Nursing Care and Multidisciplinary Management of STEMI Assignment Answers

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1. Discuss STEMI, considering the following: definition, pathophysiology, epidemiology and the risk factors/possible causes and how this can deteriorate if left untreated.

Definition

STEMI (ST-Elevation Myocardial Infarction) is a severe and sometimes lethal form of acute myocardial infarction resulting from complete occlusion of the coronary artery (Elendu et al., 2023). This leads to the prolongation of ischemia and myocardial damage identified by St-segment elevation on the electrocardiogram (ECG). STEMI is an emergency in that it demands relocalisation of the affected artery and prevention of further myocardial damage (McLaren et al., 2024).

Pathophysiology

The basic pathophysiology behind STEMI is mainly associated with the erosion or rupture of a Guillemoin/atherosclerotic plaque in a coronary artery (Carter et al., 2020). This disruption facilitates access to the sub-endothelial matrix that results in platelet adhesion, activation, and aggregation. Thus, a thrombus forms and occludes the coronary artery so that there is no blood flow to the demanded rate to the affected myocardial area (McLaren et al., 2024).

Figure 1: Plaque erosion and acute coronary syndromes

If oxygen is not delivered in adequate quantity to the myocardial cells, the cells get chemically injured and switch to an anaerobic mode of metabolism which produces lactic acid (Li et al., 2022). This leads to cell hypoxia and impaired mitochondrial function where if ischemia continues for over 20-30 minutes it progresses to cell necrosis. The necrosis develops in the sub-endocardial layer, and it has the potential to go up to a transmural level which involves the whole of the myo-cordial wall thickness (Gupta, 2022). In clinical terms, it manifests as chest pain, diaphoresis, nausea and dyspnea & & Evidence in this regard that is clinically discernible includes chest pain, sweating, nausea and short breathlessness. If left undiagnosed or untreated, the condition can result in heart dysfunction, heart rhythm disturbances, or low cardiac output due to heart failure.

Epidemiology

In the world, ischemic heart disease involving STEMIs is among the significant causes of death. STEMI prevalence in UK patients is estimated to be 50-100 per 100,000 population per year; STEMI is more frequent in males (Salari et al., 2023). The use of PPCI as an emergency reperfusion treatment has increased the number of patients surviving myocardial infarction. However, placing them in different health risk categories based on access still holds After that, differences in healthcare accessibility persist (Ibanez et al., 2017).

Risk Factors and Possible Causes

There are many causes of STEMI. Hypertension, hyperlipidaemia, diabetes, smoking, obesity, sedentary lifestyle, and poor diet are examples of modifiable risks (Yusuf et al., 2020). This includes age, sex as a male, and a documented history of cardiovascular disease in the family. one would also probably look at pre-existing diseases such as hypertension or diabetes, a lack of activity, or suppressed desire (Teo and Rafiq, 2021). Synergism of these factors makes them more predisposed to plaque rupture and subsequent development of thrombus and occurrence of STEMI.

How STEMI May Deteriorate/Exacerbate if Left Untreated

STEMI can be fatal if left unnoticed and consequently, untreated properly. Ischemia that persists for an extended period leads to growth in the size of the infarction and subsequent myofibrillar damage, and lowered segment contractility (Jäger, 2017). This may then lead to congestive cardiac failure because the heart can either pump inadequately or there is a malfunction in the ability of the heart to fill with blood. Thus electrical conduction disturbances in the ischemic myocardium have a potential for proarrhythmic and the individual is at risk of life-threatening rhythms such as ventricular fibrillation. In addition, chronic ischemia can cause cardiogenic shock when decreased output impairs vital organs and leads to shock (Heusch, 2024). The end-stage of STEMI if left untreated is death, and death rates rise dramatically when reperfusion therapy like thrombolysis or PCI is not administered promptly. It is thus important to identify these patients early and intervene to avoid these complications that hurt the outcome of the patients.

