Scenario Based Assignment Nursing

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In this scenario-based assignment I am going to write about a patient, for whom I have cared for whilst I was in placement. I am going to refer to the patient as Mrs. X due to confidentiality as the Nursing and Midwifery Council, 2008 states, that you must respect people right to confidentiality.

Mrs X was a 74-year-old lady, who was very weak and could hardly mobilise. She had a history with falls and chest pain and she came into the hospital because of severe chest pain and high pulse rate. She was moved to our ward from Accidents and Emergencies, as her chest pains were not stable and as she could not mobilise by herself, which meant she needed to stay in hospital further and be closely observed.

My mentor gave me the task to admit Mrs X and during the admission, I learned more about Mrs X and was able to find out that she was having Heart Palpitations along with the chest pains. Palpitations are heartbeat sensations that feel like your heart is pounding or racing. It is like an unpleasant awareness of your heart beat, Medline Plus, 2010.

After completing her admission, I reported my findings to the nurse in charge, from which the nurse in charge decided to investigate further and went on to talk with the patient to gain further information on what was happening to Mrs X. After that, the Charge Nurse decided to put Mrs X on a Cardiac monitor to observe her.

I was also given the task to do her observations and due to her fragile and serious condition, the Nurse in charge told me to do record the observations hourly, so she gets top care and so that we get precautions if something was to wrong with her. As I did my Observations, I found that her heart rate was quite high along with the respirations.

When I asked Mrs. X what sorts of other symptoms she got while having fast heart rate, she said she had shortness of breath, dizziness along with chest pain. The other symptoms patients with tachycardia finds are light headedness, fainting (syncope) and heart palpitation and sometime people get no symptoms until any physical examination or with heart monitoring test called electrocardiogram.

From the research back then, I found out that Heart rate is the number of heartbeats per unit time, usually per minute. Also found out that, the heart rate is based on the number of contractions of the ventricles (the lower chambers of the heart). The heart rate may be too fast which is called tachycardia or too slow which is known as bradycardia and finally the pulse is bulge of an artery from the wave of blood coursing through the blood vessel as a result of the heartbeat. The pulse is often taken at the wrist to estimate the heart rate, Medicine Net, 2011. A normal heart rate for average person is 60-100 times a minute whereas in a high pulse rate, which is also called tachycardia the heart, beats more than the average heart does (Mayo Clinic, 2011). If the heart keeps on pumping oxygen-rich blood fast to the body like that then it won’t be able to do it efficiently.

From this, I recalled when Mrs X said that she smoked in the admission and just went to double check in the admission folder to confirm it was written there, as it was very important because whilst when I had a quick time to spare I researched about Palpitation and chest pain and I found out that smoking was one of the causes of palpitation, so I went further to research about it and later on I decided to just have a chat with Mrs X in which, I explained about her condition and I also advised her about smoking, told her about the harms that smoking can do and told her the different kind of options available to her if she was willing to quit smoking.

Also from the cardiac monitor I could see that her Heart rate was high and her respirations were a bit high too, as I knew this was dangerous I quickly informed the Charge Nurse, who called up a doctor and the doctor arrived and after a few checks, prescribed some Beta blockers (medication) also known as beta adrenoceptor blocking drugs, which is used to help control the heart rate and they work by blocking the transmission of certain nerve impulses, Patient, 2009. The Beta Blocker’s are medication, that are taken when you have chest pain, high blood pressure, Arrhythmia, heart failure or heart attack (to reduce the risk of having another one), They are also given to relive the symptoms of anxiety, such as palpitations and fast heart rate, BUPA, 2011. In Mrs X’s case, she was prescribed Bisrolol, a tablet medication.

The causes of the tachycardia were high blood pressure, poor blood supply to the heart muscle, other medical condition thyroid disease, alcohol and drug abuse, binge drinking, emotional stress and many more. So, for Mrs. X she had history of chest pain this could be the main cause for her tachycardia.

The treatment goals for tachycardia is to slow a fast heart rate when it takes place (Mayo Clinic, 2011), prevent future episodes and minimizing the complications. Some of the medical treatments are vagal maneuvers, which helps to regulate the heartbeat during the episodes. The other procedure is called cardio version, which is usually used, in emergency care when other procedures are not available. This procedure delivers shock to the heart through paddles or patches on the patient’ chest.

There are also ways of preventing fast heart rate, the first ways is a procedure called catheter ablation, which is most often used when an extra electrical pathway is responsible for an increased heart rate. The other ways is the medicine called Anti-arrhythmic which may prevent a fast heart rate when taken on regular basis.

The additional ways is to have a surgery where a pacemaker is placed under your skin. The device senses an abnormal heart beat and it emits an electrical pulse that helps the heart resume a normal beat. However if you are at risk of having a life threatening tachycardia episodes then the doctors will recommend the surgery called implantable cardioverter defibrillator, which continuously observes your heart rhythm and restores the normal heart rhythm by calibrating electrical shocks (Mayo Clinic, 2011).

Also, I saw that Mrs. X was a large lady, so I went and did a bit of research on the topic of unhealthy diet and how it affects the Heart, which is when I found that eating lots of fatty food can mean that the fat can reach the arteries and therefore narrow the arteries which meant not enough blood can be passed through the area which can cause chest pains, so with this little bit of knowledge, I went to talk about this with Mrs. X in a relaxed and advising manner so I don’t offend her and talk to her about healthy lifestyle and what all the vitamins and other mineral do to the body and why it is essential for the body for a healthy lifestyle.

When the doctors examined Mrs. X they decided to have a surgery to put a pacemaker in her heart. So the nurse in charge made and appointment to a cardiac catheterization lab where it was going to take place.

After the surgery for pacemaker was done Mrs. X came back to the ward, she was connected to the cardiac monitor for the whole day after that to keep on track of her heart rhythm. After when the multi-disciplinary team had meeting to decide, they thought it would be appropriate to send her to a elderly ward where she will get proper care. The result of the surgery was successful and after two days she was been transferred to an elderly ward.

From this experience I learnt many important information about heart rhythm and tachycardia. I also learnt to communicate well with the patient as well as learning that that the integration of theory to practice is very important, as it is the theoretical side of care that helps you make decisions when caring in practice and overall makes the care and communication with the patient more effective and satisfying as you know what methods you are using and also know alternatives if the care method is not working. I also learned that learning doesn’t stop after being qualified as I saw a lot of Nurses research about their patient’s condition during there spare time which was inspiring and I myself believe without research and good theoretical knowledge you can’t properly deliver a care plan and care. I believe it is the combination of Practical and theory that helps Nurses help/intervene patient when they are at the most vulnerable.

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