Assignment 1 Short answer questions on a case study

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Western Sydney University *

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NURS2016

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Medicine

Date

Apr 3, 2024

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docx

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Uploaded by JudgeEnergyLark35

Question 1: Central crushing chest pain with radiation to the jaw Angina, also known as central crushing chest pain with radiation to the jaw, is a common symptom of STEMI (ST-elevation myocardial infarction), which occurs when a blood clot obstructs the coronary artery (Pek et al., 2017). The coronary artery is responsible for supplying oxygen and nutrients to the heart, therefore when a blood clot that is typically caused by a plaque ruptures, it disrupts the blood flow to the heart and leads to ischemia, or a lack of oxygen supply (Niccoli & Eitel, 2018). The heart and surrounding tissues become damaged when there is a lack of oxygen and nutrients, irritating the nerve endings (He et al., 2022). This results in chest pain, which many patients frequently described as a crushing sensation (Kikuta et al., 2019). When the heart muscle is deprived of oxygen and nutrients, it sends signals to the nervous system, which can be perceived as pain in other parts of the body, such as the jaw ( Luo, He & Chen, 2021) . Patients, like Mr. Kumar, can experience pain in their jaw as a result of the convergence of visceral and somatic inputs in various brain/brain stem regions (Kikuta et al., 2019). As the heart attempts to pump blood efficiently, the chest and neck muscles, including those that control the jaw, may become tense and compressed (Luo, He & Chen, 2021). Additionally, depending on which area of the heart muscle is affected, the pain may also radiate to the arm, shoulder, back, or neck (Kikuta et al., 2019). Question 2: Non-pharmacology interventions – Supplemental oxygen if SpO 2 < 92% One of the non-pharmacology interventions for patients experiencing STEMI includes oxygen therapy. Supplemental oxygen may be given to patients who are experiencing hypoxia or shortness of breath (Sarkar, Niranjan & Banyal (2017). It is frequently given to STEMI patients to help increase the amount of oxygen delivered to the heart muscle (Kloner et al., 2021). When the blood supply to the heart is blocked during a STEMI, little to no Page 1 of 6

oxygen reaches the heart muscle, which can harm the heart muscle and lead to heart failure (David et al., 2019). Healthcare providers can help increase the amount of oxygen delivered to the heart muscle by giving patients supplemental oxygen, which will increase their oxygen saturation and can potentially lead to better patient outcomes (David et al., 2019). Furthermore, if Mr. Kumar is hypoxic, oxygen therapy is extremely crucial because his shortness of breath could be damaging to his heart (Sarkar, Niranjan & Banyal, 2017). Therefore, supplying oxygen therapy is one of the important non-pharmacology interventions that healthcare providers can utilise. Question 2: Pharmacology interventions – Morphine 2.5mg IV A pharmacology intervention that healthcare providers can use for Mr. Kumar is administering morphine 2.5mg intravenously to reduce pain, suffering, anxiety, and dyspnoea. STEMI can cause severe chest pain, which Mr. Kumar is experiencing, and this can be distressing for him. Morphine is a powerful pain reliever that can help alleviate his pain and improve Mr. Kumar’s comfort level (Vaidya, Khan & Ghafghazi, 2019). In addition to its effects to reduce pain, morphine has significant advantages for STEMI patients. For instance, it helps dilate the blood vessels and lower the body's need for oxygen, which decreases the workload on the heart. This is crucial for patients who are in excruciating chest pains and can improve patients’ quality of life (Caspi & Aronson, 2020). Despite the fact that morphine will alleviate Mr. Kumar's symptoms, it is important to note that the drug has potential side effects, such as respiratory depression and sedation; therefore, healthcare professionals will need to closely monitor Mr. Kumar during and after morphine administration (MIMS Online, 2023). Question 2: Reperfusion interventions – Primary Percutaneous Coronary Intervention Page 2 of 6

Percutaneous coronary intervention (PCI) is one of the evidence-based strategies for reperfusion therapy that is critical for STEMI patients presenting within 12 hours of the onset of symptoms (Chew et al., 2016). PCI aims to minimise the amount of damage, improve patient outcomes, and quickly restore blood flow to the damaged area of the heart muscle (Driessen et al., 2018). PCI involves threading a catheter with a tiny, folded balloon on its tip through a blood vessel until it reaches the location where plaque build-up is obstructing the blood flow. The plaque is then compressed against the artery walls by the inflation of the balloon. This opens up the passageway and allows blood to flow to the heart again. Finally, the balloon is inflated and removed (Kataoka et al., 2019). According to studies, patients who receive PCI within 90 minutes of their first medical contact have higher survival rates than those who do not (Zahler et al., 2019). Additionally, PCI involves less pain and improves blood flow without requiring open heart surgery. Furthermore, PCI may help the patient breathe better and lower their risk of suffering another heart attack (Healthdirect, 2022). Page 3 of 6

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