Nursing Care and Multidisciplinary Management of STEMI Assignment Answers

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2. Discuss how to plan, implement, evaluate and evaluate nursing care for Mrs Nowak applying evidence-based decision-making using a systematic approach. Include relevant pharmacological and non-pharmacological interventions that may improve her condition

Planning, Implementation, and Evaluation of Nursing Care for Mrs. Nowak

Systematic Approach: Airway, Breathing, Circulation, Disability, and Exposure (ABCDE)

Evidence-Based Decision-Making Through a Systematic Approach for STEMI

The management of STEMI employs technical decision-making based on the guidelines of STEMI management, which guarantees the provision of appropriate and timely treatment in accordance with the form of the disease (Partow-Navid et al., 2021). The Airway, Breathing, Circulation, Disability, Exposure (ABCDE) approach is an effective format for systematically identifying priorities for life-threatening problems enforceable to pathophysiological problems (Avva, Lata and Kiel, 2023). This systematic approach is definitely useful in managing STEMI because it reveals key fields involving hypoxia, myocardial ischemia, and systemic hypoperfusion that have the tendency to worsen rapidly if neglected. For instance, reoxygenation using high-flow O2 therapy, eradicating myocardial ischemia by using nitrates and antiplatelets and preparing for reperfusion therapy match international STEMI management guidelines.

Airway

Mrs.Nowak is awake thus suggesting that her airway is clear and not obstructed in any way. However, she complains of severe short breath, and given history of COPD she at risk for developing compromised airway if her condition decompensates. Such features as anxiety and tachypnea could also precipitate excessive respiratory effort hence increasing the work load on her myocardium. It is also important to make sure her airway pathway does not close up all over. Suction equipment needs to be set because COPD carries a probability of additional secretions which can worsen the blockage of the airways (Liu et al., 2020). Currently her oxygen saturation is at 86% and therefore the high flow oxygen therapy should be started at 15 liters per minute using a non-rebreather mask (Vitazkova et al., 2024). In order to avoid deterioration of myocardial ischemia and moreover complications, hypoxia must be addressed.

Basic co-essays that include arterial blood gases (ABGs) are vital in determining oxyhaemoglobin and acid-base status since she has a history of caesarean surgery (Lamprea et al., 2022). A full blood count (FBC) will allow for the assessment of the presence of anemia, which increases myocardial oxygen demand. A reassessment should check that her airway is clear and patent, oxygen saturation is raised above 94 percent and that there are no signs of increased airway obstruction like stridor or gurgling.

Breathing

Mrs. Nowak has tachypnoea with respiratory rate of 31 breaths per minute, resulting from respiratory distress. This is accompanied by COPD which we can assume has led to oxygen imbalances thus the low SpO₂. Normally audible crackles on auscultation may point towards pulmonary edema due to reduced function of LV, frequent in MI. This requires a very comprehensive respiratory assessment in respect of wheeze indicative of bronchospasm or crackles revealing fluid overload and heart failure. Oxygen therapy should still be required, after optimization, however, the SpO₂ level must be kept only between 94 and 98% to prevent CO₂ retention which may occur in those patients with COPD (Echevarria et al., 2021).

If oxygen alone will not help her to improve her oxygenation, non-invasive ventilation, which includes CPAP or BiPAP, should be tried to support her ventilation and decrease her work of breathing. Measures aimed at reducing her anxiety level should be used in order to reduce her respiratory rate; for instance, deep and slow respiration will help her enhance her ventilation ratios. Laboratory tests such as D-dimer must to be done to negate pulmonary embolism that may manifest with respiratory distress similar to myocardial infarction. Also the measurement of BNP (B-type Natriuretic Peptide) will also used to check for heart failure as a cause of her dyspnea.

Circulation

The tachycardia Mrs, Nowak presented with heart rate of 117/min with borderline hypotensive BP of 108/55 mmhg indicate reduced cardiac output due to myocardial ischemia. Her moist palms and central oppressing chest pain again substantiate inadequate tissue perfusion. Aspirin at 300mg should be initiated for antiplatelet effect, a loading dose of clopidogrel or ticagrelor should be given to prevent clot formation, this follows guidelines from STEMI codes internationally. Chest pain should also be relieved by sublingual GTN (glyceryl trinitrate) because this enhances blood circulation in the coronary arteries (NHS, 2023).

