Acute Care

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Introduction
In this report the author will discuss an acutely ill patient discovered whilst caring for them within practice. Throughout the report the author will use a nursing process to discuss the patient’s illness also why the patient required acute nursing care. ‘The nursing process is described as being cyclical, made up of four interconnecting elements and having a dynamic nature.’ (Royal College of Nursing, 2012) Using the nursing process the author will implement this discussing the patient’s illness by using the four phases which consist within the nursing process to assess, plan, implement and evaluate. Also discussing the illness and clinical condition of the patient, the author will explain the symptoms and relevant medical history. Throughout the assessment phase the author will discuss the psychological impact of the patient’s illness and the patient’s family members as also outlining why the patient requires acute nursing care. Within the implementation phase the author will discuss the following nursing needs of the patient. The Patient

The patient was a 54 year old female, diagnosed with coronary heart disease at the age of 50. Her past medical history included atherosclerosis, angina. Before being admitted to hospital she was having regular six weekly check- ups and regular blood tests by her local GP. She lives with her husband who also suffers from a heart condition. The GP became concerned when approached by the patient due to her shortness of breath and exhaustion. She claimed she could not walk long distances without having pain and being breathless. Her husband expressed his concerns to the GP, claiming he could not cope with the demand of her nebulisers and GTN spray. She claims her mobility decreased dramatically and completing simple activities was a struggle for her. The GP felt that she would need a hospital admission in order to gain control over her symptoms and medication. She was admitted to an acute cardiac ward in a large teaching hospital trust in the north of England. The patient was admitted into the ward due to exacerbation of angina symptoms, this led to her feeling severe pain with tightening of her chest area, inability to catch her breath and exhaustion.

Angina
Angina is caused by ‘an inadequate supply of blood to the muscle of the heart.’ (National Service Framework, 2000) The most common symptom of coronary heart disease is angina; this is due to the insufficient blood flow to and from the heart as the arteries become narrow due to fatty deposits called artheromatous plaques build up surrounding the walls of the arteries. Angina can cause a severity of symptoms which cause pain of ‘constricting discomfort that typically occurs in the front of the chest (but may radiate to the neck, shoulders, jaw or arms) and is brought on by physical exertion or emotional stress.’ (NICE, 2011) Medication can be given to patients to prevent or relieve the symptoms of angina such as Beta-blockers, Calcium-channel blockers and Angiotensin-converting enzyme (ACE) inhibitors, if that does not work treatments within hospital are available. Treatments can include lifestyle changes such as stopping smoking, having a balanced diet, taking regular exercise and monitoring blood pressure.

Assess and Plan
Within the assessment phase of the Nursing Process ‘the nurse makes an assessment of the patient/client as soon as possible following admission to hospital.’ (Royal College of Nursing, 2012) Using this, the author followed the Activities of the Daily Living Model (Roper, 1983) to ensure the care provided to the patient is adequately collected by assessing the patient’s initial needs during their stay. By providing medication to ease the discomfort ensured that all information was taken from the patient effectively. Collecting and analysing information from the patient ensured staff within the multidisciplinary team determined a plan that considered a client centred approach at all times....
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