- Case Study:
It is 0800hrs.
Elliot, a 67-year-old Aboriginal man, came in yesterday with chest pain. ECG revealed acute
ST-segment elevation (in leads V2-V6) myocardial infarction (STEMI). Elliot was transferred from the emergency department to the Cath lab for an urgent angiogram and percutaneous coronary intervention (PCI) as he was at risk of cardiogenic shock.
Day 1 post-PCI, Elliot has an elevated Troponin (53 ng/L as of 0600 today). He feels tired today and is sitting out of bed as he states that it improves his breathing. Elliot had a restless night, and at 0200hrs, began to desaturate (SpO2 92% RA). Subsequently, he was commenced on oxygen at 6l/min via Hudson mask. He removed the oxygen in the morning as he found the mask uncomfortable. His medical past history includes Hyperlipidemia, T2DM, and he smokes one packet of cigarettes in two days. He weighs 130kg, and his height is 140cm. After your initial safety check, you take his vital signs.
- Elliot’s BP is 100/60 mmHg (the last reading was 115/70).
- His heart rate is 74 bpm (slightly raised since the last reading when his heart rate was 64 bpm).
- Temperature 37.5C (from 36.8)
- His respiratory rate has increased to 24 breaths per minute (from 18 breaths per minute).
You were caught up with the other two patients and did not get a chance to check up on Elliot. It is 1000hrs now, and you heard a METCall being announced for Elliot’s room. As you entered his room, you noticed that he was confused, cyanotic, and looked lethargic. His BP is 86/50, and his HR is irregular and tachycardic. As the MET team arrived, Elliot became unconscious, and you started cardiac compressions.
- Refer to the NSQHS second edition for Recognising and Responding to Acute Deterioration Standard and identify and explain the contributing factors for Elliot’s deteriorating condition. (250words)
- Using the NSQHS standards and other evidence-based resources/Standards, identify and discuss four evidence-based prevention nursing strategies that can be implemented for Elliot during his hospital stay to prevent further complications.
- Identify two different validated risk assessment tools that recognise patient deterioration with clear escalation processes embedded and discuss/critique the effectiveness with supporting evidence. (350 words)