NURS6032 Acute Nursing Practice

Part A

The moment Daisy is admitted to the High Dependency unit in the hospital, it was vital to follow up the rules and regulations of the process of the nursing for access, diagnosing the disease, planning and evaluating the treatment in order for proving the outcome that was based on the caring of Daisy. This discussion on Daisy’s treatment will examine the assessment that can be used for the diagnosing the deteriorating the health status of daisy based on the cardiovascular status with the intervention that a RN would needs to anticipate for investigating and using of the treatment related to the atrial fibrillation (January, et al., 2014).

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For beginning the assessment process, it was quiet important for ensuring the patient’s airway or the breathing is needed for compromising. When we have set up aviation route patency, and typical breathing, an arrangement of essential signs will be embraced as a central beginning stage to acquire a pattern set of observations. This will give the treatment group some bearing in the matter of what might happen to bring about the patients disintegration (Gladstone, et al., 2014).

On focussing the important signs and the symptoms, it was known that Daisy was a tachycardia with the irregularity in the pulse. The next important step in the process of the assessment would be conducting an electrocardiogram or ECG for the detection of the electrical activity of the heart of Daisy’s. This ECG revealed the Arterial fibrillation in the heart of Daisy (Munn, Porritt, Aromataris, Lockwood, & Peters, 2014).

Subsequent to diagnosing AF by means of the ECG, it is vital for the Registered nurse (RN) to acquire assent from Daisy, to examine her condition in advance. A basic stride in the examination procedure will be a blood test (Verma, et al., 2015). This will check for certain hidden reasons for Daisy’s high AF and to reduce the damage to the heart, from heart attack or from the cardiac arrest. A critical level to check in this circumstance is a troponin level. This test should be rehashed throughout the following 6-24 hours (Dougherty & Lister, 2015), to recognize any ascent in troponin that may show a myocardial dead tissue as the fundamental contributing variable to Daisy’s disintegrating cardiovascular status (Gupta N. , Pinto, Morogan, & Bourbeau, 2014).

Respiratory Status:

The data of the patient is showing that the patient is hypoxemia. The blood pressure and the SpO2 suggested the disease of the patient. Marked chest / abdomen movement; use of accessory muscles; Intercostal recession; sternal retraction; tracheal tug are some of the respiratory status that could be incurred.

In most cases it can be seen that cardiac problems causes the pulmonary oedema. the fluid gets accumulated including pneumonia with the exposure of some toxins and the medications, chest walls gets traumatised and exercising and living at the elevations that are high.

Pulmonary oedema that grows all of a sudden (acute pulmonary oedema) is a restorative crisis requiring prompt care (Covello & Merkhoher, 2013). However pneumonic oedema can in some cases demonstrate lethal, the standpoint enhances when you get instant treatment for aspiratory oedema alongside treatment for the hidden issue. Treatment for pulmonary oedema fluctuates relying upon the cause however for the most part incorporates supplemental oxygen and medications.

Depending on the particular condition of the pulmonary oedema, few medications can be provided. Reducing the preloaded drugs diminish the weight pressure created by the liquid going into your heart and lungs. Health practitioners generally recommend nitroglycerin and diuretics, for example, furosemide (Lasix) to treat pneumonic oedema. Diuretics may make you urinate so much at first that you may briefly require a urinary catheter while you’re in the doctor’s facility. The medication nifedipine (Procardia) may once in a while be endorsed. Morphine is a particular opiate might be utilized to assuage shortness of breath and tension (Cohn, Gautam, Preddy, Connors, & Kennedy, 2016). Be that as it may, a few specialists trust that the dangers of morphine may exceed the advantages and are more able to utilize other more-powerful medications. Medications that brae being used for reducing the afterload such as nitroprusside  (nitropress) for the dilation of the blood vessels and for taking the load off the pressure from the left ventricle of the heart.

Blood pressures need to be monitored regularly after developing the pulmonary oedema. Medications are the important part for reducing or keeping control over the blood pressure. In addition to, if the patient has very low blood pressure they are being given medicines for increasing the blood pressure. If pulmonary oedema is caused due to some other conditions, like nervous system, the health care practitioners will focus on that particular issue and provide medication for treating the particular disease.

Part B

Percutaneous coronary intervention (PCI) is a non-surgical process used to treat narrowing (stenosis) of the coronary supply routes of the heart found in coronary arterial illness. Subsequent to getting to the circulatory system through the femoral or outspread conduit, the methodology utilizes coronary catheterization to envision the veins on X-beam imaging. After this, an interventional cardiologist can play out a coronary angioplasty, utilizing an inflatable catheter in which a flattened inflatable is progressed into the deterred vein and expanded to diminish the narrowing; certain gadgets, for example, stents can be conveyed to keep the vein open. Different methodology can likewise be performed.

