Title: Advanced clinical Assessment and Decision Making
goal of the case study – perform holistic assessment to a patient (short definition of holistic assessment with reference),use of theorettical model assessment tool ( calgary-cambridge model- what is it? include reference). interpret patient/s information, perform clinical investigations such as blood test, chest xray, echocardiogram, collaborate + communicate with colleagues/ multidisciplinary team to reach differential diagnosis and then lastly the diagnosis (why is it important? reference it), short introduction of patient – 57 year old man admitted via emergency department due to central chest pain radiating to the back of neck and left arm and with short of breath. Past medical history: cardiac disease – father died at 50 due to heart attack, smokes 15/day since 20 yrs old, works as a finance manager (appendix for full patient history). To maintain confidentiality in line with the Nursing and Midwifery council’s code (NMC 2015), pseudonym Mr. Vlog will be used. Short introduction of my job – I work as a nurse team leader in adult critical care unit and as part of an outreach team.
Conclusion will be made at the the end of this case study
Main body of the case study:
1.Critically analyse the role of the holistic assessment and the application of the theoretical model within patient assessment, applying this to the case study.
= Why holistic assessment important? critique it , reference
= use Calgary-cambridge as assessment tool – what is it, reference. critique it, reference!
= use the mnemonic SOCRATES in assessing chest pain, critique this tool,
family history of cardiac disese, smoker, stress – why are they relevant? short explanation with references
2. Critically appraise clinical decision making strategies used within the the case study to formulat e a therapeutic plan.
= investigations: blood tests such as Troponin T, Full blood count, Renal Profile, C-Reactive Protein, D-Dimer, ECG, echocardiogram, chest x-ray
3. critically discuss effective collaboration and communication with other healthcare professionals within clinical patient assessment.
= collaborate with cardiologist, radiologist, pathologist, fellow staff nurses, discuss referral to specialised cardiac centre,
4. Synthesise and interpret investigations and assessment information to reach conclusion and differential diagnosis that are based on evidence, clinical judgement and risk assessment.
Troponin T – elevated in :
1. cardiac – such as myocardial infarction, Why? critique it, reference, congestive heart failure, myocarditis, ( full list in appendix)
2. non cardiac – such as renal failure – why is it elevated? reference, sepsis,- why? Pulmonary embolism- why? , etc ( full list in appendix)
ST elevation – not always acute myocardial infarction, Reference it! mnemonic for causes of ST elevation – ( full list in appendix)
Final diagnosis = acute myocardial infarction – standard marker/procedure in diagnosing MI. ST segment elevation in 2 leads , raised trop t, chest pain radiating to the neck and left arm- paraphrase the short definition, discusss the sensitivity and specifity of troponin T in Myocardial infarction, reference it!
Treatment of MI – acute coronary syndrome protocol – reference, MONA M-morphie,Oxygen,Nitrate, Aspirin – reference, antifibrinolytic treatment, Cardiac catheterisation/ PCI – references
Ruled out other cardiac and non cardiac issues as the sensitivity/specifity …
chest xray result -normal
CTPA- normal – no pulmonary embolus
Rest of the blood tests – normal
Conclusion: what did i learn from this case study? what would I do in the future to make my practice safe and effective = in order to reach the final diagnosis one needs to apply holistic assessment, explore the probable diagnoses …
= Differential diagnoses:
-chest pain – cardiac problems ie aortic dissection, pericarditis etc, pulmonary ie pulmonary embolism,, pleurisy, gastroentestinal ie pancreatitis. (full lists in appendix)
-Short ness of breath – heart failure, pneumonia, pulmonary embolism, etc (full list in appendix)