Care Plan

Student: Jordyn Moore Date: 2/29/2020

Course: NSG-430 Instructor: Professor Nopoulos

Clincial Site: Banner Boswell Client Identifier: V.S. Age: 75

Reason for Admission: Admission Date: 2/22/2020 Reason: Chest pain and shortness of breath
Patient suddenly felt as if her heart was beating rapidly and that she could not catch her breath. Due to the patient having a history of COPD, the
patient tried her inhalers to see if they would help her breathe. The inhaler did not work and the chest pain worsened. She then had her husband
drive her to Banner Boswell to seek medical attention.

Medical Diagnoses: (Include Pathophysiology and Risk Factors): Clinical Manifestation(s):

NSTEMI and 3 Vessel Disease Displayed by the patient
NSTEMI occurs when the coronary arteries are not receiving enough oxygen in - Shortness of breath
order to oxygenate the heart. This occurs when the arteries are partially occluded - Chest pain
from plaque or even a thrombus. NSTEMI stands for non-ST-elevation myocardial - Diaphoresis
infarction (Basit, 2019). Three vessel disease is considered the most severe form of - Heart rate of 160-180
coronary atherosclerosis (Máchal, Pávková-Goldbergová, Hlinomaz, Groch, & Expected manifestations
Vašků, 2014). This means that the patient has blockages from plaques in the left
anterior descending, right coronary, and circumflex arteries. This can lead to a - Pain lasting more than 10 minutes
myocardial infraction due to the lack of oxygen being delivered to the heart. - Pain radiating to arm, neck, or jaw
- Fatigue
Risk factors - Syncope
- Older age - Dyspnea
- Nausea/vomting
© 2018. Grand Canyon University. All Rights Reserved. Rev 2.17.18
 - Family history of cornary artery disease (Basit, 2019)
- Diabetes
- Personal history of coronary artery disease
- Renal insufficiency
- Increased BMI
(Basit, 2019)

Assessment Data
Subjective Data: Patient states that, “It feels like it is hard to catch my breath, even on this oxygen. I’m feeling pain by my surgery site that I
would rate a 5/10.” While talking to the patient she seems concerned and engaged into what is going on around her and what medications she is
receiving.
VS: Labs: Diagnostics:

2/27/2020 2/27/2020 2/27/2020 CBC done on 2/27/2020 2/22/2020 ECG

at at at Lab Values Reasoning Indication: This was performed as emergency
11:15am 10:15am 9:15am protocol when a patient complains of chest pain.
WBC 13.4 High
T 37.5° C 37.5° C 37° C K/mm3 Findings: NSTEMI with heart rate of 170.
4.5-11
BP 138/65 134/64 115/93 K/mm3 2/22/2020 Cath Lab

H 93 77 81 This could be Indication: This was performed based on

R a result of the emergency chest pain protocols.
patient having
RR 17 18 12 Findings: 3 vessel disease.
a hisotry of
smoking or 2/26/2020 Chest X-Ray
O2 97% 94% 91%
even the fact
Sat Indication: Patient complaining of shortness of
2 Liters 2 Liters 2 Liters that the
patient was breath.
NC NC NC
under a lot of Findings: Left lung bsae atelectasis
stress during
2
 this situation. Other diagnostics that could help determine
condition
(Mayo Clinic,
2018) Echocardiogram: The visualize the heart and
possible view the diseases vessels.
RBC 3 m/mm3 Low
Stress test: To determine if the heart pumps
4.2-5.4
adequately to provide enough blood to the body
K/mm3
and the heart.
This could be
Heart Scan In order to visualize the heart and
due to the
see possible calcium deposits that attribute to
patient
coronary artery disease.
undergoing
surgery and
losing blood.
(Mayo Clinic, 2018)
(Mayo Clinic,
2018)
HgB 8.2 g/dL Low
12-15.5 g/dL
This could be
due to the
patient
undergoing
surgery and
losing blood.
(Mayo Clinic,
2018)
Hct 27.7% Low

