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SNPG962 Clinical Judgement and Reasoning: Case Study Assessment 2 Answer

University of Wollongong Australia

SNPG962: Clinical Judgement and Reasoning

SCHOOL OF NURSING

FACULTY OF SCIENCE, MEDICINE & HEALTH

OVERVIEW

Assessment 2Case study
Weighting40%

Submission
Your assignment will be submitted into Turnitin submission boxes within the SNPG962 Moodle site. You will have the opportunity to review and re-submit your assignment up to the due date and time.
To learn more about how to use Turnitin please access the resources at the following link: http://www.uow.edu.au/dvca/ltc/tel/resourcehub/students/index.html
Type of CollaborationIndividual Assessment
LengthSuggested word length 2500 words


Details
The objective of this assessment is to discuss your ideas related to a focused health assessment of your case study patient. A focused health assessment concentrates on a specific area of concern, for example if a patient is breathless, then your assessment
should include a respiratory/cardiovascular and functional assessment. From the attached case studies, select one case that you find interesting. Your case study will 
include a number of findings that will assist you in discussing your case study patient.
Your case study should include the following;
  1. Describe the sequencing of your proposed assessment.
  2. In relation to the health history, what questions will you ask? How do these inform your proposed assessment?
  3. Analyse the findings of both the health history and the focused health and clinical assessment and relate these findings to the underlying disease pathophysiology.
  4. Formulate the nursing interventions for your selected patient using appropriate evidence based nursing literature to support your care decisions.
It is essential that a clear relationship between the health history, the assessment and the process of care be outlined in your case study. Your case study must demonstrate your clinical judgment

Style and formatCase study report


Subject Learning Outcomes
  1. Demonstrate clinical judgment through the overt association connecting health history,
assessment and nursing care;
  1. Relate the processes of clinical assessment to the delivery of patient care, by selecting and implementing appropriate assessment techniques;


Answer

CASE STUDY ANALYSIS


Executive summary

Health assessment plays an important role in the identification of diseases. In this report, there is a case study where a patient is suffering from myocardial infarction (MI). The patient-centred approach has possessed huge importance as it deals with respect, response as well as preference towards the individual patient. Sedentary lifestyle, unhealthy daily routine, excessive intake of fast food, high involvement of the technology regarding the physical activity in the daily life induces the chances of heart diseases. In this study, there is an analysis of all the findings related to the patients. Relationship of myocardial infarction (MI) heart diseases to the pathology of the ailment has been also described in this study. There is an analysis of health assessment on George that has been conducted in the hospital by an experienced nurse in order to get deep as well as relevant information regarding these health issues.

Introduction   

A patient-centred approach is a process where the patients are effective cares by the experienced professional in the respective field. This approach has possessed huge importance as it deals with respect, response as well as preference towards the individual patient. In addition to that this approach fulfils all the needs and demands of the patients. In this approach, there is an attachment of the patient's family as well as a friend which leads to emotional comfort to the patients. In this study, there is a case study which deals with a patient who has been suffering from some severe symptom of heart diseases such as excessive sweating, nausea, shoulder pain and arm pain. All of the symptoms of the patients indicate the myocardial infarction (MI) disease as well as right radial artery blockage. The ailment has been confirmed by the doctor. In this study, there is an analysis of all the findings related to the patients. Relationship of myocardial infarction (MI) disease to the pathology of the ailment has been also described in this study. In addition to that, there is a description of care in the form of a plane in the context of the diseases in this study. The patients have been gone through coronary angioplasty surgery via right radial artery in order to resolve the problem in the body. 

Findings   and   relationship to pathology 

Myocardial infarction (MI) disease is a condition where the artery of the heart is blocked through the deposition of several things such as LDL (Low-density Lipoprotein), cholesterol, Trans-fat and many others. In addition to that the blockage is known as arterial plaque. According to Rittger et al. (2015), sedentary lifestyle, unhealthy daily routine, excessive intake of fast food, high involvement of the technology in the daily life induces the chances of heart diseases in the earth. In the case study, the patients have been suffering from heart diseases. George is a descendant of Greece and he is suffering from nausea, back shoulder and arm pain from the last week. The patient has been admitted by his wife in the hospital since George showed the symptom of myocardial infarction (MI) disease (Heart attack). In addition to that, he is suffering from excessive sweating. It has been also noticed that his body has become pale as compared to this normal gesture. This has led the health team to subject George towards certain pathological test. The result of the pathological tests has revealed that his blood pressure is 174/100 that indicates he has been suffering from hypertension at this time.  His serum cholesterol level is 7.2 mmol/L. The cholesterol level above 6.2 mmol/l is considered very high in the medical field (Mayoclinic.org, 2019). His LDL level is 6.2 that is also above the desired level of the mark. LDL is lipoprotein that is considered as the harmful in the context of the heart. The HDL (High-Density LipoProtein) level of the patient is 0.7. As per the viewpoint of Hirose et al. (2016), HDL is a type of lipoprotein that is considered as the friend of the heart. The level of his fasting triglyceride level is 5.9 mmol/L. 

