Clinical Decision Making Process (Research Paper Sample)

CLINICAL DECISION MAKING PROCESS
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Issue Description
Working jointly with my mentor, we were alerted to attend to a fifty year old patient who called for an ambulance complaining of severe chest pain. We found the patient seated eschew across the couch, drenched in sweat and in great distress. Drawing from the medical history of the patient, we learned that he had picked a hard-hitting row with his wife as he moved furniture from one location in the house to another, and then collapsed. Moreover, the client had been under medication for Stable Angina and hypertension. Upon examination of his blood pressure it was 170/100, his heart rate was 120 whilst his respiration recorded 24, his chest was clear on both sides and his GCS was at 15.
We carried out a pulse Oximetry, with an ECG monitoring level at SaO2 92% and an ECG of Sinus tachycardia with St Depressants. The patient complained of intense pain on his middle chest. In a scale of 10, his pain rated at seven before we arrived at the scene, but after a while the pain abated to rate at 4 in a scale of ten. After carrying out the resting 12-lead electrocardiogram (ECG) the patient did not show St Elevation
Thinking Process Analysis
During the onset of the various assessments carried out on the patient we deduced that he was suffering form unstable angina. He complained of chest pain and certain tightness on which gave him a heavy crushing feeling on the chest making his breathing difficult. The patient was diagnosed with unstable angina given that he presented stable chest pain. Unlike unstable angina, stable angina can be diagnosed through clinical assessment alone or clinical assessment in addition to diagnostic testing (NICE, 2010 p.7). Thus the diagnosis of stable angina would have required two tests namely anatomical testing for obstructive coronary artery disease (CAD) and functional testing for myocardial ischaema. Moreover, other features that made the diagnosis of stable angina unlikely include very prolonged or continuous chest pain and chest pain that is unrelated to the activity the patient was doing (NICE, 2010 p.8).
We managed the patient's cardiac pain by administering the anti-platelet therapy; we administered 300 mg of aspirin orally. To cater for the oxygen deficiency, we administered oxygen 10later per pint using the Non re-breather mask. To relieve pain, we administered GTN 5gm S/L decreased heat preload and vasodilator to coronary artery, hence easing the chest heaviness and pain (NICE, 2010 p.15). We transferred the patient to the hospital from where he had been receiving medication for stable angina and hypertension for further specialized medical examination. This is because the patient's lod ECG needed to be compared with the current ECG (Dekker and Crow, 2001 p.67).
Evaluation
After carrying out the diagnosis and managing the patient's cardiac complication the tests revealed that the patient was gradually feeling better. The chest pain had drastically reduced so that the client said that in the scale of ten the pain was now at two. Moreover, the blood pressure was minimized to a manageable level of 150/90, RR 18, pales 100 and SaO2 96%.The patient was stable and breathed normally, there were no more excessive perspirations and he was able to sit down with ease. We were definitely carrying out the right management.
Recommendations
In future, I would recommend adherence to the following clinical procedure as an improvement in the decision making process. First and foremost I recommend the recording of 12-lead electrocardiogram (ECG) immediately and sending the results to the hospital before the arriv...