3
 37-48%
This could be
due to the
patient
undergoing
surgery and
losing blood.
(Mayo Clinic,
2018)
MCH 27.3 pg Normal
27-33
MCHC 30.1 g/dL Low
33.4-35.5
g/dL
This lab is
low related to
the loss of
hemoglobin
while in
surgery.
(Huang, &
Hu, 2016)
RDW-CV 17.2% High
11.5%-14.5%
This shows

4
 that the
patient has
some type of
heart disease
or anemia
related to
blood loss
during
surgery.
(MedlinePlus,
2020)
RDW-SD 56.4 fL High
40-55 fL
This shows
that the
patient has
some type of
heart disease
or anemia
related to
blood loss
during
surgery.
(MedlinePlus,
2020)
Nucleated 0 Normal
RBC
0-1000 mL

5
 Platelet 250 K/mm3 Normal
150-450
K/mm3
MPV 9.8 fL Normal
9.4-12.3 fL
Neutrophils 9.8 K/uL High
2-7 K/uL
This high
result could
be a result
from the
patient having
a history of
smoking, the
patient
undergoing
surgery,
suffering from
an injury, and
high stress
levels.
(MedlinePlus,
n.d.)
Lymphocyte 2 K/uL Normal
s
1-4.8 K/uL
Monocytes 14 K/uL High
6
 0.2-1 K/uL
This could be
related to the
cardiovascular
disease that
the patient has
or even
because the
patient had
surgery.
(Romeo,
Cruccetti,
Turiaco,
Implellizzeri,
Di Bella,
Salpietro,
2002)
Eosinophils 0 Normal
0-500 K/uL
Basophils 0 Normal
0-300 K/uL

2/27/2020 General Chemistry

Lab Value Reasoning

7
 Glucose 112 mg/dL High
60-100
This is
related to the
patient
having
diabetes type
2.
BUN 22 mg/dL Normal
7-30 mg/dL
Creatinine 1.1 mg/dL Normal
0.6-1.2
mg/dL
GFR 49mL/min/1.73 Low
m2
60-90
mL/min/1.73
m2
This could
be related to
the patient
being
dehydrated
or even after
having
surgery.

8
 (National
Kidney
Foundation,
2017)
Na 137 mol/L Normal
135-145
mol/L
K 4.6 mol/L Normal
3.5-5 mol/L
Chloride 104 mol/L Normal
96-106
mol/L
Anion 13 Normal
8-16 mEq/L
Mg 2.2 mg/dL Normal
1.7-2.2
Ca 10 mg/dL Normal
9-11 mg/dL

9
Assessment: Orders:
Patient History - 2/25/2020 Bed to chair
- 2/22/2020 Continuous cardiac monitoring
- A-fib with RVR
- 2/27/2020 D/C chest tube and foley
- Type 2 Diabetes
- 2/26/2020 SCD
- High Troponin
- 2/25/2020 Measure I&O Q1H
- COPD/Emphysema
- 2/25/2020 Oral care 2 times a day
- Hypertension
- 2/25/2020 VS Q1H
- NSTEMI
- 2/24/2020 Blood glucose before meals
- CABG x3
- 2/26/2020 CBC every 2 days
- Smoker
- 2/26/2020 Basic metabolic daily
Neuro
- A&O x4
- Patient is alert and speech is clear
- Pupils are brisk, round, equal, regular, reactive to light, 3mm bilaterally
- Eyes open spontaneously
- Affect is cooperative
Skin
- Pink
- Warm
- Intact
- Dry
- Wound located on sterum, closed by first intention
- No drainage is noted
- Dressing was changed once throughout entire shift at 3:45pm
Respiratory
- 2 Liters Nasal Canula

