Key Assessments for Violet
Clinical reasoning cycle can be explained as the systematic framework that guides nursing professionals to develop evidence based care plans that meet up of the healthcare needs of the patient and accordingly help the patient in living better quality lives. This cyclical framework advises nurses to first identify the cues and symptoms of the patients and the, relate them with their health concerns and the disorders they have. Following these, the nursing professionals need to set nursing priorities which mainly help in attending the main health concerns that needs care on an urgent basis. Following this, nurses need to set nursing goals and develop evidence based care plans that help patients overcome their suborders and achieve holistic health. In the case study it is seen, that the patient named Violet is a 77 year old woman who has been admitted to the ward with Acute Myocardial Infarction (AMI). With thorough treatments by the experts of the emergency ward, she is now stable. The patient history reveals that she is also suffering from hypertension as well as osteoarthritis. Both the disorders are not been able to be managed by the patient successfully and hence they have impacted her life making it difficult for her to continue her activities of daily living. She is residing currently in her own apartment on the third floor that has no lift. This is yet another concern for the patient as her restricted mobility due to osteoarthritis might make it difficult for her to climb up or down. This would ultimately make her socially excluded which would in turn affect her mental stability.
One of the most important tests that the nurses need to conduct is an ECG or electrocardiogram. This test helps nurses to diagnose the current condition of the heart. This is mainly done by recording the electrical activity of the heart. This system mainly utilizes a system of electrodes which are attached to the skin and this helps in recording the impulses (Fors et al., 2015). It has been found that the system of ECG mainly helps in revealing the information about whether the heart is facing the acute myocardial infarction or whether it is in progress. Injured muscles of the heart cannot conduct electrical impulses and ECG works through identifying such impulses and helping professionals to understand the condition of the heart. Another important test that can be also conducted for Violet to know about her health condition is the blood test. It has been found that there are important proteins in the heart which gets leaked into the blood when the heart gets damaged (Boyde et al., 2015). Nurses can also follow the blood test report to find out whether those proteins are found in abnormal conditions in the blood. This would also help nurses to identify whether the heart conditions are still at the risk or is out of danger.
Nursing Goals, Interventions, and Rationales
Another important assessment is to develop an idea about the present condition of osteoarthritis in the patient named violet. Nurses would first need to identify the pain level of the patient so as to relieve her from the pain and also develop proper care interventions to relieve her from the pain (Finney et al., 2016). For this, the pain assessment tool can be used where patients are asked to provide score to their pain level from 0 to 10 with zero being complete absence of pain to 10 being high level of unbearable pain. Another important assessment that also needs to be conducted for Violet is the fall risk assessment (Fors et al., 2016). She is suffering from excessive pain from osteoarthritis which had restricted her activities of daily life and mobility. Hence, she might be at increased risk for fall both in the hospital as well as in her apartment. Hence the FRAT tool or the Fall Risk Assessment Tool can be used which incorporates assessing three important segments. These are the Part 1 – falls risk status; Part 2 – risk factor checklist; and Part 3 – action plan. With the help of the score, the nurses can accordingly set up precautionary measures and prevent the patient from any form of additional harm.
Nurses should constantly measure the vital signs from time to time. This assessment would provide a detailed account of her body temperature, blood pressure, respiratory rate, saturated oxygen level as well as heart rate. Measuring the blood pressure is extremely important in order to assess the present blood pressure of the patient (Bray et al., 2016). It has been found that nurses need to consider an average of three blood pressure readings that would be taken 2 minutes apart with the use of the mercury manometer. In this way, the current blood pressure of Violet needs to be taken and accordingly care plans would be to help her bring her blood pressure under control.
