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Essay: Reflective nursing essay (Myocardial infarction admission)

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INTRODUCTION

This is a reflective essay based on the interaction between the nurse, client and their family from the point of encounter, rendering of nursing care and termination. The essay will focus on managing care from the perspective of clinical experience and reviewing this in relation to a literature review. It also includes recommendations for future professional development. The aim of this study is to teach patients the importance of recognition of signs and symptoms of myocardial infarction and prompt report to the hospital. To health educate the patients on preventive measure of myocardial infarction. To broaden my knowledge about the causes, management and prevention of myocardial infarction. Mr Uche is a 56 year old man who presented with chest pain, dyspnea on exertion was seen by a medical doctor who diagnosed him acute myocardial infarction, managed and discharged home in a stable condition.

Myocardial infarction also known as heart attack is a medical emergency in which the supply of blood to the heart is blocked suddenly (NHS, 2016). Myocardial infarction (MI) is the irreversible damage of the myocardial tissue caused by prolonged ischemia and hypoxia, this commonly occurs when a coronary artery becomes occluded following the rupture of an arteriosclerotic plague which then leads to the formation of a blood clot (coronary thrombosis) this event can also trigger coronary vasospasm. (Richard, 2014)
Acute MI is a leading cause of hospital admissions and mortality in the UK and around the world (Azaha, Parvix et al, 2017). The most common form of coronary heart disease is MI (W.H.O, 2015). MI is the leading cause of morbidity and mortality worldwide. The prevalence of MI is higher among men in all specific age groups than women. Although the incidence of MI is decreased in the industrialized nations partly because of improved health care system and implementation of effective public health strategies, however the rates are rising in developing countries (Joshua et al, 2018).

According to the world health organization (WHO), it is estimated that 7.4 million deaths are due to coronary heart disease in 2015. Eighty two percent of death in low-middle income countries are accountable for CVD, it is estimated that 236 million people will die from CVD’s by 2030 these are projected to remain the leading cause of mortality.

According to a 2014 based study on the self-reported national survey in the United Kingdom, the prevalence of MI was reported as 640,000 in men and 275,000 in women, this represents about 915,000 people that have suffered MI in the UK. In 2013, the prevalence of MI in men was about three times higher than women in the UK (Bhatnagar, 2015).

Priorities’ in this study will cover the nursing management of the patient during the period of admission. It involves documenting the patient’s problems how the nurse finds solutions to such problems using the nursing process approach which is based on the concept of holistic care. Nursing process is a systematic approach which nurses use to identify patient’s problems and potential problems and plan on how to deliver and evaluate nursing care in an orderly and scientific manner (Slidesharenet, 2019) which will be backed by nursing theories. Each discipline has a unique focus for knowledge that directs its practise and distinguishes it from other fields of study. As nursing is professional discipline, nursing theories serves as a framework designed to organise and explain phenomena in nursing on a more concrete level (Smith and Liehr, 2015).

Patient presentation

Confidentiality is a practice which involves keeping of confidence between the client and the practitioner and it can be broken if the health worker discuss about or names them when talking about the situation (Resourcehub, 2013). Informed consent is the process that applies to the communication to a patient about the benefits and risks the patient is likely to face in the course of the study (Nihgov, 2019).During the course of this study for the purpose of confidentiality and anonymity the patient will be referred to as Mr Uche

My patient is Mr. Uche who is a 56year old university lecturer who was said to be well until about three days prior to presentation to the hospital with the history of chest pain which was gradual at onset but later severe and was aggravated by movement with no recovery factor . Mr. Uche is a known hypertensive (15years) and peptic ulcer patient (6years) and on medication (nfedipine and omeprazole). He never smokes nor takes alcohol and no allergies of note. On general examination he is in painful distress, anicteric, cyanosed, not pale or dehydrated, pain is stabbing in nature and said to be radiating to the back and worse on exertion. Conscious and alert well oriented to person, place and time. Vitals on admission T. 36.4 HR. 84b/m BP. 120/90 R. 28 oxygen saturation 90%. On auscultation there is transmitted crepitation and wide spread breath sound, associated dyspnea on exertion, nil pedal edema, nil palpitation but associated sweating. Seen by a medical doctor who made a diagnosis of acute myocardial infarction. Lab investigation was ordered which include electrolyte, urea and creatine, Lipid profile, Random blood sugar, Cardiac enzymes, Electrocardiography, Echo cardiogram and Coronary angiography. He was admitted into the ICU and managed for 12days and was discharged home in a stable condition, was advised to comply to prescribed medications, dietary modification and to please report to the hospital if he notices any abnormality with his health, emphasis was made on preventive rather than curative.