10
 - O2 97%
- Fine crackles noted at the base of the lungs bilaterally
- Unlabored breathing
- Cough is present but no sputum
Musculoskeletal
- Upper: moves against resistance, strong, equal bilaterally
- Lower: moves against resistance, strong, equal bilaterally
- Up and lib with x1 assist
- No assistive devices
- Fall precaution
Cardiovascular
- HR 93
- Normal Sinus Rhythm
- 138/65 BP
- S1 and S2
- No S3 or S4 heard
- Cap refill <3 seconds on fingers and toes bilaterally
- Slight edema on lower legs, no pitting noted
- No JVD
Hygiene
- Patient has not showered since arrival
- Oral care 2/27/2020 at 2:00pm
- Linens changed 2/27/2020 at 3:14 pm
- Pericare on 2/27/2020 at 1:20 pm
GI
- Round nontender abdomen

11
 - Hypoactive bowel sounds
- No BM since admission
- Cardiac diet (no caffiene and restricted fluids)
- Blood glucose 112 mg/dL
Lines/drains
- Foley catheter
- Mediastinal anterior chest tube, drainage 40 mL
- Central line on the left subclavian
- Peripheral IV line Right AC 18 gauge
GU
- Foley catheter
- Urine is clear and yellow
- No pain
- Output: 276 mL
Pain
- Chest pain related to incision site
- Dull
- Does not radiate
- Severity 5/10
- Occurred after surgery
- Goal equal to or less than 2/10
- No alternative pain control methods

12
13
 Medications
ALLERGIES:
Codiene: Itch
Sulfa drugs: Hives

Name Dose Route Frequency Indication/Therapeutic Adverse Effects Nursing Considerations

Effect
Albuterol-ipratropium 3 mL Nebulized Q6H Indication - Nervousness Assessments
(Salbuamol) Used as a. bronchodilator to - Restlessness 1) Assess lung sounds, pulse
control and prevent recersible - Tremor and BP before administration
airway obstruction casued by - Chest pain and during peak of
COPD. - Palpitations medication.
Therapeutic effects - Angina 2) Observe for paradoxical
- Bronchodilation - Paradoxical bronchospasm (wheezing).
- Breath easier bronchospasm 3) Montior pulmonary function
(Vallerand, Sanoski, & tests beofre and during
Quiring, 2019, pg. 120) (Vallerand, Sanoski, & Quiring, therapy.
2019, pg. 120) Patient Education
1) Instruct patient to take as
direct, if on scheduled
dosing take missed dose as
soon as remembered.
2) Contact health care
professional if shortness of
breath is not relieved.
3) Educate/warn the patient that
the medical may cause a bad
taste.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 121)

Aminodarone 200 mg PO BID Indication - Dizziness Assessments

(Cordarone) Life-threatening ventricular - Fatigue 1) Monitor ECG continuously
arrhythmias unresponsive to - Malaise during therapy. Monitor rate
less toxic agents. - Headache and rhythm.
Therapeutic effects - Corneal microdeposits 2) Assess for signs of

14
 - Suppression of - ARDs pulmonary toxicity
arrhythmias - Pulmondary fibrosis (rales/crackles, decreased
(Vallerand, Sanoski, & - Pulmonary toxicity breath soundsm pleuritic
Quiring, 2019, pg. 142) - Bradycardia friction rub).
- Hypotension 3) Assess for PR prolongation,
- Worsening of slight QRS widening, T-
arrhythmias wave amplitude reduction
- QT interval with T-wave widening and
prolongation bifurcation. U wave may
(Vallerand, Sanoski, & Quiring, occur.
2019, pg. 142) Patient Education
1) Teach patient to monitor
pulse daily and report
abnormalities.
2) Advise patient’s that
photosensitivity may occur.
3) Advise patient to avoid
drinking grapefruit juice
during therapy.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 144)
Acetylsalicylic Acid 81 mg PO Daily Indication - Tinnitus
(Aspirin) Prophylaxis of blood clots - GI bleeding 1) Patients with
related to decreasing chances - Dyspepsia asthma, allergies,
of a clot forming and - Epigastric distress and nasal polyps are
clogging the new artery graft. - Nausea at an increased risk
- Abdominal pain for developing
Therapeutic effects - Anorexia hypersensitivity
- Blood thinning - Hepatotoxicity reactions.
- No blood clots are - Vomiting 2) Assess for rash
formed - Exfoliative periodically during
(Vallerand, Sanoski, & dermatitis therapy due to the
Quiring, 2019, pg. 1110) - Stevens-Johnson possibility of the
Syndrome patient developing
- Toxic epidermal Stevens-Johnson
necrolysis Syndrome or toxic
- Anemia epidermal
- Hemolysis necrolysis.
- Increased bleeding Discontinue if
time severe.

