Complex Needs

This assignment is a case study which critically examines the complex care needs, of a service user with type 2 diabetes mellitus. The selected key pathological processes involved will be discussed. The nursing assessment and interventions, required to provide holistic person centred care will also be considered, in order to examine the wider context of care management for a patient with complex circumstances.

Pulling off the ramp, we turned onto Church Hill Road responding on a priority one for the cardiac arrest. I tried to review my field guide en-route to the call, but all I could see were flashing lights reflecting off the guide’s pages and crowds of cars moving over for our wailing sirens. Within three minutes we had arrived on-scene and it was clear that our patient was not in cardiac arrest; however, his 12-Lead EKG and oxygen saturation were marginally reassuring and pointed to an active heart attack. At this point in my EMS training I was a BLS provider, but had adequate knowledge to assist Kathy. Instinctively, I went right to work and loved every second of it. The concept of formulating a differential diagnosis in the field and testing that theory is one of the principle factors that kept drawing my back to EMS. In addition, I developed an unparalleled appetite for knowledge, stemming from my desire to get every differential diagnoses right. Coming to this realization early in my EMS career, we [healthcare providers] frequently forget that patients often lack the medical knowledge provided to us through years of training. Behind CT Scans and MRIs are patients with questions. Having the ability to provide compassion, sympathy and reassurance to a patient is a central part to their recovery and survival; therefore, we [healthcare providers] need to be able to care for our patients on a holistic level, focusing less on the disease and more on the

Ms. Sunshine immediately was placed on oxygen, sitting upright, an IV infusing, had blood work sent for numerous labs, including cardiac markers, had a chest x-ray and an electrocardiogram (EKG) performed. A clinical nurse leader is able to teach patients and patients regarding health promotion, disease prevention, or disease management (American Association of Colleges of Nursing, 2011). It is important to understand the pathophysiology behind disease processes in order to help facilitate better outcomes for Ms. Sunshine.

When you reach the five principles of Maslow’s Hierarchy of Needs, it means you understand human motivation and your life is fulfilled, but the truth is, it is difficult to reach these principles because most of human beings have lack of these needs due to the style of life they have, or they are not happy with themselves or with the world in general. To find some examples of these five principles, let’s do it thru songs that can be related.

You are working in the internal medicine clinic of a large teaching hospital. Today your first patient is 70-year-old J.M, a man who has been coming to the clinic for several years for management of CAD and HTN. A cardiac catheterization done a year ago showed 50% stenosis of the circumflex coronary artery. He has had episodes of dizziness for the past 6 months and orthostatic hypotension, shoulder discomfort, and decreased exercise tolerance for the past 2 months. On his last clinic visit 3 weeks ago, a CXR showed cardiomegaly and a 12-lead ECG showed sinus tachycardia with left bundle branch block. You review his morning blood work and initial assessment.

Pericarditis is another complication of acute MI. The incidence of early pericarditis after a MI is about 10% (American Heart Association 2015). This is caused by the inflammation of pericardial tissue which overlies infarcted myocardium. Clinically a patient can present with severe pleuritic chest pain and pericardial friction rub. Pericarditis usually develops between 24 and 96 hours after an acute MI. The treatment of this complication is with anti-inflammatory drugs and analgesia (American Heart Association 2015).

A heart attack occurs when an artery that supplies blood to the heart becomes blocked. The loss of oxygen and nutrients damage the heart's muscle tissue, causing the remaining healthy tissue to pump even harder to keep up.

On arrival at the ED, the physician auscultates muffled heart tones, no breath sounds on the right, and faint sounds on the left. A.W. is

Parker included collecting cues in 12-lead ECG, blood pressure, potassium level, sodium level, the warmth of hands and feet and pain score (Corrales-Medina et al., 2012). Also, the process involved identifying the risk factors associated with the patient's condition. From the immediate assessment, it included weight, smoking history, history of depression and family history of cardiac conditions (Corrales-Medina et al., 2012). One evening, Mr. Parker slumped on the bed; I monitored the continuous cardiac monitor to determine his heart rhythm. Based on current information, the T wave on the ECG indicated that the ventricles are repolarising (Levett-Jones et al., 2010).

His heart had stopped beating. It is hard to describe how I felt in that moment as I am still trying to process my emotions. I remember turning away from the table where the patient lay lifeless, and staring at the sink in the far corner. A single tear rolled down by flushed face. Suddenly, I felt as if my throat was closing in on itself. After a few deep breaths I turned around and began to focus only on the medical treatment being provided. The storm of emotions that was brewing inside of me was kept at bay for the moment. Instantly, I became infatuated with all of the medical procedures that were being performed, central lines, chest compressions, and intubation were all unfolding before my eyes. Watching a code is nothing like how it is portrayed in the movies. Everyone is extremely calm and precise in their actions. Seeing a human heart be shocked is something that I will never forget. When a heart is being shocked, the whole room stops. Time stops. Everyone has their eyes glued to the monitor hoping to see a rhythm appear. A rhythm didn’t appear. I will never forget his skin turning into a grey blue pallor. It is a color I will never forget, for this is the color of imminent death. Compressions begin again, and then it is my turn. I am still shocked that I was able to find the courage to hop up on the stool and deliver chest

Patient Y is known to have suffered many myocardial infarctions in the past which she has been treated for and made a full recovery. She had also been referred to the hospitals cardiac rehabilitation service after her previous heart attacks but refused to attend.

but it proved to be anything but. During that day the emergency room was very crowded and the staff was overworked. I found the attendant and together we determined the patient’s diagnosis. I knew that myocardial infarction was one of the differential diagnoses to be considered, especially since Ahmed was a heavy smoker.

This Friday, September 29th, I had my second clinical observation experience in the Cardiac Cath Lab. I was there from 7:00 a.m. till noon, viewing the flow and duties of the nursing staff on the unit, learning about the procedures done on this specialized unit. Throughout most of the morning I followed Sara, an RN, who had been in the unit for eight years. It was an impressive experience that broadened my previously limited knowledge of the roles and experience of a Cath Lab nurse.

Those desires also must be satisfied to avoid “dire consequences.”4 Desires and aspirations for social support, to stay in their own homes, to be understood, to be financially stable, and to return to former function are entailed in the construct of holistic comfort that embodies physical, psychospiritual, social, and environmental needs.2 Because the theory is based on the needs of patients, it is a representation of what patients hope to receive from nurses who are assigned to their care. Two facets of human needs have been identified and described as reflexive. First, needs provide a motivational drive

Her ideas revolve in having the nurse and the client work on these needs for improving health condition. In the nursing profession, assessment is very critical for the plan of care. The success of our interventions would greatly depend on how substantial our assessment to our client. Henderson’s 14 basic needs would be a good reference in assessing our client’s needs for care.