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C​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​ase study – The Patient with Cardiac Chest Pain.
You are working in A+E and you are attending to a male patient called Brian who is 53 and
was brought in by ambulance. The patient appears alert but is obviously experiencing
discomfort.
When you introduce yourself, Brian responds in full sentences and appears to have rapid,
shallow breathing. Brian explains he has developed a tight, crushing pain in centre of the
chest while moving boxes in garage > 2 hours ago.
Brian is recently divorced and has moved into a 2-bedroom flat on the 2nd floor of a block
with no lift. He has 2 teenage sons who occasionally stay with him. He works as a waiter in a
restaurant but is very anxious as he not entitled to sick pay and is very aware of staffing
cutbacks. His shift working means he does not eat regular meals and often buys fast food on
his way home.
Brian has a history of hypertension and takes a beta blocker but cannot recall the name. He
has smoked 20+ cigarettes a day for 20 years. He has tried to quit a couple of times but
always returns to it.
He also has a family history of heart disease and an allergy to penicillin.
The patient tells you he has:
? Pain is currently 8/10 and radiating down left​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​ arm and in jaw. Not relieved by rest or
paracetamol. Got better in ambulance (following GTN) but now recurred
? Feels like someone is sitting on his chest.
? Never experienced before
OTHER SYMPTOMS
? Feels nauseous but no vomiting
? Feels hot and sweaty.
? Has had headache (since GTN spray)
Brian’s vital signs are:
? RR: 22
? SpO2: 95% RA
? BP: 188/110
? HR: 98
A CSW completes the 12-lead ECG and gives it to you. You find that the patient is having an
ST elevated MI.
Summative Assessment Requirements:
Select one of the case study patients
Discuss the patient’s key symptoms and link these to the underlying pathophysiology (300 words)
Discuss one evidence-based nursing intervention or strategy to manage the main sign or symptom (300 words)
Consider any integrated care needs, for example discharge into a community setting (100 words)
Critically discuss one research paper to explore the effectiveness of your nursing intervention (300 words). This should include the:
Aim / purpose of research
Methodology
Method
Findings
Limitations
How does this contribute to the existing body of knowledge?
References (not included in the word count)
Include evidence from academic and professional sources to support yo​‌‍‍‍‌‍‌‍‍‍‌‌‌‍‌‌‌‌‌‌​ur work