15
 - Anaphylaxis 3) Monitor patient for
- Laryngeal edema tinnitus, headache,
(Vallerand, Sanoski, & Quiring, hyperventilation,
2019, pg. 1111) agitation,
confusion, lethargy,
diarrhea, and
sweating. These are
signs and symptoms
of toxicity and a
health care provider
needs to be
contacted as soon as
possible.
Patient Education
1) Instruct patient to
take with full glass
of water and to sit
upright for 15-30
minutes after taking
to ensure that it
reaches the
stomach.
2) Caution patient to
avoid concurrent
use of alcohol with
the medication to
minimize possible
gastric irritation; 3
or more glasses of
alcohol per day may
increase the risk of
an GI bleed.
3) Instruct the patient
to notify health care
professional if rash
or signs and
symptoms of
hypersensitivity
reaction occurs.
(Vallerand, Sanoski, & Quiring, 2019,

16
 pg. 1112)
Budesonide 2 mL Nebulized BID Indication - Headache Assessments
(Pulmicort Flexhaler) Prophylactic therpay, - Agitation 1) Monitor respiratory status
decrease the need for - Dysphoria and lung sounds.
systemtic corticosteriods for - Hoarseness 2) Assess patient for
COPD. - Cataracts wtihdrawal symptoms (joint
Therapeutic effects - Anaphylazis pain).
- Decreased - Laryngeal edema 3) Monitor for hypersensitivity.
frequency and - Urticaria
secerity of - Bronchospasm Patient Education
COPD attacks. (Vallerand, Sanoski, & Quiring, 1) Advise to use bronchodilator
Improves 2019, pg. 350) first and allow 5 minutes to
symptoms. pass before using this
(Vallerand, Sanoski, & medication.
Quiring, 2019, pg. 349) 2) Advise that this medication
should not be used to treat
acute attacks, but is for
prophylaxis.
3) Caution patient to avoid
smoking.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 351)
Clopidogrel (Plavix) 75 mg PO Daily Indication - GI bleeding Assessments
Reduction of atherosclerotic - Acute generalized 1) Assess patient for symptoms
events in patients at risk for exanthermatous of stroke, peripheral vascular
such events including recent pustulosis disease, or MI periodically
MI. - Drug rash during therapy.
Therapeutic effects - Bleeding 2) Monitor bleeding time
- Decreased - Neutropenia during therapy.
occurrence of - Back pain 3) Monitor patient for signs of
atherosclerotic - Hypersensitivty thrombotic thrombocytic
events in - Depression purpura.
patients at risk. - Dizziness Patient Education
(Vallerand, Sanoski, & - Cough 1) Advise patient to notify
Quiring, 2019, pg. 330) - Dyspnea heatlh care professional if
(Vallerand, Sanoski, & Quiring, fever, weakness, chills, sore
2019, pg. 330) throat, and extreme skin
paleness occur.
2) Advise patient to notify
health care professionals of

