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.”

Please address the following questions related to the scenario.

What do you suspect is the cause of the patient’s symptoms?
Describe the course of action that you will take to confirm this suspicion and prevent further decline.
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.
While you are caring for this patient, how will you ensure that the needs of your other patients are being met?

Solution:

What do you suspect is the cause of the patient’s symptoms?

Esther Jackson symptoms correlate with myocardial infarction. She is 1-day post-op from a left radical mastectomy. She is experiencing increased discomfort in her back with little relief when medicated. She is tired and nauseous. Her pulse is all over the place. According to our book, signs of a heart attack in women can be quite different than men. Women can experience “atypical” symptoms, such as no chest pain, but experiencing cold sweats, nausea, and light-headedness, extreme fatigue and feelings of having the flu. Other symptoms can be an uncomfortable chest pressure and shortness of breath. Pain or discomfort is experienced in other body areas such as arms, back, neck, jaw, and/or upper abdomen (Jarvis, 2016).

“Atypical non-specific symptoms of acute coronary syndrome, such as epigastric, intermammary, intrascapular back and right arm pain, dyspnea and prodromal symptoms such as fatigue, weakness, indigestion, nausea, sleep disturbance and a sense of dread, while evident in both sexes, predominate in women. Women are more likely to complain of jaw and neck pain and describe the chest pain as a feeling of ‘fullness’ than men, and fatigue, tiredness, weakness and sleep disturbance were commonly reported by women diagnosed with depression presenting with ACS” (Malecki-Ketchell, 2017).

Describe the course of action that you will take to confirm this suspicion and prevent further decline.

“Prompt, accurate assessment of cardiovascular history, clinical examination, and a 12-lead ECG and measurement of troponin levels are essential to provide a definitive diagnosis of acute coronary syndrome” (Malecki-Ketchell, 2017). So, as her nurse, the first step I would….Please click the Paypal icon below to purchase full solution for only $5