Critical Care Nursing: Decision-making In Acute Myocardial Infarction

Patient History

Aims and objective of the assignment 

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The very purpose of the case study is to find out the proper processes and the decision-making ability of the patient and the clinical nurses. That indicates the assessment of the medical condition of any person in a critical stage. The aims of the case study are particularly stated below:

  • To understand the criticalness of the situation when the life of a person is at stake that also refers that the person must be aware of his/her own physical condition considering the life-threatening situation to be avoided
  • To evaluate the situation where the patients are in a critical condition and act accordingly to save their lives (Buttigieg, Rathert and Eiff, 2015).
  • To understand the importance of shared decision making
  • To derive some theoretical perspective of the scenario so that it will be beneficial for the students to outline the rational decisions at the time of emergency.

The process of decision making in an appropriate way will be helpful for the students so that they can pursue the right decisions at the right time as required at the time of emergency. That interprets the ability of a person to save the lives of the patients at the hour of need.

The objectives of the following case study are also very clear and stated as follow:

  • To define an appropriate assessment ability within the fellow students so that they can assess the critical scenarios using the proper knowledge and skills
  • To outline an example in front of the students so that they become aware of such condition to save the lives of the patients hanging between life and death (Dattani et al., 2016).
  • To illustrate the students the power of shared decision-making ability and the possible actions to be taken at the time of emergency.

There are some possible ways to achieve the intended aims and the objectives in an appropriate manner. Initially, the assessment of the physical condition should be done in order to gather critical information regarding the health. The previous case history of the patient is very helpful in such a scenario so that the practice nurses can draw a frame to intervene in the condition of the patient and take the decision accordingly. For that purpose, the proper knowledge, focus, and skills are required as must to have. The experiences of such similar scenarios are also helpful to meet the aims and objectives (Dinckal, 2013).

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The theory of decision-making is a process of assessing the possibilities and act accordingly. In the case of clinical decisions, the nurses have to make a significant evaluation of the situation to administer the appropriate steps. Clinical decision-making can be defined as an evolving process that gathered and evaluates the data of the patient. Clinical decision encompasses different tools to develop the decision-making process in the case of clinical workflow. Clinical reasoning is the process by which nurses gather clues, develop the information, calculate outcomes and the decision making a step for the patient. Decision- making theory and clinical reasoning is a joint process in nursing practices (Furnes, Natvig and Dysvik, 2014).

Nurses can play an important role in patients’ lives. Nursing staff and nurses treat the patients in their care with humanity and dignity. Nurses are able to understand the needs of the patients, show sensitivity and compassion, and provide care. Nursing staff and nurses are able to take the responsibility that they provide to the patient and answerable for their own actions. The judgment of the nurses should be maintained by the patient and the family members. Nurses are the prime caretaker of the patient as they reduce the health risk by giving medicine and instruction (Haugen and Musser, 2012). Nurses are playing a crucial role in taking care of the patient. Nurses are involving in the collection of data, analyzing the fact, outcomes and take the effective decisions. In this case study, it has been seen that the patient, Mr. Amir Khan has been diagnosed by a nurse and felt well to go to the hospital for further treatment.

Drug History

In this case study, the role of the nurses in human life has been shown. Mr. Amir Khan is a patient of diabetes, reported to the nurse for his central chest pain. Mr. Amir Khan is a diabetes patient. The symptom of diabetes has been found 12 years back. He took medicines daily for twelve years. He used to smoke tobacco but 2 years before he left his tobacco habits (Shippee-Rice, Fetzer and Long, 2012). He was a chain-smoker as he took 20 to 30 cigarettes daily when he was 18 years old. Being a diabetic patient, Mr. Amir Khan takes medicine which is Metformin. According to the present situation, or Amir Khan is suffering from chest pain also. The chest pain was increasing rapidly and it covered the left side of his jaw and neck (Hill, 2011). The colour of the face of Mr. Amir Khan was changing and it becomes a blue-grey colour. The practising nurse collects all the information of the Mr. Amir Khan’s health. After observing the data of Mr. Amir Khan, the nurse found that the respiratory rate is 22. The heart rate of the patient is 66. The blood pressure of Mr. Amir Khan is very low. After getting the report, the nurse takes action and provides the proper medicine to the patient. When the chest pain became low, the nurse suggested the patient consult the Accident and Emergency Department.