17
 medication regimen prior to
treatment or surgery.
3) Advise patient to notify
health care professional of
all medications being taken.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 332)
Docusate-Senna 1 tab PO BID Indication - Throat irritation Assessments
(Colace) Prevention of constipation. - Mild cramps 1) Assess for abdominal
Therapeutic effects - Diarrhea distention.
- Softening and - Rash 2) Assess for bowel sounds
passage of (Vallerand, Sanoski, & Quiring, 3) Assess color, consistency,
stool. 2019, pg. 448) and amount of stool.
(Vallerand, Sanoski, & Patient Education
Quiring, 2019, pg. 448) 1) Advise patients that laxatives
should be used only for
short-term therapy.
2) Encourage patient to use
other forms of bowel
regulation.
3) Instruct patients with cardiac
disease to avoid straining
during bowel movements.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 448)
Enoxaparin (Lovenox) 0.4 mL SC Daily Indication - Dizziness Assessments
Prevention of DVT, or PE. - Headache 1) Assess for signs of bleeding
Therapeutic effects - Bleeding and hemorrhage.
- Prevention of - Anemia 2) Assess patient for evidence
thrombus - Thrombocytopenia of additional or increased
formation. - Erythema at thrombosis.
(Vallerand, Sanoski, & injfeciton site 3) Assess for hypersensitivity.
Quiring, 2019, pg. 632) - Hematoma Patient Education
- Osteoporosis 1) Insturct patient in correct
- Fever technique for self injfection,
(Vallerand, Sanoski, & Quiring, care and disposal of
2019, pg. 632) equipment.
2) Advise patient to report any
sumptoms of unusual
bleeding or bruising.

18
 3) Instrict patient not to take
aspirin or NSAIDs without
talking to a doctor.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 634)
Insulin Lispro 7 units SC TID (before Indication - Hypoglycemia Assessments
(HumaLOG) meals) Control hyperflycemia in - Anaphylaxis 1) Assess for symptoms of
patients with type 2 diabetes. - Hypokalemia hypoglycemia.
Therapeutic effects - Swelling 2) Monitor bpdy weight
- Control of - Erythema periodically, change in
hyperglyceima (Vallerand, Sanoski, & Quiring, weight may result in change
is diabetic 2019, pg. 688) of dosage.
patients. 3) Monitor serum potassium.
(Vallerand, Sanoski, & Patient Education
Quiring, 2019, pg. 688) 1) Instruct patient on proper
technique for administration.
2) Explain that the medication
controls hyperglycemia but
does not cute diabetes.
3) Explain that this therapy is
long term.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 689)
Metoprolol 25 mg PO BID Indication - Faituge Assessments
(Lopressor) Hypertension, agina, - Weakness 1) Monitor BP, ECG, and pulse
prevention of MI and - Bradycardia frequently during dose
decreased mortality in - Heart failure adjustment and periodically
patients with recent MI. - Pulmonary edema during therapy.
Therapeutic effects - Diarrhea 2) Monitor vitals and ECG
- Decreased BP - Memory loss every 5-15 minutes during
and heart rate. - Nervousness and for several hours after
- Decreased - Dry mouth administration.
frequnecy of - Increased liver 3) Monitor intake and output
attacks of enzymes ratios and daily weights.
angina. (Vallerand, Sanoski, & Quiring, Patient Education
- Decreased rate 2019, pg. 840) 1) Abrupt withdrawal may
of precipitate life-threatening
cardiovascular arrhythmias, hypertension,
mortality and or MI.
hospitalization. 2) Teah how to check pulse

