Case Scenario
Provide a 3000-word written response to the below case scenario.
- Ensure you use the DMU Harvard referencing and adhere to the usual academic writing guidelines for this assignment.
- Evidence from literature/clinical guidelines should be used to underpin/support your answers.
Mr Rajesh Patel is a 48-year-old taxi driver who presents to his local Emergency Department (ED) with a crushing central chest pain that radiates to his left arm. He has rapid breathing, seems very anxious and reports feeling nauseated.
Mr Patel does not smoke. He drinks alcohol when not working, often about 20 units or more a week. Due to his shift work doing day and night shifts, his eating patterns are irregular, tending to eat a large meal once he has finished working after 10pm or during his night shift; and he snacks on high calorie and high carbohydrate-based foods while working.
Mr Patel has hypertension which he takes an angiotensin-converting-enzyme (ACE) inhibitor for. He has a family history of cardiovascular disease (CVD), with his father having a first myocardial infarction (MI) before he was 55 years old. On this occasion the emergency medical treatment was successful but he died of a myocardial infarction before he was 65 years old.
Mr Patel and his family were on their way to visit his brother, sister-in-law and children when his chest pain began. He arrived at the ED with his wife, mother and two children. Mr Patel is employed on a zero hours contract and he is the only member of the family whose work is income-generating. He very keen to be treated quickly, so he can return to his job as soon as possible.
His wife is extremely worried for Mr Patel and has been observed to be crying when she thinks no one is looking. She has confided in a member of the nursing team that her anxiety levels have been high since they began their journey today and she has described symptoms consistent with mild agoraphobia having not been out of the house much at all since the pandemic started. She has also mentioned that she is a full-time carer for her mother-in-law since her diagnosis of dementia a year ago.
Mr Patel’s mother presents as moderately confused, disoriented and anxious, and has been observed to be wandering around the ED at times. She appears to respond well to her daughter-in-law and becomes much calmer and contented for a period of time when she has physical contact with her.
Mr Patel’s children, who are twelve and nine years old, are not fully aware of what is happening and have asked a number of times when he will be allowed to leave, so they can go and visit their family.
On admission, the following observations are recorded:
Respiratory rate: 28 breaths per minute at rest
Oxygen saturation: 90 % on room air
Blood pressure: 170/88 mmHg
Heart rate: 117 beats per minute, regular, ST segment elevation noted on electrocardiogram (ECG)
Temperature 36.60C
A diagnosis of ST elevation myocardial infarction (STEMI) is made.
In relation to the above scenario:
- Define and discuss the condition the patient is presenting with, including the relevant related pathophysiology. (500 words)
- Using a systematic approach, discuss the assessment and the priorities of nursing care related to the scenario, and demonstrate an understanding of the biopsychosocial factors that may influence the patient’s care. (1500 words)
- Critically discuss the impact of acute illness on the patient and family. (1000 words)
Specific guidance:
- Familiarise yourself with the learning outcomes below, as these will be used to assess your written assignment.
- Be sure to use the clinical definition in relation to your scenario and please research the diagnostic criteria/manuals and consider relevant guidelines e.g. NICE guidelines.
- Ensure you fully explain the definition and pathophysiology of the condition as well as identify risk factors and commonly used prediction tools with up to date clinical/academic sources to support your writing.
- Demonstrate a systemic assessment approach using the Resuscitation Council’s (2015) ABCDE assessment method and explain the nursing priorities for the scenario demonstrating an understanding of biopsychosocial factors.
- Critically discuss how the acute illness impacts upon the patient, family, carers etc. with an understanding of how the nurses’ role can influence this.