Disability

Mrs. Nowak is fully oriented but anxious and has type 2 diabetes that must be considered. Acute stress and illness such as STEMI are characterized by sharp rise in sugar levels which aggravates the implications of a diabetic patient. Blood glucose levels should be checked daily and raised blood sugar should be brought back to normal range with insulin. Ensuring she is afraid can be treated through continued reassurance and stamping out further ongoing treatment processes can help reduce sympathetic nervous system activity and therefore the workload on the myocardial (Oxford Medical Education, 2016). This is so because an assessment of her neurological status often requires the use of instruments such as the Glasgow Coma Scale (GCS) especially as patient’s cerebral perfusion pressure may be an issue if her hypotension were to worsen.

Exposure

Perspiring and clammy skin complicated by Mrs. Nowak is a sign of systemic hypoperfusion resulting from myocardial ischemia (Higgs., 2018). This has to be taken care of by wrapping her with blankets to avoid instances of hypothermia which will increase workload on the cardiac muscles hindering her recovery process. She should be checked for injuries on her skin particularly those that may have occurred when she fell in the garden recently, while presenting other symptoms of STEMI (Yamamoto et al., 2020). Abnormal skin color, especially pale or blue and mottled skin,should also be documented because they suggest avascular peripheral tissue.

Cardiac Rehabilitation

After the initial phase of management of Mrs.N nowak with STEMI she will need cardiac rehabilitation (Salvioni et al., 2021). Cardiac rehabilitation is an important part of her recovery as it comprises physical exercise training and education to enhance the quality of life and reduce cardiovascular risk. The plan would comprise physical exercise, nutritional guidance and smoking cessation services for her; as well as psychological support for her anxiety and grief.

Pharmacological and Non-Pharmacological Interventions

Pharmacological

Antiplatelet preparations such as aspirin and P2Y12 inhibitors like clopidogrel are prescribed to Mrs Nowak to prevent platelet activation and thrombus formation as a medical treatment. Actually, low molecular heparin or heparin has the objective of delaying clot formation because it is blood thinner. In brief, glyceryl trinitrate (GTN) is a vasodilator given to reduce myocardial oxygen demand for the relief of ischaemic chest pain (Abdul, 2019). Morphine is also care for severe pain associated with anxiety (Rathod, 2024).

Non-Pharmacological Interventions

Non-drug management is an important component that supports and enhances the Drug Management strategy (Castellano-Tejedor, 2022). In this position, Mrs Nowak has the best chance to oxygenate her tissues and ease the work of the heart. Oxygen therapy is used to maintain the patient’s SpO _{2} above 94%, but, hypoxemia is a criterion for administering oxygen. To support this, there is a need to employ psychological intervention to reduce levels of anxiety that increase myocardial stress (Ernstmeyer and Christman, 2023). A major component of follow-up care involves patient counselling involving risk factor reduction including following a diet low in saturated fats, increased physical activity levels, and smoking cessation to reduce the risk status for future adverse cardiovascular outcomes (Verma et al., 2021). Pulmonary complications demand constant surveillance of underlying vital sign parameters and cardiac rhythms to identify any sign of decline or deterioration. Further, the inclusion of family members in care leads to patient satisfaction and compliance with utterances from the medical team after discharge.

Reassessment and Evaluation

The ongoing and dynamic roles of assessment and evaluation guarantee that Susan Nowak’s condition is scrutinized, and that the care plan is appropriately modified in light of Mrs. Nowak’s feedback on interventions (Goldsby et al., 2020). After carrying out the first nursing care plan, systematic reassessment using the nursing model: ABCDE is imperative, to assess for any changes in her condition.

Assessment related to the airway concerns ensuring that the airway is still clear for the patient. Evaluation is needed to ensure that a sign of obstruction that may present as gurgling noise, or change in mentation is not present; and if suctioning or any airway adjuncts are applied, the efficacy should be assessed (Sontakke, Sontakke and Rai, 2023). As part of the respiratory evaluation the level of oxygen, the rate of breathing and the lungs are observed in an attempt to identify an enhanced respiratory function due to the use of oxygen or bronchodilators respectively. It is also important to note that to prevent oxygen toxicity while trying to keep saturation higher than 94% adjustments to oxygen concentration ratios may be needed (McCollum et al., 2019).