19
 (Vallerand, Sanoski, & daily and BP biweekly and
Quiring, 2019, pg. 839) to report changes to
provider.
3) Advise patient to notify
health care professional if
slow pulse, difficulty
breathink, and wheezing.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 841)
Pantoprazole 40 mg PO Daily Indication - C. Diff Assessments
(Protonix) Reduce the incidence of - Headache 1) Assess routinely for
GERD. - Hyperglycemia epigastric pain
Therapeutic effects - Acute interstitial 2) Assess for blood in stool and
- Dministhed nephritis emesis.
accumulation of - Vitamin B12 3) Monitor AST and ALT labs.
acid in the deficiency Patient Education
gastric lumen. - Abdominal pain 1) Advise patient to take
- Decreased acid (Vallerand, Sanoski, & Quiring, medication for the full
secretion in 2019, pg. 972) course of therapy.
hypersecretory 2) Adive patient to avoid
conditions. alcohol.
(Vallerand, Sanoski, & 3) Instrict patient to notify
Quiring, 2019, pg. 972) health care professions of
rash, diarrhea, cramping,
fever, or bloody stools.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 974)
Rosuvastatin (Crestor) 5 mg PO Daily at Indication - Abdominal Assessments
bedtime Slow profession of coronary cramps 1) If patient develops weakness
atherosclerosis. Primary - Constiaption monitor creatinine levels.
prevention of cardiovascular - Diarrhea 2) Monitor liver funciton tests,
disease. - Flatus AST and ALT.
Therapeutic effects - Heartburn 3) Obtain dietary history,
- Lowers total - Rashes espcially with regard to fat
and LDL - Rhabdomyolysis consumption.
cholesterol and (Vallerand, Sanoski, & Quiring, Patient Education
triglycerides. 2019, pg. 640) 1) Adive patient to not drink
- Slightly more than 200 mL/day of
increased HDL. grapefruit juice.
(Vallerand, Sanoski, & 2) Instruct patient to notify

20
 Quiring, 2019, pg. 640) health care professionals if
signs of liver injury of
muscle weakness occurs.
3) Advise patient to notify
health care professional of
medication regiment before
treatment or surgery.
(Vallerand, Sanoski, & Quiring, 2019,
pg. 644)
Oxycodone with 1 tab PO Q4H Indication - Confusion Assessments
Acetaminophen Moderate to severe pain - Sedation 1) Assess type, location, and
(Percocet) - Dizziness intensity of pain prior to and 1
Therapeutic effects - Dysphoria hour after administration.
- Decreased pain - Euphoria 2) Assess BP, pulse, and
after taking - Floating feeling respirations before and
medication - Hallucination periodically during
(Vallerand, Sanoski, & - Headache administration. If respiratory rate
Quiring, 2019, pg. 946) - Unusual dreams is less than 10 per minute, assess
- Blurred vision level of sedation.
- Diplopia 3) Assess risk for opioid addiction,
- Miosis abuse, or misuse prior to
- Respiratory administration.
depression
- Orthostatic
hypotension Patient Education
- Constipation 1) Advise patient that
- Dry mouth oxycodone is a drug with
- Choking known abuse potential.
- GI obstruction 2) Instruct patient to call for
- Nausea help when ambulating due to
- Vomiting the medication causing
- Urinary retention drowsiness or dizziness.
- Flushing 3) Advise patient to change
- Sweating positions slowly to minimize
- Physical orthostatic hypotension.
dependence (Vallerand, Sanoski, & Quiring, 2019,
- Psychological pg. 948)
dependence
- Tolerance
(Vallerand, Sanoski, & Quiring,

21
 2019, pg. 948)

Nursing Diagnoses and Plan of Care

Goal Expected Outcome Intervention(s) Rationale Evaluation
Client or family focused. Measurable, time-specific, Nursing or interprofessional Provide reason why intervention Was goal met? Revise the
reasonable, and attainable. interventions. is indicated/therapeutic. plan of care according the
Provide references. client’s response to current
plan of care.
Priority Nursing Diagnosis (including rationale for choosing this as the priority diagnosis)
Risk for decreased cardiac output related to history of NSTEMI, hypertension, and previous CABG surgeries.
This is the priority nursing diagnosis because all bodily functions depend on cardiac output. With decreased cardiac output, Maslow’s Hierarchy
of Needs is interfered with and the patient could possibly suffer from great physiological complications.
Patient will verbalize Patient will understand the need - Monitor and record - Changes in the - Patient will
understanding the need of for smoking cessation and level of level of understand that
lifestyle modifications in order cardiac medication compliance consciousness, heart consciousness, lifestyle
to maintain cardiac health. by the end of discharge in order rate, and blood heart rate, and modifications
to reduce the chances of pressure. Report any blood pressure may need to occur
resulting in decreased cardiac abnormal results. indicate decrease such has
output. - Monitor patient for cardiac output. quitting
dyspnea, fatigue, - Monitoring for smoking before
crackles in lungs, dyspnea, fatigue, discharge.
jugular venous crackle in lungs, - Patient will
distention, or chest jugular venous understand the
pain. distention, or chest importance of
- Measure and record pain may indicate compliance to
input and output cardiac failure or cardiac
accurately. other medications
- Tell patient to report complications. before
any chest pain. - Decreased urine discharge.
- Teach patient about output may be a - Patient did not
cardiac medication result from experience
such as name, decreased renal decreased
22
 dosage, frequency, perfusion. This can cardiac output
and adverse effects. indicate decreased during hospital
- Teach patient about cardiac output. stay.
lifestyle - Chest pain may be - Patient did not
modifications such a sign of complain about
as a heart healthy myocardial chest pain,
diet and smoking hypoxia. dyspnea,
cessation. - Educating the decreased
patient allows her urinary output,
to understand the or fatigue
importance of during hospital
medication stay.
compliance. - Patient’s vitals
- Educating the and level of
patient about diet consciousness
(Ralph & Taylor, 2019, pg. 52) and lifestyle remained at
modifications helps baseline
the patient throughout
understand the hospital stay.
importance of the (Ralph & Taylor, 2019, pg.
change. 53)

