Critical Analysis of nursing intervention

[preshee92]

Hi, I need some help on an assignment. Basically, I have to do a critical analysis of a nursing intervention in relation to a scenrio as well as a care plan. The sceario is:

Mrs Davis is 62years old, and was at family gathering when she started complaining of nausea and heartburn which she put down to the food she had eaten and had taken some antacid tablets for the symptoms. After about two hours the symptoms had not resolved and she explained that she was experiencing a dull pain that seemed to spread to her shoulders and some mild shortness of breath. Her family called for an ambulance as they were concerned. She was given aspirin by the ambulance crew and sublingual GTN as they suspect she has Acute Coronary Syndrome (ACS)from the ECG strip. She is still complaining of chest pain on admission to the ED and very restless stating I feel like I have something heavy sitting on my chest.”

Having formulated your care plan you critical analysis of the nursing interventions identified in your care plan. To undertake a critical analysis of the nursing interventions you will first need to do a literature review of the nursing problem identified to explore what the evidence from research has to say about the specific nursing problem and how it is managed. For this piece of work you will need to source a minimum of

three articles from peer reviewed journals or clinical guidelines for the identified nursing problem

The problem I have identified is "Acute pain related to myocardial ischemia as evidenced by shortness of breath and radiation of pain to the shoulders."

Will I have to find articles and guidelines on acute pain management and link the intervetions that I have come up with the the inerventions in the articles? I do not know what do, and my tutor does not seem to want to help me. Please help me.

[Magsulfate, BSN, RN]

1. Shortness of breath

2. Pain

I think as a nursing diagnosis impaired gas exchange should be top priority. Look up in your schools library database for that nursing diagnosis and see where it takes you. Other nurses would point in a different direction, but we are always taught airway first right?

[Here.I.Stand, BSN, RN]

I would think "altered tissue perfusion" would be a more appropriate nursing dx, because what is happening with ACSs? Myocardial ischemia (or infarction, if ischemia isn't reversed quickly enough), right?

I would think searching for info on pain management would tell you lots about chronic pain, postop pain, neuropathic pain etc. But pain management isn't your main goal with ACS -- your goal is to reverse or minimize that myocardial ischemia until that pt hits the cath lab or OR.

Re gas exchange, again the SOB is r/t the cardiac situation. It doesn't say anything about a PE or pneumonia or airway obstruction, anything that would prevent gas exchange (which happens between alveoli and capillaries.)

[Here.I.Stand, BSN, RN]

but we are always taught airway first right?

Not necessarily -- BLS since 2010 has taught CAB. In a pulseless arrest, start chest compressions first. "Hands only" CPR is even taught to the lay public. A conscious choking victim, of course you clear the airway first, because it's obvious what the issue is, and a conscious pt does have a pulse.

[preshee92]

I would think "altered tissue perfusion" would be a more appropriate nursing dx, because what is happening with ACSs? Myocardial ischemia (or infarction, if ischemia isn't reversed quickly enough), right?

I would think searching for info on pain management would tell you lots about chronic pain, postop pain, neuropathic pain etc. But pain management isn't your main goal with ACS -- your goal is to reverse or minimize that myocardial ischemia until that pt hits the cath lab or OR.

Re gas exchange, again the SOB is r/t the cardiac situation. It doesn't say anything about a PE or pneumonia or airway obstruction, anything that would prevent gas exchange (which happens between alveoli and capillaries.)

Oh so the priority is not pain as I thought that it's what the patient is complaining of is what we act on which is her chest pain which radiates to her shoulder. So instead it's ineffective gas exchange or altered tissue perfusion related to myocardial infarction ?

[Here.I.Stand, BSN, RN]

Oh so the priority is not pain as I thought that it's what the patient is complaining of is what we act on which is her chest pain which radiates to her shoulder. So instead it's ineffective gas exchange or altered tissue perfusion related to myocardial infarction ?

I don't think it's impaired gas exchange, because again there's no pulmonary issue. Remember "gas exchange" refers to O2 moving from the alveoli into the bloodstream, and CO2 from the blood into the alveoli for exhalation. "Perfusion" is the passage of O2 from the blood into the tissues.

Unfortunately I don't have a NANDA book handy...I'd need to refresh my memory re: acceptable etiologies. I do remember you're not supposed to give a medical dx as the etiology, though, so you couldn't say "r/t MI." "Ischemia" like you said in the OP maaaay be ok while "infarction" is a dx...but I'd look at a NANDA-I resource to be sure. (*blush* I actually haven't written an actual NANDA ndx on paper since school.)

When someone is showing ACS sx, like in your scenario the pt is given aspirin and nitro -- the goal is to increase perfusion. The pain is a direct result of ischemia...so that's different than typical pain control interventions. Does that make sense?

If you do a search on CINAHL or Google Scholar for "nursing interventions in ACS," or "nursing role," or ditto for "acute MI," you should find some good info.