During the circulation phase, it is the assessment of the client’s, pulse rate, and capillary refill time about pharmacological measures such as aspirin, heparin, and glyceryl trinitrate (McGuire, Gotlib and King, 2023). It aggressive search for signs of bleeding or hypotension that may be precipitated by anticoagulation therapy is important. Pain levels are also repeatedly checked to affirm that opioids such as morphine are controlling ischemic chest pain without side effects.

Disability reassessment focuses on changes in the neurological state using a tool such as the Glasgow Coma Scale to observe any changes in consciousness or cognition. New blood glucose levels are checked if there is hypoglycemia and it is made sure that hypoglycemia is not getting worse (McGuire, Gotlib and King, 2023). Finally, for exposure, an examination done with a naked abdomen is again carried out to look for new clinical abnormalities like pallor, cyanosis or altered skin temperature (Panchal et al., 2020). Hypothermia is identified whenever a child’s body temperature drops and fever management is constant and depends upon clinical prioritization (Wesołek et al., 2024).

Assessment is a way of identifying the efficiency of the targeted and implemented change strategies (Errida and Lotfi, 2021). This encompasses measuring the changes in symptoms that include chest pain, vital signs and oxygen levels. Following the result of the assessment of each care plan, its effectiveness and revisions are made concerning Mrs Nowak’s improvement plan and any other new or persisting issues if any. In this process, there is a liaison with the managing team to discuss and share her care plans and goals besides her condition fluctuations (Aguilera et al., 2023). The records of the reassessment and the findings as well as interventions initiated and responses for reconsideration are important for continuity’s sake.

3. What multidisciplinary team (MDT) would be useful to review Mrs Nowak during her admission and prior to discharge? What communication strategies would you use with the MDT, the patient and her family/careers to ensure that interprofessional working (IPW) is effective and how would this be documented accurately?

MDT Involvement During Admission

Multidisciplinary team (MDT) involvement is necessary, especially during admission because of Mrs. Nowak’s acute STEMI upsetting by other diseases. The cardiologist is at the centre of her management to determine the correct diagnosis and initiate therapies such as PCI or thrombolysis, which are critical in preventing myonecrosis (Partow-Navid et al., 2021). The establishment of continuous surveillance of her status, including ECG and other vital signs, as a cardiac nurse specialist. Bronchospasm and flushing are the main side effects a nurse is expected to monitor for, as well as other cardiovascular complications like arrhythmia or hypotension.

A pharmacist is essential in counselling her to ensure that the most appropriate doses of cardiovascular agents, including antiplatelet and anticoagulants, are given safely. They discuss possible drug interactions, especially about her coexisting conditions, such as type 2 diabetes and COPD, which should be controlled (Tamis-Holland et al., 2024). A dietitian is crucial to assessing her nutritional status since her diet history likely played a role in developing hyperlipidemia and worsening her cardiac risk factors (Mughal and Sastry, 2022). The need to call a psychologist or clinical therapist will be of high importance to address her anxiety and stress, as she is a candidate for developing poor cardiovascular health due to sympathetic activity (Salari et al., 2023).

MDT Involvement Before Discharge

During discharge planning, the MDT changes its function to promoting a safe journey from the hospital to home environment and decreasing the risk of the client’s readmission. Cardiac patients suffer from high rates of readmission due to noncompliance with medical management, failure to get a follow-up appointment, and propagation of unfavorable lifestyles that worsen the patient’s condition and mortality rates.

A highly important member at this stage is the Cardiac Rehabilitation Nurse, who odd for a structured recovery program (Graham et al., 2020). Cardiac rehabilitation is a comprehensive program that involves exercise training, nutritional advice, risk factor control and counselling (Bozkurt et al., 2021). These interventions are primarily intended for the recovery of cardiovascular fitness, enhancing the quality of life and for preventing further episodes of cardiovascular adversity.

