I need help answering strategies, techniques, and approaches to critical thinkin

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I need help answering strategies, techniques, and approaches to critical thinking fifth edition chapter 2 problem 1PCP.

The handoff shift report includes miss T 56-year-old was admitted around midnight from the ER after experiencing some chest pain. She has coronary artery he disease and smokes one pack of cigarettes a day. Her father died of heart disease and she has a brother with hypertension. Her VS are T 90 8F, P 90, our 26, BP 1 64–100, pain level 0, pulse ox 97%. She has been taking vera Panamera NEFFA time and Anna look and she will continue with her usual cardiac and blood pressure medication and is also started on aspirin 81 mg, Dr. said sodium, and I love the stadium. Nitroglycerin tablets .4 mg are ordered PRN chest pain she has bathroom have ridges with assistance, a saline lock and oxygen at 3L/min/nasal can you add to keep the oxygen saturation greater than 96% she's upset about not being able to get up in smoke. She is requesting to use the commode as you start your shift.

Prioritize the five nursing interventions as he will do them initially take to take care of her right number in next to them and state the rationale for each intervention

Take vital signs and assess pain level

assist to commode

performing body systems assessement

check oxygen saturation levels

talk with Mrs.t

Explanation / Answer

Nursing Diagnosis : Acute Pain related to heart tissue ischemia, or blockages in the coronary arteries.

Objective: The client is expected to be able to demonstrate a decrease in chest pain, showed a decrease in pressure and how relaxation.

Interventions - Rationale:

1. Take vital signs and assess pain level

· Monitor and review the characteristics and location of pain - To know the intensity of pain and it’s radiation to take quick action

· Monitor vital signs (blood pressure, pulse, respiration, consciousness)- Vitals are the indicators if there is any alteration with the patient condition

· Instruct the patient to immediately report instances of chest pain.- To bring awareness of getting help from hospital

2. Performing body systems assessement:

· Perfrom systemic assessment CVS – Perform auscultation of the heart, record S1 and S2 sounds, If you hear abdnormal heart sounds perform ECG –To check myocardial activity

· Assess other systems – To know the pain radiation and to notice any other associated diseases present.

3. Check oxygen saturation levels:

·         Collaboration in: Giving oxygen and drugs

Oxygen supply 3L/Min through nasal and record the saturation level as per the doctor’s advice – To induce decrease myocardial oxygen demand to minimize risk of tissue injury and necrosis

Drugs: Administer Tab: Nitroglycerin 4mg per oral as per doctor’s advice -- Nitroglycerin has a vasodilator effect and can be used as a prophylactic preparation to prevent angina attacks.

4. Assist to commode:

· Instruct the patient to have more rest first.

· Instruct the patient not to "push" at the time of defecation and help them in their movements –To prevent sudden change in rhythm of the heart

· Explain to the patient about the stages of activity that may be performed by the patient.

5. Talk with Mrs. T:

· Ceate an atmosphere of calm and comfortable environment.- To get relaxed and free from tensions

· Teach and encourage the patient to do relaxation techniques. – To maintain Blood pressure within normal limits

· Give psychological support and recreational activity – To cope with the health and fast recovery

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