NUR 643E WK2 SBAR Discussion
Clinical Log in the SBAR Format
| Situation | A middle aged man was brought in the emergency department with a chief complaint of difficulty in breathing, stabbing chest pain radiating to the back, tightness of the chest, and nausea. There were several advanced practice registered nurses (APRNs), one of whom was my preceptor. She guided me through clerking the patient and was there to assist me since this was a medical emergency. All the other APRNs and staff nurses who were without a patient were also there to assist. The patient was a 45 year-old Caucasian male and was brought to the ED by his wife. He looked anxious and confused.NUR 643E WK2 SBAR Discussion |
| Background | The patient has a history of smoking and alcohol consumption for the last 20 years and still smokes and drinks. He has been admitted four times before for pneumonia and severe hypertension. He does not have a surgical history. He lives with his wife and has a son who is in high school. He was sweating and had obvious signs of labored breathing. He is a chef by profession and also has a history of obesity and hypertension. His vital signs on admission were P=100 b/m, RR=22/m, BP=100/50 mmHg, and T=36.1°C (96.98°F). His BMI was 30.5 kg/m2. |
| Assessment | The patient was well-groomed and dressed appropriately for the weather and time of the day. He was oriented in place, space, time, and person; and his pupils were both equal, round, and reactive to light and accommodation (PERRLA).
After assessing the patient’s symptoms by way of objective assessment and taking note of the history given during the subjective assessment, the unanimous impression was that Mr. C.F. was suffering from acute coronary syndrome. To be specific, he had acute myocardial infarction (AMI). Patient C.F. significantly had notable cardiovascular risk factors in the form of obesity, smoking, alcohol consumption, and hypertension (Barstow et al., 2017). He required urgent administration of streptokinase, acetyl salicylic acid, opioid pain relief, a tranquilizer, and oxygen by face mask at 2-4 L/min (Carville et al., 2015). |
| Recommendation | The patient needed immediate admission in the intensive care unit for treatment and observation. He would also need referral for evaluation by a cardiologist.
For a confirmation of the diagnosis, patient C.F. would need to undergo an ECG as well as laboratory blood tests for CK-MB and troponins (Barstow et al., 2017). These would indicate the characteristics STEMI abnormalities on the ECG and possible myocardial injury or necrosis through the CK-MB and troponin levels. NUR 643E WK2 SBAR Discussion Once stabilized, the patient would have to be taken through an evidence-based nurse-led educational intervention for lifestyle change and healthy living (Snaterse et al., 2016; Kirchberger et al., 2015). He would be taken through the behavioral steps necessary for achievement of smoking cessation. This will be done both as an inpatient and later on during follow up. The patient would also be guided through measured aerobic exercises that he would be able to perform even at home. These are isotonic exercises that would assist in controlling the hypertension and reducing his big weight. He would also be taken through the appropriate diet for him in terms of diet management and the importance of taking food rich in fruits and vegetables. Lastly but not least, he would be educated on the vital importance of complying with the medications that he would be discharged with. This is because these would be instrumental in the secondary of a subsequent myocardial infarction which may be fatal. |
| References | Barstow, C., Rice, M., & McDivitt, J.D. (2017). Acute coronary syndrome: Diagnostic evaluation. American Family Physician, 95(3), 170-177. https://www.aafp.org/afp/2017/0201/p170.html
Carville, S.F., Henderson, R., & Gray, H. (2015). The acute management of ST-segment-elevation myocardial infarction. Clinical Medicine, 15(4), 362-367. http://dx.doi.org/10.7861/clinmedicine.15-4-362 Kirchberger, I., Hunger, M., Stollenwerk, B., Seidl, H., Burkhardt, K., Kuch, B., Meisinger, C., & Holle, R. (2015). Effects of a 3-year nurse-based case management in aged patients with acute myocardial infarction on rehospitalization, mortality, risk factors, physical functioning and mental health. A secondary analysis of the randomized controlled KORINNA study. PLoS ONE 10(3), 1-17. http://dx.doi.org/10.1371/journal.pone.0116693 Snaterse, M., Dobber, J., Jepma, P., Peters, R.J.P., Ter Riet, G., Boekholdt, S.M., Buurman, B.M., Op Reimer, W.J.M.S. (2016). Effective components of nurse-coordinated care to prevent recurrent coronary events: A systematic review and meta-analysis. Heart, 102(1), 50-56. https://doi.org/10.1136/heartjnl-2015-308050 |
NUR 643E WK2 SBAR Discussion