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Nursing goals |
Nursing interventions and nursing rationale |
Evaluation |
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Violet has suffered from acute myocardial infarction and therefore, she might be at an increased risk for decreased cardiac output. This can result in inadequate blood pumped up by the heart which in turn might affect the metabolic needs of the body. Hence, the nurses need to set goals for the management of the risks for the decreased cardiac output |
· The nurse would need to monitor both the heart rhythm as well as the heart rate. She would also need to document any dysrhythmias with the help of the telemetry. The main reason behind this intervention is that both heart rate as well as heart rhythm responds to different types of medication as well as activity and other developing complications. Studies have also found that dysrhythmias compromise cardiac function as well as increase in the cardiac function or increase in cardiac damage (Falsini et al., 2018). · Nurses also would need to administer supplemental oxygen as indicated. the main rationale is that it would help in increasing the amount of oxygen which is important for that of the myocardial uptake. This would also help in reduction of the ischemia and other types of resultant cellular irritations and dysrthymias (Hardin et al., 2019). · The patient should be given small as well as easily digested meals and all forms of caffeine containing products should be limited in the diet of the patient. Studies have found that large meals have the capability in increasing the different forms of myocardial workload and can also result in bradycardia or ectopic beats (Harris et al., 2015). It is also found that caffeine acts as direct cardiac stimulant. This can thereby increase the heart rate and affect the health of the patient. |
The nurses would need to evaluate the results of serial ECGs as this would help in providing information regarding status of ventricular function, electrolyte balance, progression or resolution of infarction, and effects of drug therapies. The nurse can also review chest x-rays from time to time to find out whether any pulmonary edema is present or not due to ventricular dysfunction. |
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Violet is suffering from pain due to unmanaged osteoarthritis which might also increase his chances of fall because she is also facing mobility issues. Hence, the nursing goal would be to manage osteoarthritis and fall risks. |
· The nurse should first allocate physiotherapists who would be undertaking physiotherapy sessions of exercises as well as hot and cold compress to relieve the patient from pain (Nunes et al., 2016). He may also recommend the patient a functional knee or ankle brace as this helps in supporting the joints. He would also help the patient to learn to walk with crutches, a walker, or cane when needed · In order to reduce the chances of falls of the patient, the nursing professionals should modify the layout of the rooms. Rooms should be brightly lit along with support systems like hand bars, bathrooms rails, lowered height of the bed and many others (Briani et al., 2018). Nurses should also provide non-skid shoes to reduce the risk of fall. Clutters should be removed from the floors as well |
The pain assessment scale would be used to analyze the pain level of the patient. reduction of pain and participation of activities of daily lives can help nurses in understanding whether patient is overcoming pain issues. |
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The patient is suffering from high pressure and the next nursing goal would be managing hypertension |
· The nurse should be providing diuretics or water pills. The main rationale is that the medication helps in eliminating unneeded water as well as salt through that of urine. Studies opine that getting rid of excess salt and fluid would help in lowering the blood pressure thereby making it easier for the heart in pumping blood (Inamdar et al., 2016). · Another set of medication that can be also provided is the beta-blockers. The main rationale behind using this drug is that it helps in blocking the effects of the sympathetic nervous system on the heart and thereby lowers the blood pressure (Porcherett et al., 2018) · Another set of drugs that can be also provided is Angiotensin converting enzyme (ACE) inhibitors. These drugs mainly work by dilating the blood vessels and improving the amount of blood that is pumped by the heart. This helps o lowering of blood pressure |
Blood pressure should be measured from time to time to find out whether blood pressure is coming under control or not. |
The patient should be educated about the importance of diet and lifestyle modifications as both of them are found to be intricately associated with the management of heart disorders as well as hypertensions. This might include avoiding salty foods for reducing blood pressure, avoiding fatty and cholesterol containing foods, depending more on fruits and vegetables, staying away from fast foods and many others. The patient should be also educated about importance of physical activities (Conn et al., 2015). Physical activities are also found to be intricately associated with lowering of the blood pressure and reduction in the chances of AMI. Studies are of the opinion that cardiovascular exercises such as running, biking as well as swimming for at least 30 minutes can help in reduction of the blood pressure. As the patient is suffering from osteoarthritis, running might not be a good option and so brisk walking for 30 minutes can be advised to her when her health conditions become stable (Von visger. For handling osteoarthritis, the patient should be educated about the importance of weight loss and weight managements. Excessive weights put pressure on joints making them vulnerable to developing osteoarthritis. Hence, nurses can advise her to lose weight. With the help of the physiotherapists, nurses can educate physical therapy and exercise sessions that can help in improving and strengthening the muscles surrounding the joints. Freehand exercises, swimming and cycling can be instructed (Jung et al., 2017). The patient can be also educated about the use of assistive devices like Canes, walkers, electric-powered seat lifts, raised toilet seats, and tub and shower bars and should be requested to use them to reduce fall risks. Besides, importance of taking all medications at the right time, regular participations in the screening sessions and others should be educated so that she feels empowered and manage herself properly.
Evaluation
Violet is suffering from multiple chronic health conditions and therefore, she would need the service of different experts from multi-disciplinary healthcare team. Apart from the nursing professionals, the patient would be attended by cardiologist. The nurses would be reporting about the heart conditions of the Violet to the cardiologist and would be acting according to the advices of the cardiologist only. She would be also attended by physiotherapists who would be helping her with the different exercises that would enable her to regain back her mobility and reduce pain. Hot and cold compress methods would be also taught to her (Fortuna et al., 2015). Physiotherapists would teach her the ways to maintain body mechanics and the ways for developing her gait. Occupational therapists should be also included in the team. Occupational therapists help in the teaching the patient different ways by which the strain in the joints can be reduced during the daily activities. They also participate in modifying the home of the patients in ways that can prevent aggravation of her arthritis situations. They mainly help the patients to come in back in normal lives by helping the patient to participate in activities of daily lives and helping them in regaining back independence in different actions like bathing, dressing and maintaining the house (Devenhorn et al., 2015). A dietician should be also involved as patients who had suffered from Ami. She needs to take light meals and dieticians can help the team to plan her meal. He would be also helping in developing a food diet chart that would help in reducing blood glucose level. Social aides can be allocated to take care of her and conduct all household chores on behalf of the patient as he has no extended families to help her. She would be doing the shopping as Violet would not be able to climb stairs until her osteoarthritis is under control.