Primary PCI is the extremely urgent utilization of PCI in individuals with intense myocardial infarction (heart attack), particularly where there is proof of serious heart damage on the electrocardiogram (ST rise MI). PCI is additionally utilized as a part of individuals after different types of myocardial localized necrosis or insecure angina where there is a high danger of further occasions. At long last, PCI might be utilized as a part of individuals with stable angina pectoris, especially if the side effects are hard to control with pharmaceutical. PCI is another option to coronary artery bypass grafting (CABG, sidestep surgery), which sidesteps stenotic conduits by joining vessels from somewhere else in the body.

Risk Factor For The Coronary Heart Disease

Hypertension is the single greatest hazard for stroke. It additionally assumes a noteworthy part in heart attacks. It can be forestalled and effectively treated however just in the event that you have it analyzed and adhere for the suggested administration arrange (Ilton, Brown, Tideman, Zeitz, & Wilson, 2014).

Abnormal blood lipid levels that is high in aggregating cholesterol, elevated amounts of triglycerides, abnormal amounts of low-thickness lipoprotein or low levels of high-thickness lipoprotein (HDL) cholesterol all expansion the danger of coronary illness and stroke. Changing to a healthy diet, exercise and medicine can adjust the blood lipid profile (Tillin, et al., 2013).

Physical activities expand the danger of coronary illness and stroke by fifty percent. Obesity is a noteworthy hazard for cardiovascular infection and inclines you to diabetes. Diabetes is also a risk factor for cardiovascular ailment.

A diet containing high level in saturated fat increases the risk of heart disease and stroke.  It is evaluate to cause about thirty-one percent of coronary heart disease and eleven percent of stroke worldwide.

Chest Pain Action Plan

Name of the Patient: Daisy

Past medical history:

Hypertension, Hyperlipidemia, Mild obesity   

Surgical history:

Hysterectomy at 42 years of age

Past medications:

Perindopril 5 mg daily    

Atorvastatin 20 mg daily    

Aspirin 150 mg daily    

Progynova 2 mg daily    

Vital signs during admission:

Pulse 130-150 irregular     

BP 100/65    

RR 24    

SpO2 98% on 2L NP.     

Temp 37.2

Do’s for Daisy:

Better food like fruits and vegetables must be included in the diet

Mild exercise must be incorporated

Stress need to manage

Adequate sleep needed

Don’ts for Daisy:

High lipids content in food need to be reduced in the diet

Mild obesity and high blood pressure need to be reduced


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Covello, V. T., & Merkhoher, M. W. (2013). Risk assessment methods: approaches for assessing health and environmental risks. Springer Science & Business Media.

Dougherty, L., & Lister, S. (2015). The Royal Marsden manual of clinical nursing procedures. John Wiley & Sons.

Gladstone, D. J., M., S., Dorian, P., V., P., E., T. K., J., H., et al. (2014). Atrial fibrillation in patients with cryptogenic stroke. New England Journal of Medicine. Atrial fibrillation in patients with cryptogenic stroke , 2467-2477.

Gupta, N., Pinto, M. L., Morogan, A., & Bourbeau, J. (2014). The COPD assessment test: a systematic review.

Ilton, M. K., Brown, A. D., Tideman, P. A., Zeitz, C. J., & Wilson, J. (2014). A framework for overcoming disparities in management of acute coronary syndromes in the Australian Aboriginal and Torres Strait Islander population. A consensus statement from the National Heart Foundation of Australia. , 639-43.

January, C. T., Wann, L. S., Alpert, J. S., Calkins, H., Cigarroa, J. E., Cleveland, et al. (2014). AHA/ACC/HRS guideline for the management of patients with atrial fibrillation. 

Munn, Z., Porritt, K., Aromataris, E., Lockwood, C., & Peters, M. (2014). Summary of findings tables for Joanna Briggs Institute systematic reviews. Joanna Briggs Institute. 

Tillin, T., Hughes, A. D., M., J., W., P., S., N., F., et al. (2013). The relationship between metabolic risk factors and incident cardiovascular disease in Europeans, South Asians, and African Caribbeans: SABRE (Southall and Brent Revisited)—a prospective population-based study.

Verma, A., Jiang, C. Y., Betts, T. R., Chen, J., Deisenhofer, I., Mantovan, R., et al. (2015). Approaches to catheter ablation for persistent atrial fibrillation. 1812-1822.