ACUTE CARE

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, blood pressure 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.

•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.

•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.

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.

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