References:
Boyde, M., Grenfell, K., Brown, R., Bannear, S., Lollback, N., Witt, J., … & Aitken, L. (2015). What have our patients learnt after being hospitalised for an acute myocardial infarction?. Australian Critical Care, 28(3), 134-139.
Bray, B. D., Cloud, G. C., James, M. A., Hemingway, H., Paley, L., Stewart, K., … & SSNAP collaboration. (2016). Weekly variation in health-care quality by day and time of admission: a nationwide, registry-based, prospective cohort study of acute stroke care. The Lancet, 388(10040), 170-177.
Briani, R. V., Ferreira, A. S., Pazzinatto, M. F., Pappas, E., Silva, D. D. O., & de Azevedo, F. M. (2018). What interventions can improve quality of life or psychosocial factors of individuals with knee osteoarthritis? A systematic review with meta-analysis of primary outcomes from randomised controlled trials. Br J Sports Med, 52(16), 1031-1038.
Conclusion
Conn, V. S., Ruppar, T. M., Chase, J. A. D., Enriquez, M., & Cooper, P. S. (2015). Interventions to improve medication adherence in hypertensive patients: systematic review and meta-analysis. Current hypertension reports, 17(12), 94.
Drevenhorn, E., Bengtson, A., Nyberg, P., & Kjellgren, K. I. (2015). Assessment of hypertensive patients’ self?care agency after counseling training of nurses. Journal of the American Association of Nurse Practitioners, 27(11), 624-630.
Falsini, G., Grotti, S., Porto, I., Toccafondi, G., Fraticelli, A., Angioli, P., … & Romanelli, S. (2018). Long-term prognostic value of delirium in elderly patients with acute cardiac diseases admitted to two cardiac intensive care units: a prospective study (DELIRIUM CORDIS). European Heart Journal: Acute Cardiovascular Care, 7(7), 661-670.
Finney, A., Healey, E., Jordan, J. L., Ryan, S., & Dziedzic, K. S. (2016). Multidisciplinary approaches to managing osteoarthritis in multiple joint sites: a systematic review. BMC musculoskeletal disorders, 17(1), 266.
Fors, A., Ekman, I., Taft, C., Björkelund, C., Frid, K., Larsson, M. E., … & Swedberg, K. (2015). Person-centred care after acute coronary syndrome, from hospital to primary care—a randomised controlled trial. International journal of cardiology, 187, 693-699.
Fors, A., Taft, C., Ulin, K., & Ekman, I. (2016). Person-centred care improves self-efficacy to control symptoms after acute coronary syndrome: a randomized controlled trial. European Journal of Cardiovascular Nursing, 15(2), 186-194.
Fortuna, R. J., Nagel, A. K., Rose, E., McCann, R., Teeters, J. C., Quigley, D. D., … & Rocco, T. A. (2015). Effectiveness of a multidisciplinary intervention to improve hypertension control in an urban underserved practice. Journal of the American Society of Hypertension, 9(12), 966-974.
Hardin, S. R., & Kaplow, R. (Eds.). (2019). Cardiac surgery essentials for critical care nursing. Jones & Bartlett Publishers.
Harris, H., & Crawford, A. (2015). Recognizing and managing osteoarthritis. Nursing2018, 45(1), 36-42.
Inamdar, A., & Inamdar, A. (2016). Heart failure: diagnosis, management and utilization. Journal of clinical medicine, 5(7), 62.
Jung, H., & Lee, J. E. (2017). The impact of community-based eHealth self-management intervention among elderly living alone with hypertension. Journal of telemedicine and telecare, 23(1), 167-173.
Nunes, S., Rego, G., & Nunes, R. (2016). Difficulties of Portuguese patients following acute myocardial infarction: predictors of readmissions and unchanged lifestyles. Asian nursing research, 10(2), 150-157.
Porcheret, M., Main, C., Croft, P., & Dziedzic, K. (2018). Enhancing delivery of osteoarthritis care in the general practice consultation: evaluation of a behaviour change intervention. BMC family practice, 19(1), 26.
Von Visger, T., Thrane, S., Klatt, M., Dabbs, A., Chlan, L., & Happ, M. B. (2016). Feasibility and Acceptability of Integrative Therapy for Management of Symptoms in Persons with Pulmonary Hypertension.
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