Evidence Based Practice Paper – Cardiovascular Diseases Essay

This week’s graded discussion topic relates to the following Course Outcomes (COs).
 CO1 Utilize prior knowledge of theories and principles of nursing and related disciplines to explain
expected client behaviors, while differentiating between normal findings, variations, and
abnormalities. (PO 1)
 CO3 Utilize effective communication when performing a health assessment. (PO 3)
Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical
mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that
the patient has been experiencing increased discomfort in her back throughout the night and has
required frequent help with repositioning. She states that the patient was medicated for pain
approximately 2 hours ago but is voicing little relief and states that you might want to mention that to
the doctor when he rounds later this morning. With the patient appearing to be in no visible distress,
you proceed on to the next patient’s room for report.
Approximately 1 hour later, you return to Ms. Jackson’s room with her morning pills and find her
slumped over the bedside stand in tears. The patient states, “I don’t know what is wrong, I don’t feel
right. My back hurts and I’m just so tired. What is wrong with me?” The patient refuses to take her
medications at this time stating that she is starting to feel sick to her stomach.
Just then the nursing assistant comes into the patient’s room to record Ms. Jackson’s vital signs, you
take this opportunity to quickly research the patient’s medication record to determine if she has a
medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs:
T 37, R 18, and BP 132/54, but states she couldn’t get the patient’s pulse because “it is all over the
place.”

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Please address the following questions related to the scenario.
1. What do you suspect is the cause of the patient’s symptoms?
2. Describe the course of action that you will take to confirm this suspicion and prevent further decline.
3. What further assessments, lab values, and tests will likely be ordered for this patient and how often?
If testing is to be completed more than once, please explain the rationale for doing so.
4. While you are caring for this patient, how will you ensure that the needs of your other patients are
being met?
1. What do you suspect is the cause of the patient’s symptoms?
Based on the patient’s symptoms, I would suspect either a possible cardiac event or post-surgical
complication.
2. Describe the course of action that you will take to confirm this suspicion and prevent
further decline.
I would immediately request the aide stay with the patient while I update the Charge Nurse/Nursing
Supervisor for the unit of the situation and contact the physician to provide an update on the patient,
present my concerns, and request orders.
3. What further assessments, lab values, and tests will likely be ordered for this patient
and how often? If testing is to be completed more than once, please explain the rationale for
doing so.
 STAT EKG to determine the patient’s current cardiac electrical activity and rhythm.
 STAT Serial Troponin level.
 CMP & CBC may be ordered to “help evaluate the patient’s major body organs, electrolyte
balance, blood glucose, and red and white blood cells to see whether there are any excesses,
deficiencies, or dysfunctions that may be causing or worsening the person’s symptoms”
(AACC, 2016).
 Continuous ECG monitoring to continually monitor the patient’s heart rhythm.
 Continued vital sign monitoring every 15 minutes.
While you are caring for this patient, how will you ensure that the needs of your other patients
are being met?
I would immediately notify the Charge Nurse/Nursing Supervisor of the situation and request their
assistance with monitoring/caring for my other patients or assigning other nurses on the floor to assist
until the situation with Ms. Jackson has been resolved.