Case Study : David Komber
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David is a 68 year old male who is a retired school teacher.He lives with his wife and son. He is normally fit & healthy. He has regular walks and plays badminton weekly . He complained of chest pain to his wife who called the ambulance. He was brought to the local ED with crushing central chest pain (feeling tight) and acute shortness of breath (SOB). He also felt palpitations. He has previous cardiac history. He was diagnosed with hypertension 25 years ago and hypercholesterolemia for which he takes regular medications. In the ambulance the ECG initially showed tachycardia with a heart rate of 145 beats per minute and ST elevation. ECG on admission suggested an anterior myocardial infarct [MI] confirmed by follow up ECGs. He was sent to the catheter laboratory for a primary percutaneous coronary intervention (PCI).
Medications:
Amlodipine : 5 mg OD(once a day)
Lisinopril : 10 mg OD
Atorvastatin: 20 mg OD
On examination in ED , he was pale, clammy,
BP 127/56;
Pulse 133 beats per minute
Monitoring in Sinus Tachycardia
Temperature 360 C
Respiratory Rate 35 breaths per minute
Oxygen Saturation : 84% on rebreathing bag.
Chest auscultation : Wheezy
Initial blood results in ED
Hb : 134 g/L
WCC: 5.8 X109/L
Platelets : 290 X109/L
Glucose: 8.l mmol/l
Na: 139 mmol/l
K : 4.5 mmol/l
Creatinine: 82 umol/L
Urea: 4.2 mmol/L
Creatine Kinase(CK): 890 U/L
Troponin T = 15 ng/mL
Total cholesterol: 7mmol/L
High Density Lipid(HDL): 1.8 mmol/L
Low Density Lipid (LD)L: 7 mmol/L
Triglycerides: 4 mmol/l
INR : 1.3
APTT: 34 sec
ECG showed a LBBB. With ST elevation in leads V1-V4..
The plan is to :
Cardiac monitoring via defibrillator pads
Cannulate with large bore venflon.
Catheterise
Start ACS protocol : administer Aspirin 300 mg & Clopidogrel 75 mg
intravenous infusion of GTN
To give analgesia and anti emetic :
Morphine 10 mg PRN
Metoclopramide 10 mg
Patient was started on high flow oxygen.
Initial Arterial blood gas showed :
pH 7.073 ;pCO2 :3.6 KPa; pO2 : 9 Kpa; HC03 :23.6 ;BE :8.5
Repeat ABG: pH :7.260 ;pCO2 :5.1 KPa ;pO2 :10.9 KPa ;HCO3: 20.8;
BE :6.4
Respiratory Rate of 36 bpm using accessory muscles.
BP 106/76; Pulse 122 beats per minute; Temp 36.9°C.
He was very anxious but settled a little since explanations given about his care.
| Essay sections – place these sections in any order to show a logical sequence of topics for your essay.
Font and format: we advise that you use arial (body) size 12 with 1.5 spacing and align left. The total word Count is 2500 words +/- 10%
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| Introduction
Clearly introduce the acute or long-term condition for the case study of David Komber which is Myocardial Infarction . Supply some context of the prevalence of the condition and impact on the individual and their family. Include one or two current statistics. Outline the themes that this essay will be including pathophysiology, psychosocial, coping strategies, potential deterioration, and appropriate nursing assessment. Emphasise that this is based on a fictional case study, not a real person. Suggested word count 150 words.
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| Pathophysiology
Explain the primary pathophysiology of Myocardial infarction. Discuss the physiological changes that occur and how they lead to the common physical signs and symptoms that a person with this condition may experience. Suggested word count 500 words
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| Acute Deterioration
Explain how and why this patient might deteriorate in their physical and/or mental health and wellbeing. Relate to the signs and/or symptoms in the case study and choose one or two key signs of deterioration to discuss. Integrate theory and research in your explanation. For example, you might explore acute physical deterioration such as breathlessness and acute mental health deterioration such as anxiety Suggested word count 450 words
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| Assessment & Care
Discuss a suitable assessment tool that would be used for one of the signs of deterioration. Explain how this assessment tool is used and the appropriate nursing response when acute deterioration is detected. Integrate theory and evidence in your explanation. You can choose to focus on the assessment of deterioration in physical or mental health in this section then prioritise the nursing care input Suggested word count 450 words
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| Integrated psychosocial care
Choose two features from the case study and discuss how spiritual, sociological, psychological, emotional, and/or cultural aspects impact on the individual and influence nursing care. Integrate theory and evidence in your explanation. Suggested word count 400 words
Coping Consider the coping strategies shown in the case study. Discuss the individuality of the person in your case study and explain how their fears, concerns and beliefs may influence their capacity to cope with the symptoms associated with the long term condition or acute illness. Suggested word count 400 words.
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| Conclusion
Pull together the key learning from your essay and show how this can be applied to nursing practice. Check the focus in this section is the case study of DAVID KOMBER and aims of the essay. Suggested word count 150 words.
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| Reference List
The references should be listed as per the current HSK school guideline . Check that the list matches all citations within the essay. This section is not included in the word count |
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