Nurses play integral roles in the health care provision. As a bedside caregiver the nurse is supposed to provide services which depend on the medical conditions of the patient basing on different stages of illness. Essentially, bedside caregiving varies because some patients require more attention as compared to others (Atzema, Austin, Tu & Schull, 2009). The case presents Mrs. S as acutely ill and suffers from anxiety because of the current sickness. In this regard, a nurse has to pay maximum attention to the patient as a caregiver. The nurse has to monitor Mrs. S’s changes in the cardiac functions considering various issues which might be present in the cardiac tissues hindering her from proper breathing. Additionally, the bedside care has to pay attention on provision of self-care services such as pain changes, ensuring that the patient takes the correct dosage without missing, provision of various supportive cares and assisting Mrs. S to use the bathrooms due to the operation done on her knee which makes it difficult for her to walk.
The Nurse as Counselor
The nurse is also referred to as a counselor because of the professional preparation they go through before qualifying. As a counselor a nurse is always equipped with key counseling concepts such as a bias for optimism, a thorough method of investigating the patients’ case and a proper clinical judgment of a patient (Atzema, Austin, Tu & Schull, 2009). Apparently, as a counselor nurses respond to various clinical situations regarding to the patients conditions and assists them in making decisions. The advices provided support and encourage the patient. In this case, the nurse has to offer counseling to Mrs. S in order to help her reduce her anxiety which makes her exhibit symptoms such as shortness of breath. The nurse can also offer counseling services might help Mrs. S share other health issues that might help her respond positively to the treatment being offered. The nurse has to encourage Mrs. S that she will be fine because her anxiety originates from the acute change in her normal health living with dyslipidemia and hypertension which were well managed on medication.
The Nurse as an Advocate
The nurse acts as the voice of the patient in various health situations. This is the most vital role of the nurse because it entails protecting the rights of the patients (Atzema, Austin, Tu & Schull, 2009). The nurses prioritize the needs of their patients which ensure that they recover from various medical conditions. As such, the nurse taking care of Mrs. S was supposed to advocate for the patient in ensuring that various health changes are attended to immediately with no haste. Consequently, from the time Mrs. S was admitted the nurse had to ensure that all medical concerns of the patient are addressed. The nurse was supposed to move to her retirement community and obtain different services that she could need in the hospital.
The Nurse as an Educator
As an educator the nurse has to assist the patient in gaining knowledge about their specific health conditions and the medications they are supposed to take (Atzema, Austin, Tu & Schull, 2009). This is because in most cases the patients will be confused and might mix the dosages which were prescribed by the doctors. Additionally, change in the medical conditions of the patient might make them more aggressive and confused. It requires the clarity of the nurse to teach them on various aspects. Similarly, the nurse handling Mrs. S, the nurse needed to educate her on dietary changes which might be long-term for her health changes. In addition, the nurse has to provide education materials which teach the patient on autonomy after being discharged from the hospital.
The Nurse as an Innovator
The nurse can be innovative in various were in regard to the patients care. Essentially, as an innovator the nurse is supposed to recommend an innovative procedural work-plan to be used by the patient during medication (NANDA, 2012). Mrs. S’s condition can be exacerbated by her anxiety or depression. As a result, the nurse has to be very creative and innovative to help calm her down. Methods such as use of soft music therapy, relaxation technics, and visualization through specific video clips, therapeutic touch and massage can be used to lower Mrs. S’s anxiety. This will cool her psychological functioning and allow for proper medication.
The Nursing Process: Assessment
The case study presents Mrs. S who is a 78 year old woman suffering from shortness of breath and indigestion in addition to various medical conditions.
Signs and Symptoms
Mrs. S reported fatigue and indigestion which began intermittently 2 weeks prior to visiting the hospital. Initially, the indigestion was treatable with OTC antacids, but the situation has worsened because the patient suffers from shortness of breath on exertion, nausea and cough with an increase in epigastria for the last two days. SOB and non-radiating indigestion does not respond to medication.
Medication List
Mrs. S is has been prescribed the following medications: Losatarn, 50 mg PO daily, 10mg PO daily, naproxen sodium, 250 mg PO bid, OTC antacids, PO PRN for indigestion. She is allergic to penicillin.
Diagnostic Tests
The following diagnostic tests were carried out on Mrs. S. EKC revealed some ST depression in leads VI and VS suggestive of posterior heart ischemia. No cardiac enzyme or CXR tests were conducted at the time.
Objective and Subjective Data
The objective information presents Mrs. S being awake alert, and in the correct place. The patient is visibly short of breath and looks agitated. She has a weight of 150 lbs, 64 inches, BP 80/70, P: 106, T: 98.6, PR: 24. Chest assessment shows diminished sounds and wincing on inhalation. Regular cardiac tachycardia and irregular S1, S2, and S4 sounds were noted. On the other hand, the subjective information shows the patient as acutely ill and anxious due to the onset of the sickness. She has a history of dyslipidemia and hypertension though managed by medication. She has a surgical history of the caesarian section at 40 years and a total knew replacement.
Comorbidity
Additional diseases at this level included ambulatory which highly influenced the development of cardiac conditions
Nursing Process: Analysis
Disease
The patient suffers from the acute onset of MI which includes hypertension, BMI, dyslipidemia and a recent inactivity in breathing showing SOB.
Disease Process
Mrs. S conditions adequately suggest the onset of a myocardial infarction due to tachycardia and cardiac output. Additionally, this condition aligns with the presence of HBP and dyslipidemia which might result into MI due to arteries blockage.
Diagnostic Testing
The tests have to include EKG which identifies the presence of ST depression leading to V1 and V2 which suggests posterior ischemia. In addition, cardiac enzymes and CXR have to be done for the identification and treatment of MI and surgical interventions.
Prognosis
The care for Mrs. S has to involve immediate treatment for MI using both medical interventions and other surgical treatments such as coronary artery bypass surgery. This will loosen the blockage in the patient’s cardiac area insuring proper breathing.
Comorbidities
As aforementioned, the additional diseases at this level for Mrs. S included ambulatory which highly influenced the development of cardiac conditions. Arterial blockage was also the additional medical condition which fostered development of MI.
Nursing process: Implementation
In order to ensure that Mrs. S recovers from her current medical condition, she has to be admitted to the hospital and placed under acute nursing care. The nurse has to perform the aforementioned fundamental roles to the patients to ensure that she takes her medication properly lives in healthy (NANDA, 2012).
Nursing Process: Evaluation
After strictly following the above discussed treatment plan for Mrs. S in a period of not less than two weeks, the following tests have to be done by the nurse. The nurse has to examine the breathing system of the patient to ensure that he breaths properly with no signs of SOB. Additionally, the nurse has to taste for the absence of ST depression leading to V1 and V2 which suggests posterior ischemia using EKG (Atzema, Austin, Tu & Schull, 2009).
- Atzema, C., Austin, P., Tu, J., & Schull, M. (2009). Emergency Departments Triage of Acute Myocardial Infarction Patients and Effects on Outcomes. Annals of Emergency Medicine, 53(6) 736-745
- NANDA (2012). The Complete List of NANDA Nursing Diagnoses. NANDA Nursing Diagnoses 1-7
