assignment information attached

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Name: Tanuja Dass
Student Number: 220183921
Unit: HSNS368
Written assignment:
Professional Practice: Contexts of Acute Care
Cardiac Case Study
Due date:18/03/19
Unit Co-ordinator: Elaine Gilbody-Towne
Word Limit:1000
Word Count: 1004
Elements Signifying Deterioration in Patient’s Condition
A 65-year-old male named Mr Jae-Kwang Lee was admitted to the emergency department (ED) complaining of chest pain and shortness of
eath. His vital signs included a temperature 36.5 Celsius, HR 110, BP 108/73, RR 21 and SpO2 of 95%.
A 12-lead ECG showed Non-ST-Elevated Myocardial Infarction (NSTEMI). After his vital signs were recorded, he was moved to the coronary care unit for a cardiology review. Blood tests were ca
ied out for UEC, FBC, CK-MB, Trop T and Coags. Mr Lee was also administered 2 doses of sublingual Glyceryl Trinitrate (GTN) 300 mg at 5 minutes apart without any effect, and administered 5 mg of Morphine in 2.5 mg increments with good effect.
However, after 2 hours, his condition started to deteriorate with signs of tachycardia, hypoxia and hypotension along with lethargy, which can indicate the occu
ence of cardiogenic shock, which is common in case of people who have history of heart attack. All these symptoms required a rapid response as a cardiogenic shock is rare but fatal if immediate action is not taken. As suggested by Damluji, Al-Damluji and Moscucci (2017), tachycardia, if not treated rapidly, can lead to the cardiogenic shock, especially in cases where individuals have previously suffered a severe heart attack. Ghane et al. (2015) noted that lowering of blood pressure is difficult to control without a rapid response and patient may slip into a coma if the blood pressure keeps dropping.
Henning et al. (2018) mentioned that patients exhibiting hypotension with hypoxia, tachycardia and tachypnoea could enter into cardiogenic shock. Ostadal et al. (2016) stated that hypoxia requires immediate oxygen therapy; these signify elements signify Mr. Lee’s deterioration. As per the NSW Health Between the Flags, all three elements need a rapid response (Clinical Excellence Commission, 2019). These elements signify that the condition of Mr. Lee is deteriorating.
Communication with Doctor about Patient’s Deterioration using ISBAR Tool
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    INTRODUCTION/ IDENTIFY
    This is nurse Tanuja and I have a 65-year old male patient whose name is Mr. Jae-Kwang Lee came to ED with chest pain and shortness of
eath .After examination he was transfe
ed to the coronary care unit under my care. He came alone unaccompanied.
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    SITUATION
    He presented with lethargy, hypotension, hypoxia and tachycardia. Temperature is 36.5, HR110, BP108/73, RR 21, SpO2 95%. After 2 hours, his condition has further deteriorated and vital signs are HR 133 BP 87/53 and body SpO2 88%.
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    BACKGROUND
    Mr. Lee was admitted to Ed...