Ronald Bates Case Study

Assessment 2 Short Essay

Question -01

Discuss Mr. Ronald bates systemic assessment and priorities of management Mr. Ronald bates presented to the emergency department with shortness of breath (Respiratory rate- 24 breaths/min) and general discomfort (pain score- 4/10) and it was started in the morning and worsens when doing activities. The above presenting complaints lead to a possible cardiac event, so that this presentation would be triaged as category 2. Therefore, medical officer would be notified regrading patient presentation and put Mr. bates to semi fowler’s position in the Emergency bed if this position is comfortable for him. Further primary systemic assessment of the patient starts with an order with an assessment of

Mr. Bates’ oxygen saturation is 94% so oxygen would be administered on 6 liters per minute via a Hudson mask. The patient oxygen saturation should be maintained at 95 % or above. If the oxygen saturation is not improving via Hudson mask then it would be replaced by non- rebreather masks on high flow oxygen, which delivers 100% oxygen concentration (NSW Health, 2012).

Glyceryl Trinitrate (GTN): GTN Sublingual 300-600 mg or GTN Spray 400-800 mg is given if systolic blood pressure is greater than 90 mm of hg. (NSW Health 2012:20). Glyceryl Trinitrate acts on vascular smooth muscles and dilate arteries and veins. Vasodilatation results in the reduction of venous return which also reduces the work load of the heart and oxygen demand. GTN sublingual tablet or spray can be repeated every 5 minute for maximum of 3 doses. Regular monitoring of vital signs is important because GTN can cause Hypotension. (College of Nursing, 2015:24).

Nursing Consideration: Monitor vital signs frequently to find the possible side effect of hypotension. Please give a comfortable lying or sitting position for the patient when taking GTN to avoid hypotension and syncope (Brunner and Suddarth’s, et al, 2010: 765

An initial dose of 300-600 mg clopidogrel should to be given along with the aspirin (NSW Health 2012).

Nursing consideration: monitor for internal and external bleeding and allergies.

Heparin: heparin prevents conversion of fibrinogen to fibrin and prothrombin to thrombin. IV bolus of unfractionated Heparin or Subcutaneous injection of low molecular weight heparin (LMWH) may be used to prevent the formation of new blood clots.

Nursing consideration: Require regular monitoring of activated partial thromboplasitn time (aPTT) and needed frequent heparin dose changes (Brunner and Suddarth’s, et al, 2010: 765).

Fibrinolytic therapy: This therapy is given to dissolve the thrombus in the artery and restore the blood flow. There are two fibrinolytic drugs which are streptokinase and Recombinant tissue plasminogen activators (r-TPA) which includes Alteplase, reteplase and tenecteplase (Brunner and Suddarth’s, et al, 2010: 772). Fibrinolytic therapy would be commenced within 4-6 hours of myocardial infarction to restore blood flow, reduce oxygen demand and reduce myocardial tissue damage (Silvestri,