The Patient with Tachycardia

The Patient with Tachycardia.

Case Study 3: The Patient with Tachycardia
Arjun Bakta is a 58-year-old gentleman of Hindu heritage. He came to England from Punjab with his parents when he was a child. He is married to Nisha and they have 4 adult children. Two of their children live at home, along with Arjun’s mother who is 82. They live in a 4-bedroom terraced house.
Arjun has a PhD and works as a laboratory technician for a pharmaceutical company. He finds his work incredibly stressful due to staff shortages and is expected to work long hours. This has resulted in him having episodes of anxiety and depression which he does not like to discuss. Gradually, he is beginning to lose interest in his job and phones in sick regularly.
He has come into A&E via his GP with tachycardia, palpitations and shortness of breath.

• Airway: Patent, no issues. Able to talk in short sentences.
• Breathing: RR – 22 breaths per minute, SpO2 – 95% on air. No wheezing or added sounds.
• Cardiovascular: HR 120 bpm, BP 115/84 mmhg, (usual BP is 148/88). ECG shows fast AF. Peripherally warm. Passing urine via commode.
• Disability: AVCPU Alert. GCS 15/15 but feeling lightheaded and dizzy. Exposure: Temperature 36.2°C.

Signs and Symptoms
• Palpitations
• No pain

Past Medical History
• Hypertension
• Obese – BMI 37 (180cm/120Kg)

Current Medication
• Ramipril 2.5mg, BD

Family History
• Father passed away from stroke 10 years ago.
• Mother has hypertension and type 2 diabetes.

Social History
• Ex-smoker, 30 pack years. Gave up 8 years ago.
• Enjoys rich high fat foods.
• Inactive lifestyle
• No drug or alcohol use.

Case Study
• CRITICALLY evaluate the communication skills or strategy the nurse will engage in when caring for this patient.
• Provide a CRITICAL EXPLORATION of one psychological response of this sign or symptom including a coping strategy and ONE EVIDENCE-BASED STRATEGY.
• CRITICALLY discuss the holistic role of the nurse in this scenario based on one EVIDENCE-BASED INTERVENTION to manage the care.

Section 1: Introduction
 Introduce your assignment
 Set the scene of the essay
 Define any major concepts that will be explored
 Reference should be made to the patient in the case study
 Detail that this is a fictional case study and therefore will not breach confidentiality of any real patients in line with the NMC (2019) code.
 Reflect the wording in the learning outcomes to ensure that you give a clear and full introduction.
 Approximate word count (100 words)


Section 2: Communication Strategy

 Evaluate the range of communication skills, models and strategy the nurse might use to interact with this patient.
 This will include verbal and non-verbal communication skills, critical analysis of Motivational Interview (MI) or Teach Back Technique as well as communication models and theories.
 Provide a critical discussion of the barriers to communication
Your discussion should include factors such as the environment, patient symptoms, fear, anxiety, attitudes and beliefs of the patient and their relatives
 Show extensive reading around these skills and strategies
 How does the strategy help to improve communication and patient outcomes?
 Is it an appropriate strategy for this patient?
 What are the advantages and limitations?
 Approximate Word Count (400 Words)


Section 3: Psychological Response
 Provide a critical exploration of one psychological response of this sign or symptom including a coping strategy
 Consider the patient in the case study living with the sign or symptom you have explored and critically discuss how this will result in stress, anxiety or depression.
 Critically discuss one coping strategy in response to the psychological response. Support with literature to critically analyse the coping strategy and its outcomes.
 A definition of a coping strategy is expected
 Read extensively around coping strategies that the patient may adopt – are these positive or negative? Active or passive?
 Why might these be adopted according to literature? Consider the overall patient here (symptoms and psychosocial, lifestyle, perceptions and beliefs.)

 Explore one evidence-based strategy or intervention to manage the psychological response you have identified.
 A critical discussion of the psychological intervention or strategy is expected. This will demonstrate a critical discussion of findings of relevant resources. This will include research papers, policies, NICE Guidance, protocols which highlights the efficacy and limitations of the psychological intervention identified.
 Read extensively around the psychological intervention
 Approximate Word Count of 3a and 3b (400 words)

Section 4: The Holistic Role of the Nurse
 CRITICALLY discuss the holistic role of the nurse in this scenario based on ONE EVIDENCE-BASED nursing intervention or strategy to manage the sign or symptom discussed.
 It is expected that a brief introduction to holistic care is provided.
 Choose one evidence-based strategy to manage the sign or symptom.
 This should be critically discussed using contemporary research to explore the effectiveness or limitation of this intervention.
 What does the literature say about these interventions?
 What is the effectiveness or limitations of these interventions?
 Present a critical analysis of the intervention or strategy and relate this specialised knowledge to the care of the patient in the case study
 Approximate Word Count (500 words)

Section 5: Conclusion
 Draw a conclusion from the key points raised in your case study
 This must highlight a brief reflection of the key learning you have gained from writing this case study.
 Approximate Word Count (100 words)

Also Discuss one assessment strategy for this symptom/sign and explain the underlying pathophysiology.


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The Patient with Tachycardia


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