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Identify assessment data required when formulating nursing care for people with an episodic illness. Identify assessment data required when formulating nursing care for people with an episodic illness that results in alterations in homeostasis;

Case study Myocardial Infraction
· Identify assessment data required when formulating nursing care for people with an episodic illness that results in alterations in homeostasis;
· Demonstrate appropriate care planning and delivery for people with an episodic illness that has resulted in alterations in homeostasis;
· Utilise and evaluate evidence based criteria with which to appraise clinical practice planning and delivery for people with an episodic illness that results in alterations in homeostasis across the lifespan;
· Evaluate the contribution of nursing to multidisciplinary team working;
Mr Gulyas is a 49-year-old Hungarian man who presents to the emergency department with central chest pain. He has no personal history of coronary artery disease or myocardial infarction, and no known family history of atherosclerotic heart disease. Mr Gulyas states he has associated symptoms of nausea, diaphoresis, and pain radiating to both shoulders and down his left arm. When asked to rate his pain, he states his pain score is 10 out of 10. When questioned about his social history, he states he smokes cigarettes (15 per day), works as a computer programmer in an office, and does very little exercise.

Mr Gulyas is pale and clammy. He is afebrile, with a blood pressure of 106/62 mm Hg, a regular pulse of 68bpm, a respiratory rate of 18 breaths/min, andan oxygen saturation of 96% while breathing room air. An ECG reveals an acute ST elevation myocardial infarction (STEMI). His Troponin I result is 2.4. The plan for Mr Gulyas is to admit him to the cardiac ward for monitoring and thrombolysis. Mr Gulyas is anxious and feels guilty about his lifestyle that he considers has contributed to his admission today.

1. Risk Factors and Health Promotion

What are the factors that may have contributed to Mr Gulyas’s myocardial infarction? Outline how you would approach Mr Gulyas regarding these and what health promotion information and referral you would provide to him. (500 words)

Activities of Living
Consider the twelve (12) activities of living outlined in the Roper Logan & Tierney Model of Nursing and specifically discuss which of these activities of living may be influenced or altered for Mr Gulyas during his admission. Outline how the registered nurse could assist the patient to manage them. (500 words)

Nursing Care
Outline and justify the nursing care required for Mr Gulyas with his presenting symptoms, placing this nursing care in order of clinical priority.(600 words)

Pathophysiology
Briefly describe the pathophysiology behind both a STEMI in your own words (in the way you would explain it to a family member) and identify how it differs from a non-STEMI. (400 words)

Homeostatic Mechanisms
Outline the homeostatic mechanisms that result in the following symptoms Mr Gulyas is displaying on your nursing assessment:

-Radiation of pain to shouldersand left arm
– Pallor
– Clamminess (500 words)
You should incorporate current research to support your discussion (less than 10 years old), texts/journal articles and/or other resources. Your assessment should be presented in academic format as per the Assessment Handbook.
This assignment can be presented in the numbered format using the headings provided in the case study. You should type out each heading and provide your answer to that question


 

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