Drug interaction and side effects are discussed with the patient. The services of a Mediator; the Pharmacist, again join and help in expounding the medication management and adherence plan to her (Ng et al., 2024). A dietitian can solidify her dietary plan for patients with heart disease the currents change achievable, fat decreases and fiber increases. Her home environment and support systems are evaluated; the social worker may order home care, and community support if needed. A social worker takes a look at the client’s home condition and evaluates her social networks and need for any extra help (FARKAS and ROMANIUK, 2020). In case of a need, the social worker is able to secure the assistance from the community nursing or home care services to support the patient’s needs at home.

Communication Strategies with the MDT

Communication with the MDT is essential to guarantee appropriate interprofessional working and individualised care of Mrs Nowak. The SBAR (Situation, Background, Assessment, Recommendation) structure is a vital method of communication in shift handoff and team huddles (Shahid and Thomas, 2020). For instance, in the admission area, ongoing data on the patient’s symptoms, test data, and outcomes about implemented measures, such as, for instance, Mrs. Nowak, can be made in a standardized format to support decisions.

Communication occurs through the use of documentation in the EHR – consideration can be given to product-specific toolkits the opportunity to systematically document several standard MDT assessments, interventions and plans can facilitate MDT communication (Shahid and Thomas, 2020). Communication plans should note responsibilities, contact information and frequency for follow up activities in regard to action plans. This is particularly important for Mrs. Nowak’s care, all the delivering personnel understands who does what and when. Further, such discussions involve Mrs. Nowak and her family in the care plan, helping to make sure they know what is best for her, comprehending the usefulness of every decision made, and actively contributing to the process of her recovery.

Communication with Mrs Nowak and Her Family

To facilitate this, Mrs. Nowak and her family should be told the nature of her condition, the actions to undertake to improve the situation, and the expected progress (Galehdar et al., 2020). The discussions should be taking the patient’s multidimensional perspective while translating medical terms into layman's language and avoiding complex abbreviations (Rademakers et al., 2020). Mrs. Nowak should be informed on compliance with her medications, the signs of worsening of breast pain or difficulty in breathing and different changes that can accompany the primary recommendations such as dietary changes and quitting smoking.

The family is also required to be fully involved given that they are usually involved in the support after discharge (Mountain et al., 2020). They should be told about the care plan developed for Mrs Nowak and how can they help her at home. Acting accordingly to their questions and concerns fosters their trust and guarantees they can assist in her recovery process (Molina-Mula and Gallo-Estrada, 2020). The need for psychological and emotional care for both Mrs. Nowak and her family cannot be overemphasised since cardiac diseases come with a lot of stress and anxiety.

Other needs like psychological and social should also be talked about, and perhaps connect the patient with a support group or a therapist if necessary (Brusadelli et al., 2021). The evaluation strategies should be culturally appropriate, particularly the language used, or whether they have preferred values as a family or Mrs. Nowak (Molina-Mula and Gallo-Estrada, 2020).

Accurate Documentation

Charting is one of the critical pillars of healthcare delivery and teamwork (Berry, 2023). They aid in continuity of care, enhance clinical decision making and document all care that has been provided legally. In the case of Mrs. Nowak, she needs to record all the assessments, interventions or even reports with other members of the MDT as comprehensively and as early as possible (Quinn et al., 2019).

The utilization of EHR waveform, which is a real-time documentation and writing system, ensures that every member of the MDT has an active and updated knowledge of Mrs. Nowak’s status and/or Care Plan (Quinn et al., 2019). This seamless documentation is critical for maintaining clear communication and enhancing patient care. Effective documentation should include presenting complaints, physical assessments, results of investigations prior to admission, and the details of pharmacological and non-pharmacological management administered (Kawu et al., 2022). The documentation format must allow recording any alterations in the patient’s condition or changes to the care plan, minimizing miscommunication or omission of key information. During MDT communications, clear definitions are essential, and protocols such as SBAR (Situation, Background, Assessment, Recommendation) are used for structure and clarity (Tran et al., 2022). This approach is vital, especially during shift transitions, case discussions, or emergent situations. For students navigating such complex healthcare topics, assignment help online can offer valuable guidance and support to master these essential communication and documentation practices in clinical settings.

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