The case study is all about the importance of the nurse in patient life and the decision making the quality of nursing training. In this case study, a patient who has a diabetes problem and now suffer from chest pain. The nurse provides proper medicine to the patient. The decision making the quality of the nurse has been shown as the patient feel better after taking medicine as per nurse instructions (Savage, Chilingerian, and Powell, 2005).  

A systematic, comprehensive and holistic assessment of the case  

According to the scenario, the case of Mr. Khan has been assessing as a possible threat to life in a critical hour of detection. Mr. Khan, a 68-year-old man, was detected with diabetes around 12 years ago and has been prescribed to take 1g of Metformin twice daily. His very recent level of HbA1c was 8.5%. he was found depressed in the last year which was efficiently managed by the practice nurse. Mr. Khan was identified as a chain smoker from the age of 18 with a count of 20 to 30 cigarettes daily. He quitted smoking two years ago as a preventive measure prescribed by his doctor. He is weighted 100 kg and detected as the BMI of 31.  He does not consume any other recreational drugs or any herbal remedies (Hunnicutt, 2010).

Present Situation

Mr. Khan himself has taken the initiative of the required assessments when he found some sort of crushing chest pains in the central part of his chest. The pain was radiating towards his left neck and throat area. The nurse found a horrible blue-grey colour highlighted in his face. Hence, the nurse asked him about the other symptoms and observations (Parks, 2009). Mr. Khan informed her about his initial observations that the respiratory rate was 22, SpO2 was 95%, heart rate was 66, blood pressure was 88/54 mmHg and the pain was assessed 4/10. The nurse took the initiative in a systematic way and gave him 0.4 mg SL×2 nitro-glycerine in every five minutes. ECG was also conducted and the result shows about the ST-segment elevation in II, III leads along with the aVF that indicated an acute inferior wall myocardial infection (MI). After fifteen minutes, when the third number of nitro-glycerine SL has been given to Mr. Khan, he stated that the pain has almost gone (Jamieson, McCall and Whyte, 2007). Then the nurse suggested him to visit the doctors at the accident and emergency department of the hospital.

The assessment of the nurse was responsible for taking the appropriate decision at the stage of such an emergency. The decision of giving the proper medication was based on the assessment that the nurse undertook in order to give him relief from the crushing pain and to take preventive measures to make his life out of danger (Stavans, 2010). The decision taken by the nurse was comprehensive enough that was helpful to make sure of the life of Mr. Khan secure. The decision that the practice nurse took was based on her knowledge and skills regarding the scenario and the peaceful judgemental ability at the crucial time of life and death (Manias, Bucknall and Botti, 2005). The previous case history of Mr. Khan states about his father who died due to a stroke four years ago. That information is also very helpful in order to assess the hereditary scopes of the possible strokes which was indicated by the chest pain. Hence the shared information was very important in terms of saving the life of Mr. Khan by providing the appropriate medicines in a right dose at the right time. Hence it is found that that the assessment of the of the possible life threats is very important in order to take the right decisions at the right time.

Importance of Decision-making in Nursing

The holistic approach of the nurse was so much appropriate in order to take the correct decision to administer the right medicine that was given to Mr. Khan. as a result, the decisions were looking like life-saving for him and he got some extra time to go over the Accident and Emergency Department of the hospital to undertake the proper supervision of the experts  (Manias, Bucknall and Botti, 2005). According to the given case study, the practice nurse has done the proper assessment in order to take the appropriate preventive measure to save a life of a critical patient with the possibilities of any life-threatening stroke or any other complications. The shared decision-making has been found to be very significant while assessing the physical and health complexities of old age patients. The conditions could become worse for the old aged patients having multiple chances of various organ failures or any contagious types of life-threatening possibilities. Hence, it can be said that the shared decision-making abilities should be assessed accordingly (Miller, 2011).