All the blood test reports of George is running towards the negative impacts of the health. The general physician has advised him for changing the lifestyle in order to keep a healthy heart. In addition to that, all the report also indicates that the condition of the heart of George is not well. The GP has also advised him to do ECG in order to identify the condition of the heart. 

After the general enquiry of health by the General physician, George has been asked several questions by the professional nurse of the hospital in order to get more information about the issues. The specialist nurse has first introduced herself to George then asked a few questions. The below table has included all the questions as well as the rationale to George. 

Questions
 Rationale

  1. How do you feel today?
This is a polite way in order to introduce you to the patient. In addition to that, it helps for creating a good rapport between the physician and the patient.
2. Which part of the body has been affected by pain?This part of the question has been asked in order to identify the area of problem of the patient. 
3. Can you describe the chest pain in details?In order to get more deep information about the symptoms and signs of the patients.
4. At first, George has provided some word in order to describe his pain such as dull, sharp, taught, pressure, stabbing, burning, and ache. Then he has been asked Which of the word will be appropriate in order to describe the pain?

Pain is considered as one of the most common causes for the patient for seeking health services. In this context, the intensity of the pain has to be identified by the health physician for conducting the proper treatment.  In addition to that, the history of the patents has to analyse for better understanding the cause. 
5. Do you feel pain only to the upper shoulder and neck part of the body?
Is this pain associated with the other problem?

In order to gather more information regarding the pain. In some instances, the area of the pain is not the main cause of the pain. Hence the detailed information regarding the pain can help to reduce the consequences.
6. What kind of pain you are suffering? Pain is a prominent symptom of any disease. Hence it is important to understand the details about the pain patient. 
7. In addition to the upper shoulder and neck pain is there any other related symptoms?If there is any other symptom instead of diarrhoea the medication will be different in order to reduce both the symptom.  
 8. Are you under any kind of medication? In order to get information about the medicine that has already been taken. It can help in the next medication schedule of the patient.     
9. If yes then please specify the details? 

In order to prescribe proper medicine, it is important to know the medical history of the patient. In addition to that, all the doses and type of medicine has some impact on the treatment. 
10. Have you carried any history of the surgery in the past? If yes then specify the details?The previous history of the surgery can be the reason for the current pain in his chest. Hence, in this case, it is important to know the past history of the surgery.
11. Do you smoke or consume alcohol? This part of the question can be an additional reason for the diseases of pain. Alcohol can induce health hazards. I addition to that smoking has a very negative impact on the body as well as it can decrease the health condition.  
12.  Have you suffered from the loss of weight recently?Losing weight can indicate a specific symptom of certain diseases. It also identifies if the patients are healthy or not. As the patient is suffering from diarrhoea as well as nausea then he may suffer the loss of weight. 
13. What is your weight now? It is important in order to identify if the patient is underweight or overweight.

As per the viewpoint of Xu et al. (2016), a health assessment is a perfect analysis of the health of the patient in order to conduct a perfect manner of the treatment. As per the health assessment by the experienced nurse, it can be seen that George has been admitted in the hospital as he is suffering from the chest pain as well as pain in the back shoulder and in the upper arm. George has a family history of heart diseases as his father and mother have died due to cardiac arrest. In addition to that uncle of George has done with heart surgery last year after a massive heart attack. As per the viewpoint of Her et al. (2016), hence it can be concluded that George has been shown a family history of heart diseases. Besides the chest and shoulder pain, George has been suffering from the symptom of nausea and excessive sweating last week. The intensity of the pain is so severe that he has to be admitted to the hospital last week. In the hospital, the doctor has prescribed several tests in order to get the root cause of the pain and problem. After arriving in the hospital, PQRST method has been conducted by the nurse in order to determine the severity of the pain. George has been experiencing a 9/10 score of the pain as per the nurse. George has been inserted by two large gauges of IVC. 300 mg of aspirin, PRN IV morphine and sublingual GTN have been given as the medicine. The ECG result has been showing a little elevation of V3 and V4. All the pathology result has been indicating a moderate rise of troponin I and T. After the analysing all the result of the ECG and pathology George has been transferred in the coronary catheter laboratory in order to conduct primary PCI. In this laboratory, George has been preceded with coronary angioplasty through the right radial artery by the insertion of 2 x stents into his LAD. After this operation George has been transferred to the coronary care unit in order to proper cardiac monitoring as well as assessment. 

