NR 305 Week 4 Discussion – Community Access to mental Health Services

NR 305 Week 4 Discussion – Community Access to Mental Health Services

I feel that based on Mrs. Jackson’s symptoms, she may be having a heart attack or a myocardial infarction (MI). Her complaints of back pain that is not relieved with pain medication, her complaints of feeling tired, a pulse that is unpalpable, nausea, a higher blood pressure reading, and one-day post-op make me believe this. Usually, heart rate and blood pressure can increase at the beginning of a possible MI and then goes down when the cardiac output decreases (Geiter, 2007).

The first thing that I would do to prevent further decline is call her doctor to report her symptoms and notify her/him of possible symptoms of MI. During a heart attack, women usually report extreme fatigue and flu-like symptoms (Jarvis, 2016). We would need to relieve any pain she is having, stabilize her heart rhythm, reduce cardiac workload, revascularize the coronary artery, and preserve myocardial tissue. Continue to monitor and document characteristics of pain, verbal reports, nonverbal cues, blood pressure, or heart rate changes, and check vitals before and after the narcotic is given. Instruct Mrs. Jackson to do relaxation techniques and to report changes in pain level immediately. Increasing the amount of O2 will reduce ischemia, so giving supplemental O2 is key. If her MD prescribes antianginal, Beta-blockers, Antiplatelets, or Anticoagulants, we will give them as needed. We want Mrs. Jackson to demonstrate an increased intolerance for activity with her BP and HR within normal limits. Auscultate heart sounds and breath sounds. Monitor HR and rhythm and document dysrhythmias via telemetry. Monitoring her I&O’s to calcite fluid balance and inspecting the skin for decreased skin perfusion or diminished pulses. Monitor any labs ordered. Since we identified Mrs. Jackson was in tears, we want to recognize her feelings and reduce anxiety or fear. Answer any questions that she may have and provide consistent information. To prevent further decline, she will be able to identify problems, verbalize her feelings and demonstrate positive problem-solving skills.

NR 305 Week 4 Discussion – Community Access to Mental Health Services

Other labs and testing that would be important in this scenario would be monitoring lab data: ABGs, BUN, creatinine, electrolytes, coagulation studies (PT, aPTT, clotting times), and the rationale is to indicate the organ perfusion and function. Abnormalities in coagulation may occur as a result of therapeutic measures. Electrolyte imbalances can affect cardiac rhythm and contractility. Another lab would be cardiac enzymes, and the reason is that the enzymes monitor the resolution or extension of infarction. The presence of hypoxia indicates the need for supplemental oxygen. These labs would be checked regularly. Reviewing the serial EEGs will provide info regarding the progression or resolution of infarction, the status of ventricular function, electrolyte balance, and the effects of drug therapies. Reviewing chest x-ray may reflect pulmonary edema that could possibly be related to ventricular dysfunction. Measuring I&O’s every hour is important, noting a decrease in output and paying attention to appearance because decreased cardiac output results in impaired kidney perfusion, sodium/water retention, and reduced urine output. Weighing her daily because any sudden changes in weight may reflect fluid balances. Lastly, maintaining total fluid intake at 2,000 mL/24hr within cardiovascular tolerance. The reason we do this is so her body meets normal body fluid requirements but may require some adjusting or restricting in the presence of cardiac decompensation. All these testing would be done within 24-48 hours, and it depends on how long she will be hospitalized, say, the frequency.

While caring for Jackson, I would ensure my other patient’s needs are being met by communicating with my charge nurse about the situation. I will prioritize my other patients to see if anyone else is critical. Questions I would ask myself would be, what am I doing first and why? Which is most important at this moment? Besides Mrs. Jackson. Knowing that caring for each patient is important and quality care is crucial, communicating with my team is necessary for patient safety. If I need help, I would ask my charge nurse if there is anyone that could possibly take on one of the other patients or if she can just help me with them. I would tell her how I have prioritized them and help as much as I could still. Just as the body’s many components are needed to restore an equal balance, a work team can change its pace, reorganize care tasks, reconfigure itself, and redelegate responsibilities (Nelson, 2010).

References

Geiter, H.B. (2007). E-Z ECG Rhythm Interpretation. Philadelphia: F.A. Davis, pg. 168.

Jarvis, C. (2016). Physical examination & health assessment. (7^th ed.) Philadelphia, PA: Saunders, p. 489.

Nelson, J.L. (2010). American Nurses Association: American Nurse Today. Helping New Nurses Set Priorities, 5(5).

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