each and every individual (Verosky, 2006). This paper will address J. William Worden’s four tasks of mourning as well as the nursing implications involved – both when taking care of patients’ families and when coping with the loss of patients themselves.
Ignatavicius, D. D., & Workman, M. L. (2013). Care of Intraoperative Patients. Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier.
It is often hard to give a specific diagnosis for the cause of chest pain. There is always a chance that your pain could be related to something serious, such as a heart attack or a blood clot in the lungs. You need to follow up with your health care provider for further evaluation.
Dougherty, L. & Lister, s. (2006) ‘The Royal Marsden Hospital manual of Clinical Nursing Procedures: Communication 6th Edition Oxford: Blackwell Publishing Ltd
Westhead, C. (2007). Perioperative Nursing Management of the Elderly Patient. Canadian Operating Room Nursing Journal, 25(3), 34-41. Retrieved from http://gateway.library.qut.edu.au/login?url=http://search.proquest.com.ezp01.library.qut.edu.au/docview/274594603?accountid=13380.
Ignatavicius, D. D., & Workman, M. L. (2013). Medical-surgical nursing: patient-centered collaborative care (7th ed.). St. Louis: Elsevier Saunders.
“Persons intentionally choose to become nurses to help patients meet their health needs,” even when the patient is actively dying. (Wu & Volker, 2012) Hospice nursing and palliative care nursing are both considered end of life care. However, hospice nursing is typically given to patients with a terminal illness and who have less than six months to live. Palliative care is typically given to patients with a life threatening illness, and is used to increase the patient’s quality of life. Choosing a nursing career in either hospice or palliative care can be extremely difficult, but will provide an opportunity for great personal growth. At times, an end-of-life caregiver may feel responsible for their patient’s death, or they may feel isolated due to a lack of support. Nurses new to this field should “feel that their unit acknowledges death as a difficult event and that discussion of death is acceptable in the workplace.” (Lewis, 2013) The most rewarding, and also most difficult, part of being a hospice or palliative care nurse is the ability to be a part of your patient and their family’s life, including their loss, grief, and death. (Wu & Volker, 2012)
Davenport, Joan M., Stacy Estridge, and Dolores M. Zygmont. Medical-surgical nursing. 2nd ed. Upper Saddle River, N.J.: Pearson Prentice Hall, 2008, 66-88.
The APRN listens and engages with the patient as care and compassion take place. As the nurse discerns what the patient’s needs are and considers obstacles to achieving optimal care the application of theory is necessary as the process is not always quantifiable. The APRN who does not learn nursing theory may focus primarily on EBP and miss this engagement opportunity with the patient. One may prescribe medication; however, if the patient does not take the medication, then the nurse assumes the patient is noncompliant. The application of Watson’s themes where appropriate helps the APRN discern how to help the patient become compliant. It is necessary to care for the patient outside of the idea of only providing care to understand the obstacle in that patients circumstances and reach improved patient outcomes to any disease
Potter, P. A., & Perry, A. G. (2009). Fundamentals of nursing (Seventh ed.). St. Louis, Mo.: Mosby Elsevier.
The role of the nurse in the preoperative area is to determine the patient’s psychological status to help with the use of coping during the surgery process. Determine physiologic factors directly or indirectly related to the surgical procedure that may cause operative risk factors. Establish baseline data for comparison in the intraoperative and postoperative period. Participate in the identification and documentation of the surgical site and or side of body on which the procedure is to be performed. Identify prescription drugs, over the counter, and herbal supplements that are taken by the patient that may interact and affect the surgical outcome. Document the results of all preoperative laboratory and diagnostic tests in the patient’s record
Although students were not allowed in the recovery unit, I was able to talk to one of the recovery nurses. I learned that a nurse’s duty of care includes monitoring the patient’s vital signs and level of consciousness, and maintaining airway patency. Assessing pain and the effectiveness of pain management is also necessary. Once patients are transferred to the surgical ward, the goal is to assist in the recovery process, as well as providing referral details and education on care required when the patient returns home (Hamlin, 2010).