You are the Registered Nurse working in the Emergency Department of a rural hospital. At 0830, Reverend Greg Patterson presents after being driven to hospital by his neighbour. He is pale, sweaty and clutching at his chest. He tells you that he has 8/10 chest pain and tingling in his left arm. You immediately place him into a wheelchair and bring him bring into the department.
As you assist Reverend Patterson into the bed, he is having difficulty talking and tells you that he wants to remain sitting on the edge of the bed. His pulse feels weak and thready. Reverend Patterson describes his chest pain as being central to left-sided and feeling like someone standing on my chest. He describes his left arm as \”feeling heavy and aching\”. He denies abdominal and back pain but tells you that he feels like he would pass out if he tried to stand up again and that he feels like he wants to vomit.
You place Reverend Patterson on the cardiac monitor, which reveals sinus tachycardia at a rate of 115 beat per minute. His observations and other assessment findings are as follows:
BP 135/70, HR 74, RR 24, SpO2 88% on room air, temp 36.2.
This assessment task requires you to submit a report in which you discuss your initial assessment and management of Mr Patterson. In addition to a brief introduction and conclusion, your report should address the following:
? Chest pain is a very serious clinical manifestation and should always be considered to be caused by myocardial ischaemia until proven otherwise. Discuss how you would use the PQRST mnemonic to conduct a systematic assessment of Reverend Pattersons chest pain. This discussion should incorporate any relevant information already provided in the case study and any additional information you would seek as part of your assessment.
?Identify your first five nursing priorities for Reverend Patterson. These priorities should be identified in order of clinical urgency and may include further assessments and/or interventions that can be initiated and conducted by a Registered Nurse.
?Acute Coronary Syndrome (ACS) is a term used to identify a group of conditions caused by common underlying pathophysiology. For each of the priorities you have identified, provide a rationale that explains how it will address or is linked to the underlying pathophysiology of ACS.
You must support your discussion with a MINIMUM of 12 recent (less than 7 years old) and credible sources. Credible sources include the following:
?peer reviewed journal articles
?text-books, evidence summaries
?best practice guidelines,
?health facility clinical guidelines, pathways and policies/procedures
?websites containing content aimed at health professionals.