chronic conditions nursing assignment on strategies nurses can use to improve patient care.
Task: how can nursing students use chronic conditions nursing assignment research techniques to enhance patient care?
Assessment One: Hv3 Short answer questions on a case study(TEMPLATE)
Search terms used to access literature: ST elevation myocardial infarction, Troponin, supplemental oxygen therapy, Aspirin 300 mg, primary percutaneous coronary intervention
Search engines used to access literature:Example: CINAHL, MEDLINE (Ovid) ,Clinical Key for Nursing, Cochrane library, JBI, Scopus
Question 1. (250 words)
In the given chronic conditions nursing assignment case study, 64 years old male Mr. Raj Kumar has been presented to the Emergency Department and a diagnosis of acute anterior ST elevation myocardial infarction (STEMI) is made following 12 leads ECG and pathological report showing elevated Troponin (35 ng/L Troponin). Mr. Kumar, weighing 88 kg has medical history of hypertension, hyperlipidaemia and type 2 diabtes mellitus and is undergoing medications and controlled diet for such ailments. Studies have elucidated that cardiac troponin (cTn) acts as a reliable biomarker for myocardial necrosis. cTn has been found to show high myocardial tissue specificity and even high myocardial clinical sensitivity (Jennings, 2016). Following onset of myocardial necrosis as in STEMI, the values often remain elevated for 2 weeks and beyond (Badimon, 2018). When blood flow to the coronary vessels that supply oxygen to the heart muscles gets occluded myocardial infarction occurs that ultimately leads to necrosis and cell death of the myocytes. Eventually because of the rupture of the cellular membranes, the intracellular components spill out into the extracellular spaces and finally into the bloodstream in such condition. Among these spilled over contents, troponin is one and when released in large quantities it may be detected in the blood stream as well. Research shows that typically within 2 to 3 hours from the onset of chest pain, elevated levels of troponin is detected in circulation that peaks usually between 12 and 48 hours with progressive declining trend over the next 4 to 10 days to normal level. This desired surge and fall in troponin acts as a vital distinguishing factor for MI from other reasons for elevated troponin (Elsaka, 2022).
Question 2:Category 1(approx. 165 words)
As per the chronic conditions nursing assignment case Mr. Kumar was recommended for supplemental oxygen if SpO2< 93% as part of the non-pharmacological intervention. Recent research evidences based on meta-analysis of randomized control trials have investigated the efficacy of supplemental oxygen therapy in comparison to room air in patients suspected of having or confirmed acute myocardial infarction. However, the results showed that although commonly used, supplemental oxygen therapy did not harbor any significant clinical benefits (Sepehrvandet al., 2018). Oxygen therapy although acts as a cornerstone of intervention for acute MI, yet the evidences are inconclusive in terms of its utilization in imparting cardiovascular and analgesic impacts to the intended patients. Supplemental oxygen therapy has been used in clinical settings based on the rationale that this might enhance delivery of oxygen to the ischemic myocardium and thereby alleviating the myocardial injury. Corroborating data from previous findings, another study revealed that oxygen therapy did not reap any significant clinical effect in patients with STEMI (Khoshnoodet al., 2018).
Question 2: Category 2 (approx. 165 words)
The chronic conditions nursing assignment also outlines how Mr. Raj Kumar was also put under pharmacological interventions that included administration of Aspirin 300 mg among other medications. Evidences from clinical trials have put forward interesting findings in terms of its utility in managing STEMI. Aspirin in lower doses of 75-325 mg acts as a platelet inhibitor thereby highlighting its benefits in terms of ameliorating absolute risk reduction as far as vascular mortality is concerned. For acute presentation of STEMI, oral administration of 150-300 mg Aspirin has been found to act by ensuring inhibition of synthesis of thromboxane B2 as part of adjuvant antithrombotic therapy in STEMI (Caldeira& Pereira, 2019). Another interesting retrospective study indicated that oral loading of Aspirin as part of the anti-platelet therapy in acute STEMI showed significantly less in-hospital mortality in contrast to their high dose intravenous Aspirin treated counterparts (Rossi et al., 2020).
