Mr Amir Khan is a 68 year old man who is married and has four children.
Mr Khan was diagnosed with diabetes 12 years ago he takes Metformin 1g twice daily. Most recent HbA1c levels were 8.5%. Last year he had depression which was managed by his practice nurse. Mr Khan gave up smoking 2 years ago, prior to this he had smoked 20-30 cigarettes daily from the age of 18. He weighs 100Kg and has a BMI of 31.
Mr Khan’s father was blind and died of a stroke 4 years ago.
Metformin 1gm twice daily. No recreational drugs, No over the counter medications, No herbal remedies.
Mr Khan presented to the practice nurse to review his diabetes. He reports to the nurse that he is experiencing ‘crushing’ central chest pain, which radiates to the left side of his neck and jaw. The nurse notices that he has a ‘horrible blue-grey colour’ in his face. He says the pain began that morning and he thought it would go away, but it is getting worse. His initial observations are:
BP: 88/54 mmHg
Mr Khan is given nitro-glycerine 0.4mg SL x2 every five minutes. An ECG is performed which shows ST-segment elevation in leads II,III and aVF indicating an acute inferior wall myocardial infarction (MI). Fifteen minutes later, after the 3rd nitro-glycerine SL was administrated, he stated that his chest pain was now ‘almost gone’. An ambulance is called and Mr Khan has to be convinced to go to the Accident and Emergency Department.
Upon arrival at A&E Mr Khans observations are as follows:
Cardiac Rhythm: Sinus rhythm with ST segment elevation
Alert, slow to respond
Pupils round and reacting to light
Colour dusky, cool, dry
In the care study students will discuss and critique the decision-making processes required in the assessment and delivery of care for their selected patient.
Your reflective case study should include the following:
You should be able to support your interventions, plan of care and nursing practice with appropriate evidence-based decisions
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