OVERVIEW OF DISEASE CONDITION

According to (Nice, 2013), MI is one of the most dramatic presentations of coronary artery diseases. It is usually caused by the blockage of a coronary artery resulting in tissue death and consequently the features of a heart attack (severe chest pain, changes on the electrocardiogram) and raised concentration of proteins released from the dying tissue muscle into the blood. An occluded coronary artery results in myocardial ischemia due to lack of oxygen to the myocardial cells .if the heart tissue is deprived of oxygen for a prolonged period of time approximately 20-45 minutes, this can lead to cell death (necrosis) distal to the occlusion (Hogan et al, 2014). Where the infarct has taken place, a collagen scar forms and the damaged muscle does not contract effectively. Collagen is a bundle of inelastic fibers that do not stretch or contract. Damaged heart tissue conducts electrical signals much more slowly than normal heart tissue, which can result in in effective contraction of the myocardium. This can result in decreased blood volume ejected by the ventricle, low cardiac output, low blood pressure, and poor tissue perfusion (Peate,2017). MI is divided into 2 types according to the changes they present on the ECG.ST-segment elevation myocardial infarction (STEMI) which is generally caused by complete and persistent blockage of the artery. NON-ST-segment elevation myocardial infarction (NSTEMI) reflecting partial or intermittent blocking of the artery. In England and Wales in 2011/12 more than 79,000 hospital admission were caused by MI according to myocardial ischemic national audit project (MINAP), of these 41% were STEMI’S and 51% were NSTEMI’S. Twice as many men had MI as women. Women often experience markedly different symptoms compared to men. Symptoms such as dyspnea, fatigue, sleep disturbances and weakness are more common in women than men (heartorg).

NURSING THEORY AND APPLICATION

Nurses have a role to play in the interaction with their clients and patients, and their families or careers to help in the improvement of the client or patients health. The purpose of nursing care is to improve the quality of life of the clients or patients and appreciation in nursing theories is an effective way to promote nursing care. Nursing models and theories help to develop nursing knowledge clinically. The Betty Neuman systems model is one theory which provides guidance at three level of prevention. The Neuman systems model is a unique, open system based perspective that provides a unified focus of approaching a wide range of international health concerns. Being universal in nature the model is open to creative interpretation and is widely used throughout the world as a multi-disciplinary, holistic, and comprehensive structure as a guide for excellence in nursing practice, education, research, and administration. Its concepts processes and theoretical base are relevant to future global emerging health care trends and issues. (Neuman systems model, INC. 2017)

NURSING MANAGEMENT USING THE NURSING PROCESS APPROACH

Nursing process is defined as a systematic approach to care using fundamental principles of critical thinking, client centered approach to treatment, goal orientated task, evidence based practice (EBP), recommendation and nursing intuition. (Toney-Butler, Thayer 2009).the nursing process is cyclical which means that its components follows a logical sequence but more than one component may be involved at one time. At the end of the first cycle care may be terminated if goals are achieved or the cycle may continue with reassessment or the plan of care modified. (Czhuena, 2014) The nursing process functions as a systematic guide to client-centered care with five sequential steps. These are assessment, nursing diagnosis, planning, implementation and evaluation.

ASSESSMENT

This is the first stage of the nursing process. It is the systematic dynamic way of collecting and analyzing data. Hamilton and Price (2013) describes this stage as the corner stone in establishing the needs of the patient and if well done the nursing process will be a success. One of most important part of care of a patient with MI is assessment. Information for assessment is gathered through history taking, head to toe examination, clients past records. Mr Uche was first seen at the emergency department where he presented with chest pain and was in respiratory distress. Vital signs was assessed which includes blood pressure9130/82mmHg), pulse rate (92b/m), respiration (28c/m), oxygen saturation (90%). Vital signs are important indicators of a patient’s clinical condition and informs required interventions (Griffith et al, 2015). He was assess for pain using the universal pain assessment tool with zero being the lowest and ten the representing the highest pain. He verbalized a pain score of 8 which is localized to the chest area. Pain can also be physically assessed by his facial grimace and fast breathing. He was also assess for the presence of shortness of breath, dyspnea, tachypnea and crackles by auscultation of the lungs and counting the respiratory rate. He was also assess for nausea and vomiting and also his urine output. A complete physical examination was done, on examination he was found to be looking grey, unwell and sweating, his jugular venous pressure was not elevated, and his peripherals were cold to touch but nil pedal or ankle edema seen. The focus of assessment is the patient and how they are experiencing their illness and ill health. Once all information has been collected it can be documented and sorted (Merlin-Johansson et al, 2017).

Nursing diagnosis

This is the next stage of where information gathered from the assessment is used to identify actual and potential problems as well as strengths .nursing diagnosis identified for a patient with MI includes; impaired gaseous exchange related to interruption of blood flow due to coronary artery occlusion ,ineffective cardiac tissue perfusion related to reduced coronary blood flow, pain(acute),ineffective peripheral tissue perfusion related to reduced coronary blood flow , activity intolerance related to oxygen demand and supply mismatch, anxiety related to unknown outcome of the disease . Nursing diagnosis are developed based on data obtained during the assessment. A nursing diagnosis projects a problem response present at the time of assessment. While a medical diagnosis identifies a disorder a nursing diagnosis identifies problems resulting from that disorder (Potter et al, 2013).

PLANNING

Planning is where goals outcomes are formulated that directly impact patient care based on EDP guidelines. These patient specific goals and the achievement of such aids in ensuring a positive outcome .nursing care plans are essential on the phase of goal setting, they provide a direction for personalized care specific to an individuals need (Tonrny, Thayer, 2013). These are done in collaboration with the patient. The goals identified for Mr Uche includes relief of pain, maintenance of adequate tissue perfusion, prevention of myocardial damage, absence of respiratory dysfunction, reduced anxiety achievement of activity level sufficient for basis self-care, absence or early detection of complications

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