Diabetes is the second largest reason behind congestive heart failure. The Patient has started facing a “crushing” chest pain already which is an early sign of a heart attack. Later after the ECG done on the patient revealed that he has an AVF which caused a minor myocardial infarction. The initial treatment provided to the patient was a dosage of 0.4mg SL x2, in every five minutes (Cullen et al., 2011). The pain subsided after the third dosage after fifteen minutes. Given the condition of the patient, his heart is in serious threat and can face a major myocardial infarction in the near future if left untreated. The patient must be made aware of his condition by the attending nurse or doctor. The consent of the patient is very important in this scene. The family members of the patient should be made aware as well as the present condition of the patient and the process of treatment which will be taken up. The family members and the patient both should be aware of the consequences of the treatment process.

The treatment process of a diabetic person is very complex as it doesn’t stop within the walls of the hospital. A diabetic patient should be in care at home too. The patient needs to follow a healthy balanced diet which would agree with his health condition. It has been noted that the patient has an obese condition too which is directly affecting both his heart and his diabetes. In this stage, the presence of his family members is very essential to strengthen the psychological condition of the patient (Epstein, 2013). The patient needs to be admitted in hospital as early as possible. The doctors should take up a quick routine treatment for hyperglycemia for the patient to stabilize the patient. Insulin is the most preferable treatment for this condition and the patient must be prescribed with some anti-hyperglycemic oral medications to be taken as a home remedy. As the diabetic condition of Mr. Khan has exceeded a lot and has resulted in a minor cardiac arrest, he can be distinguished as a critical patient. In this stage, the patient needs a continuous insulin infusion to achieve the optimum glycemic targets. The dosage must be regulated according to the glycemic fluctuations. The patient must be prescribed with insulin injections so that they can be injected during a much less critical scenario. The insulin injections are supposed to be scheduled according to the meals and the daily bedtime routine of the patient if continuous non-oral therapy is used. Patients who do not take anything by their mouth or who are not capable of taking anything up by the mouth is prescribed a basal-plus correction insulin regimen (Funke, 2017). Patients with good nutritional intake are treated with an insulin regimen with basal, correction and nutritional components. The doctor needs to understand the working condition of Amir Khan’s mouth and prescribe the form of insulin treatment accordingly after he is outside the danger zone. The patient should be recommended to take a Point of care glucose testing before taking his meals, to regulate the dosage of insulin. If a condition arises that the patient is having a poor oral intake then he must ingest a fair amount of insulin according to the carbohydrate count in his food, to facilitate the breaking down of the food.

Objectives of Case Study

Some of the non-insulin ant hyperglycemic therapies in the hospital is a matter of research. According to a report, it has been found that the invention agents may not cause hyperglycemia and can be substituted for insulin. The patient’s glucose must be monitored at all times as it provides estimates of the glucose trends in the body. POC testing helps to monitor and detect the forthcoming incidence of hyperglycemia (Gillespie, 2010).

The prescribed medications must be cross-checked so that no other chronic side effects can take place. The patient must visit the doctor periodically. He must be aware of his glucose levels through testing. Upon the discharge of the patient, the information about the diet changes, pending tests and other observations about the patient must be passed on properly to the outpatient physicians (Jarrett-Williams, 2012). The primary physician of the patient must be informed about his overall behavior and progress before discharging. The patient must be made understood the importance of his condition and his health care routines are to be improved. He must be made inclined towards the self-diagnosis, self-monitoring of blood glucose and he should set up new blood sugar goals. He should follow a routine balanced diet which will comprehend both his diabetes as well as obese condition.

The ethical practices of the nurses are to assure the patient an environment that maintains the human rights, values, customs and spiritual beliefs. Thus, while treating Mr. Amir Khan, the healthcare officials need to maintain the code of ethics that recognise and respect the uniqueness of the cultural, and human rights of the patient Mr. Amir Khan. The patient can be visited by different people from different social or religious background (Johansen and O’Brien, 2015). It is necessary to maintain the code of ethics for holistic services of healthcare regulations. They must assure him the safety and security first to motivate his healing process. The provided environment must not be harmful to Mr. Amir Khan and he is needed to feel safe in the healthcare organisation. The patient must be provided with spiritual care accordingly where he can get the assurance of his biological, social, spiritual and cultural requirements.