Plan of Care 

As per the case study, it has been identified that George has been suffering from myocardial infarction (MI) disease and he has been transferred to the coronary care unit as he has some severe pathological report such as high Blood pressure, high cholesterol, high triglyceride and many others. According to Dallan, Pereira & Bezerra (2019), a proper plan of care has been included in this report in order to mitigate the health hazards. 

Aim of the plan 

The main aim of the plan is to provide a proper health care guideline to George so that he can improve all of his health complications in an easy as well as quick manner. As George is in severe condition of the myocardial infarction (MI) disease then the main aim of this health plan is to reduce the severity of the health complication. As per the viewpoint of Rosario-Quinones et al. (2015), in order to mitigate the health hazards should be mitigated with a proper health plan. As seen in the case, George has to bring change in several parts of his life such as food habit, addiction habit, daily lifestyle habit and many others. 

Modification of the life cycle

Lifestyle plays an important inducing factor of myocardial infarction (MI) disease. As per the viewpoint of Mäkikallio et al. (2016), a disciplined lifestyle can reduce the severity of health issues. Heart blockage mainly occurs due to unhealthy substances in the blood mainly bad cholesterol, triglyceride and LDL. George has to take care in order to control myocardial infarction (MI) disease. 

Food habit modification

Food habit plays an important role in the plane of care for patients of myocardial infarction (MI) disease. George has to take more fibrous food that contains more amount of dietary fibre. From the viewpoint of Byrne et al. (2017), dietary fibre has the capacity to absorb the bad cholesterol as well as triglyceride from the blood and this leads to reducing heart diseases. George has to reduce the amount of oil in daily food. In addition to that, he also has to reduce the amount of alcohol consumption as it induces the complication of heart diseases. George has to reduce the amount of smoking as it also induces heart hazards.

Proper weight management

George has to control his weight in an appropriate manner. It has been revealed from the case study that he has BMI 29 and he has the chest circumference of 100 cm. Hence George has to be very careful about weight management in the context of his healthcare plan. According to Majumder et al. (2017), obesity is one of the factors of the IHD. Exercise has to be included in the daily routine of George after consulting with the physician. 

Follow the proper guideline

In addition to modification of the life cycle, food habit modification and proper weight management George have to completely follow all the guideline that has been measured by the doctor as well as health physician. As per the viewpoint of Magarkar & Lathi (2016), proper medication, as well as time management is an important part of the treatment of myocardial infarction (MI) disease as well as ischemic heart diseases.  

Conclusion  

 The myocardial infarction (MI) disease is a severe heart disease in which patients has been suffering from chest pain, nausea, breathing problem and many others. It is a condition where the blood clots have been deposited in the inner portion of the artery. They are known as plaque.  From the case study, it has been identified that George has been suffering from myocardial infarction (MI) disease as he is transferred to the coronary care unit.  The health assessment approach is a process where the patients are effective cares by the experienced professional in the respective field. In this study, there is a case study which deals with a patient who has been suffering from some severe symptom of heart diseases such as excessive sweating, nausea, shoulder pain and arm pain. All of the symptoms of the patients indicate the myocardial infarction (MI) disease. In this study, there is an analysis of all the findings related to the patients. Relationship of myocardial infarction (MI) disease to the pathology of the ailment has been also described in this study. There is an analysis of health assessment on George that has been conducted in the hospital by an experienced nurse in order to get deep as well as relevant information regarding these health issues. George has a family history of heart diseases as his father and mother has died due to cardiac arrest. In addition to that uncle of George has done with heart surgery last year after a massive heart attack. From this information, it can be said that George has a tendency towards heart diseases as the occurrence of cardiac ailments depend upon the gene factor of the family history.

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