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Department of Health and Social Sciences

Nursing Therapeutic Interventions for Adults with Specialised Needs

Word Limit: 2500 Words
Word Count: 2320 Words

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Mr
...


A colleague had found him in a

collapsed state at his place of work
...
Pink is 46 years old and is married with two
teenage children
...
He was in a distressed
state, and was complaining of severe pain
...
Mrs
...
This assignment will critically analyse
the nursing care given to Mr
...
Recommendations for improving his care will be made
wherever appropriate using evidence based research
...
Pink’s haemodynamic observations were taken and
recorded
...
These observations
would provide a base reading to monitor the effectiveness of his treatment and will alert
staff to any deterioration in his condition (Alexander et al 1994)
...
The twelve lead ECG also showed the extent and position of Mr
...


Mr
...

Thrombolytic therapy was initiated within fifteen minutes of Mr
...
Research shows that the greatest risk of death is within the first hour from
the onset of pain (Hope et al 1998)
...
Intravenous
analgesia of Diamorphine 5 milligrams and an anti-emetic of Maxalon 10 milligrams
were administered
...
This greatly helped to reduce the anxiety Mr
...


Diamorphine also produces less

nausea and hypotension than morphine (B
...
F, 2001)
...
This initially ran at 4 mls per hour via a Grasby pump but was successfully
titrated down to 1ml per hour as Mr
...
An hourly pump check was
commenced and Mr
...
GTN is a powerful coronary vasodilator that also produces
a reduction in venous return thus reducing left ventricular effort (Hand, 2001)
...

Once admitted Mr
...
McCaffery & Beebe (1989), However
suggest that pain assessment is hard to achieve without the use of a pain tool, they argue
that nurses overestimate the effectiveness of analgesia and underestimate the intensity of
an individual's pain
...
Mr
...
Mr
...
This was
particularly useful for Mrs
...
Giving
information and explanation before treatment and procedures benefits the patient in terms
of a decrease in pain, discomfort, and stress and reduces anxiety (Smeltzer & Bare 2000)
...
Pink was nursed according to the hospital's MI protocol and remained on complete
bed rest for the first 24 hours
...
Mr
...

Clinical observations were maintained hourly as these could have proved indicative of
returning pain
...
Pink expressed his gratitude for the nursing presence whilst his pain
was being controlled
...


Providing adequate information to the patient

and encouraging family members to provide comfort (Basford & Slevin, 1999) can
significantly reduce fear of dying
...
When critically examined the majority of the
nursing interventions were of comfort and reassurance rather than practical tasks
...

Pink’s pain management was achieved by a multidisciplinary approach through
collaboration between the nursing and medical staff
...

Monitoring cardiac rhythm has significantly reduced hospital deaths from acute MI
(Norris, 1982)
...


A twelve lead ECG should be

performed as soon as possible to confirm a diagnosis and to ascertain suitability for
thrombolysis
...
ECGs do have limitations, however, they
remain one of the best diagnostic tools in acute MI (Thompson, 1997)
...
Boore (1978) suggested that this stress and anxiety could cause an
imbalance in homeostasis, which may hinder recovery and prolong the admission
...

Pink was in a state of distress, anxiety and restlessness upon his admission and the
clinical environment he now found himself in compounded this
...
His consent was gained to perform cardiac monitoring
...
This was to ensure good contact and
adhesion to his skin
...
Pink was pale, sweating and

shivering caused by peripheral vasoconstriction diverting blood to the vital organs
...
On more than one occasion an electrode fell off raising the alarm on the
monitor, this bought a number of concerned members of staff to Mr
...


The rogue electrodes were changed and

repositioned and the staff would carry on with their duties leaving Mr
...
The author became aware that Mr
...
He became particularly sensitive about his
electrodes being touched and lay rigid in his bed fearful that any movement would
dislodge an electrode
...
Pink and explained about the

environment and the monitoring equipment and of what he should expect if the monitor
did start to alarm
...
Pink was reluctant at first to accept that the cardiac monitor was
not ‘doing’ anything to his heart
...
This would be both beneficial in obtaining an accurate trace as well as
reducing the possibility of lead displacement
...