The human rights, values and spiritual can be provided by understanding, respecting and satisfying the spiritual needs and values of the patient. It requires effective communication with the patient to provide him the spiritual values and awareness. Mr. Amir Khan can be communicated with effective caring, mental supporting and providing him empathy and respect for his beliefs and values (Johnson et al., 2009). He is needed to be taught the true meaning of physical well being and the importance of the Medicare testaments. Valuing of human rights and spiritual beliefs would enable Mr. Amir Khan to find the blessings and meanings of life and he may active inner peace and self-satisfaction. Moreover, it would enable him to explore the new strategies to get rid off of the physical and mental illness and handle the critical physical and mental situations. Respecting his human rights would make him unable to unify his life forces and spiritual dimensions (Zaybak et al., 2017).

Theory of Decision-making

Spiritual be3liefs and values are not only religious oriented but it is a method of inspiration, and convincing the purpose of life. If Mr. Amir Khan can be convinced that he has the blessings of the god of his religion, it can motivate the innersole of him and he can be desperate in his treatment process and would communicate the medical staffs accordingly. However, the spiritual treatment can apply to both believer and nonbeliever (Kelly, 2012). The non-believers can be influenced by stating his values in the society and the value of his culture in the society.

Ethical competence is required for the medical staffs to assure the patients with cultural, spiritual and human rights value. The medical staffs must provide Mr. Amir Khan an interrelated healthy treatment process that helps to sustain his moral value, ethical beliefs, spiritual faiths and human rights. Being a diabetes patient and affected by a heart attack, Mr. Amir must be treated with assistance and acceptance. Moreover, a trustful relationship, a healthy communication and providing necessary spiritual care must be provided to the patient (Killion and Devlin, 2011).

Personal spirituality is considered to be effective spirituality. Thus, the healthcare officials must maintain an integrated relationship with Mr. Amir Khan so that he can meet his beliefs and human rights holistically. The healthcare professionals must satisfy the spiritual needs of the patient. If Mr. Khan is a spiritual believer, a clinical pastoral education can be referred for him with the help of the chief of his religion. On the contrary, if he is a nonbeliever, a spiritual education can be conveyed to him based on his culture, customs, beliefs and human rights. It would be helpful to motivate him to face the physical obstacles (Reyna, 2008).

Awareness and respect for the cross-cultural issues must be developed by the healthcare professionals. The partnership between the patient and the healthcare professional should be ethically and morally connected (Mahlmeister, 2008). Thus, to provide a sustainable ethical treatment to Mr. Amir Khan it is necessary to respect his culture and ethical diversity.  He must get an environment which is ethically and spiritually sustainable for diversity practices for healthcare. The effectiveness of the diversity would potent the patient to have a self- believe to fight with the physical obstacles.

The recommended ethical treatment that the healthcare professionals can provide Mr. Amir Khan to give a spiritually, culturally and morally diversified are:

  • He must be provided mental support with the example of role modelling and mentorship
  • Role play is important to support the practices of values, believes and spiritual needs of Mr. Amir Khan
  • Must improve spiritual learning

Role of Nurses in Clinical Decision-making

In order to provide morally, culturally, spiritually and belief based diversified environment to Mr. Amir Khan, the caregivers may attain the healthcare organisational spiritual seminars and conferences. Moreover, they can take help of the senior medical care staffs to gain the knowledge of diversified ethical practices (MC, 2017). Thus, a diversified ethical environment can morally assist Mr. Amir Khan to improve his treatment process.


The study has basically highlighted various aspects of clinical reasoning in the medical sector. To analyse the fact the case study of MR Amir Khan has been provided who was suffering from diabetes twelve years ago and presently and was recommended Metformin 1g twice per day. Moreover, he does not have the habit of smoking a fort past two years and presently suffering overweight of 100kg (Pauker, 2010). The study has evaluated the decision-making process to treat Mr. Amir Khan in an ethical way giving him a culturally, morally and spiritually diversified environment. Moreover, the study has highlighted the significance of the ethical treatment maintaining the confidentiality of the patient. Thus a systematic and holistic approach has been discussed to treat Mr. Amir Khan. The responses from both the healthcare professionals and the patient have been recorded in the study in most precise manner. Several interventions plans have been recommended to demonstrate the treatment process appropriately (Power, Swartzman, and Robinson, 2011).


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