Question 2: Category 3 (approx. 165 words)
Further as part of reperfusion intervention, Mr. Kumar was suggested primary percutaneous coronary intervention. The primary percutaneous coronary intervention has become the choicest modality of treatment for STEMI patients when it can be performed expeditiously. Advantages in favor of this procedure shows that complete revascularization might be beneficial in fats re-establishing blood flow through expanding the viable myocardial area thereby causing improvement in left ventricular ejection fraction. Further the reduced vascular complications because of lesser requirement for punctures and decreased hospitalization time indirectly promotes heightened cost-effectiveness. In this context, a recent study evaluated the efficacy of primary percutaneous coronary intervention against a pharmacoinvasive strategy as an alternative. It was found that a selective pharmacoinvasive strategy showed improved ST-segment resolution as well as better clinical outcomes on 1 year of follow up in comparison to primary percutaneous coronary intervention (Baineyet al., 2019). Anotherchronic conditions nursing assignment study suggested that postconditioning during primary percutaneous coronary intervention for STEMI did not show early benefits although postconditioning was correlated with better left ventricular (LV) remodeling particularly in patients having microvascular obstruction (Traverse et al., 2019).
Badimon, L. (2018). Pathogenesis of ST-Elevation Myocardial Infarction. In Coronary Microvascular Obstruction in Acute Myocardial Infarction (pp. 1-13). Academic Press.
Bainey, K. R., Armstrong, P. W., Zheng, Y., Brass, N., Tyrrell, B. D., Leung, R., ... & Welsh, R. C. (2019).
Pharmacoinvasive strategy versus primary percutaneous coronary intervention in ST-elevation myocardial infarction in clinical practice: insights from the vital heart response registry. Circulation: Cardiovascular Interventions, chronic conditions nursing assignment12(10), e008059.
Caldeira, D., & Pereira, H. (2019). Adjuvant antithrombotic therapy in ST-elevation myocardial infarction: A narrative review. Revista Portuguesa de Cardiologia (English Edition), 38(4), 289-297.
Elsaka, O. (2022). Pathophysiology, Investigations, and Management in Cases of Myocardial Infarction. Asian Journal Of Advances In Medical Science, 1-14.
Jennings, G. L. (2016). Reflections on the Heart Foundation of Australia/Cardiac Society of Australia and New Zealand Acute Coronary Syndromes Guideline 2016–A New International Benchmark. Heart, Lung and Circulation, 25(11), 1048-1050. Khoshnood, A., Akbarzadeh, M., Carlsson, M., Sparv, D., Bhiladvala, P., Mokhtari, A., ... &Ekelund, U. (2018). Effect of oxygen therapy on chest pain in patients with ST elevation myocardial infarction: results from the randomized SOCCER trial. Scandinavian Cardiovascular Journal, 52(2), 69-73.chronic conditions nursing assignment
Rossi, R., Bagnacani, A., Sgura, F., Enrique Monopoli, D., Coppi, F., Talarico, M., ... &Boriani, G. (2020). Effect on mortality of different routes of administration and loading dose of aspirin in patients with ST-segment elevation acute myocardial infarction treated with primary angioplasty. Coronary Artery Disease, 31(4), 348-353.
Sepehrvand, N., James, S. K., Stub, D., Khoshnood, A., Ezekowitz, J. A., & Hofmann, R. (2018). Effects of supplemental oxygen therapy in patients with suspected acute myocardial infarction: a meta-analysis of randomised clinical trials. Heart, 104(20), 1691-1698.
Traverse, J. H., Swingen, C. M., Henry, T. D., Fox, J., Wang, Y. L., Chavez, I. J., ... &Garberich, R. F. (2019). NHLBI-sponsored randomized trial of postconditioning during primary percutaneous coronary intervention for ST-elevation myocardial infarction. Circulation research, chronic conditions nursing assignment124(5), 769-778.