(Ralph & Taylor, 2019, pg. 52)

Secondary Nursing Diagnosis:

Acute pain related to surgical incision as evidence by patient rating her pain a 5/10.
Patient will have relief of pain Patient will rate her pain a 2/10 - Use a pain scale - When using the - Patient’s pain
when pain medication is given. after pain medication is given as when assessing scale, the nurse rating will
needed and will require less pain. can compare the decrease after 30
administration of pain - Return to patient patient’s minutes from the
medication by discharge. in 30 minutes to perception of pain administration of
check intervention from one the pain
effectiveness. assessment to medication.
- Collaborate with another. - Patient decreases
patient in - Returning to the amount and
administering room helps frequency of pain
23
 prescribed determine the medication within
analgesics. effectiveness of 72 hours.
- Ask patient to help the pain - Patient reports
establish goals, medication. achieving pain
and develop plan - Gaining patient’s relief with
for pain control. trust and analgesia or other
(Ralph & Taylor, 2019, pg. 240) involvement helps measures.
) ensure compliance (Ralph & Taylor, 2019, pg. 241)
and may reduce
medication intake.
- This gives the
patient a sense of
control.
(Ralph & Taylor, 2019, pg. 241)
Definition of Client-Centered Care: Care that is unique to the age/developmental stage, gender, race, ethnicity, socio-economic
status, cultural and spiritual preferences of the individual and focused on providing safe, evidence based care for the achievement of
quality client outcomes.”
References
Basit, H. (2019, June 29). Non ST Segment Elevation (NSTEMI) Myocardial Infarction. Retrieved from

https://www.ncbi.nlm.nih.gov/books/NBK513228/

Huang, Y.-L., & Hu, Z.-D. (2016, May). Lower mean corpuscular hemoglobin concentration is associated with poorer outcomes in

intensive care unit admitted patients with acute myocardial infarction. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4885905/

Mayo Clinic. (2018, May 16). Coronary artery disease. Retrieved from https://www.mayoclinic.org/diseases-conditions/coronary-artery-

disease/diagnosis-treatment/drc-20350619

24
Mayo Clinic. (2018, November 30). High white blood cell count Causes. Retrieved from https://www.mayoclinic.org/symptoms/high-

white-blood-cell-count/basics/causes/sym-20050611.

MedlinePlus. (2020, February 26). RDW (Red Cell Distribution Width): MedlinePlus Lab Test Information. Retrieved from

https://medlineplus.gov/lab-tests/rdw-red-cell-distribution-width/

Máchal, J., Pávková-Goldbergová, M., Hlinomaz, O., Groch, L., & Vašků, A. (2014, December). Patients with chronic three-vessel

disease in a 15-year follow-up study: genetic and non-genetic predictors of survival. Retrieved from

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4603099/

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