At this point the monitor was turned away from Mr
...
Communication from health professionals is vital for both the patient
and the family to provide information that will alleviate anxiety (Hudak & Gallow,
1994)
...
However communication between the
nurse and the patient should be tailored to the knowledge, interest, purpose, social
background and needs of the recipient (Hinchcliff et al, 1993)
...
Pink responded well to the information he received about his
cardiac investigations and shortly began to relax and even shared a joke when nursing

page 5

6

staff approached him, either when there was a problem or if ECGS were required
...
He did
request that the monitor could be turned back towards him as he found it reassuring
confirming to him that his heart was beating
...
Pink
experienced was due to his emotional and psychological status or if it was a symptom of
his low cardiac output (Bassett & Makin, 2000)
...
Pink’s breathlessness
...
He was
sat upright and bent slightly forward and appeared to be using his accessory muscles to
help himself draw breath
...
This delivers a high concentration of oxygen but this
did not appear to be having any considerable effect
...
Pink, as previously stated, was
in intense pain and was anxious and distressed and this was having a detrimental effect
upon his breathing rate and pattern
...
The percentage of
inhaled oxygen is significantly reduced by open mouthed breathing (Jevon & Ewens,
2001)
In an acute myocardial infarction the myocardium is depleted of the necessary amount
of oxygen, due to coronary stenosis or obstruction (Thompson, 1997)
...
Oxygen therapy also contributes to pain relief by raising the amount of
circulating oxygen thus reducing the pain caused by low levels of circulating oxygen

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(Smeltzer & Bare 2000)
...


Mr Pinks level of

consciousness was initially assessed and recorded
...
On observation he appeared cyanotic, having a bluish tinge to his lips
and nail beds
...
However assessment of cyanosis can be
affected by the room lighting, the patient's skin colour and the distance of the blood
vessels from the skin therefore cyanosis is not a reliable indicator of hypoxia (Thompson
& Webster 1992)
...
Pulse oximetry is a non-invasive method of continuously measuring the
oxygen saturation of haemoglobin
...
A sensor was placed on Mr
...
Pulse oximetry is an effective tool at detecting subtle or sudden
changes in oxygen saturations (Chandler, 2000)
...
Mr Pink
tolerated the probe well but again his anxiety increased when his saturations dropped
causing the monitor to alarm
...
His Hudson mask was changed to a re-breather mask
and his oxygen saturations were recorded between 97% -100% on 4 litres of oxygen per

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8

minute
...
The time Mr
...
The EAU is primarily concerned with acute
illness and therefore concentrates on the physical aspect of care
...
Pink's care may have been achieved
...
Pink experienced
...
Pink was highly satisfied with the care her husband received
and indeed she seemed reluctant to see her husband transferred to the coronary care unit
...
Pinks death and on
analysis the care he received is comparable to the care he would have received if he had
been admitted directly to the coronary care unit
...
, Fawcett, J
...
(1994): Nursing Practice - Hospital and
Home, The Adult
...

Basford,L
...
(1999): Theory and practice of Nursing
...

Boore, J
...
London
...

British Medical Association,
Pharmaceutical Press
...


Oxon,

Chandler, T
...
Paediatric Nursing
...

Hudak, C
...
(1994): Critical Care Nursing, A Holistic Approach
...

Bassett, C
...
London, Arnold
...
London, The Stationary Office
...
(1999): Essentials of Immediate Medical Care
...
Edinburgh,
Churchill Livingstone
...
(1974): Patient Anxiety on Admission to Hospital
...

Hand, H
...
Nursing Standard
...

Hand, H
...
Nursing Standard
...

Hinchliff, S
...
& Schober, J
...
) (1993): Nursing Practice & Health Care
...
London, Edward Arnold
...
, Longmore, J
...
& Wood-Allum, C
...
Oxford, Oxford University Press
...
& Ewans, B
...
Nursing Standard
...


page 9

10

McCaffery, M
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(1989): Pain: Clinical Manual for Nursing Practice
...

Norris, R
...
Edinburgh Churchill Livingstone
...
(1995): Using Assessment Tools to Help Patients in Pain
...

Smeltzer, S
...
(2000): Medical-Surgical Nursing
...

Stoneham, M
...
Lancet 344 (8933) 1339-1342
...
& Webster, R
...
Oxford,
Butterworth – Heinemann
...
(Ed
...
Edinburgh, Churchill Livingstone

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