Critical Nursing Care Priorities for Comatose/Trach Patient

CASE STUDY
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Case Study
Introduction
While different patients may be suffering from a similar condition, their context is unique in that each patient has a specific set of needs. Thus, patient-centered care focuses on the patient and their specific health needs (Edgman-Levitan & Schoenbaum, 2021). Patient-centered care aims to empower patients to be active participants in the care process. The approach to care is fundamental when highlighting the physical and social wellbeing of a patient with multi-morbidity in the primary care settings (Kuipers et al., 2019). In this case, the patient (PX) is a 55-year-old female. She had a past medical history involving angina, smoking, heavy alcohol consumption (non-dependent), and poor diet. The patient suffered from a myocardial infarction at home and remained without oxygen for 30 minutes while her husband strived to perform CPR. While the patient was given a tracheostomy, she was not expected to survive once removed because her brain was presumed to be damaged. This current paper discusses comatose/trach care; GCS 3 on arrival. The purpose of the case study is to provide critical analysis of the critical nursing care priorities for this patient.
Relation of Symptoms and Pathophysiology
Myocardial infarction is also known as a heart attack. It is a dangerous condition caused by insufficient blood flow to the heart muscle. When there is no blood flow, the affected part of the heart begins to die since it is not receiving the necessary nutrients and oxygen, while at the same time, there is the accumulation of waste from the cells. When blood flow is not restored quickly, a heart attack can lead to permanent heart damage and death.
The key risk factors of a heart attack include age, gender, lifestyle, and specific medical conditions. Under lifestyle, sedentary living, smoking, and alcohol consumption are key risk factors. Under gender and age, women above 50 have a higher risk of a heart attack. In women, the key symptoms of heart attack are shortness of breath, insomnia, fatigue, pain in the back, nausea, and vomiting.
A blockage causes most heart attacks in one blood vessel that supplies the heart with blood (Sadaka et al., 2018). Plaques are responsible for this phenomenon. They are the sticky substance that builds within arteries in atherosclerosis. In some instances, plaque deposits with the coronary artery can rupture, allowing a blood clot to be stuck at the point of the rapture. Sometimes, this clot can be big enough to block the artery and limit blood flow to the heart. A part of plaques, 5% of heart attacks are caused by spasms of the artery, trauma, rare medical conditions or disease that causes unusual narrowing of blood vessels, embolism, electrolyte imbalance, and eating disorders.
PX is 55 years, and her lifestyle involves poor diet, smoking, and heavy alcohol consumption. This combination of risk factors increases her chances of having a heart attack (Zhan et al., 2019). The patient has been diagnosed with angina, a chest pain associated with reduced blood flow to the heat. It is not only a sign but a symptom that the patient may be having a heart attack.
During her heart attack, the patient stayed for 30 minutes without oxygen. Oxygen deprivation between 30 to 180 seconds leads to loss of consciousness (Goodall et al., 2014). At 60 seconds, the death of brain cells begins; at three minutes, neurons begin to be damaged with an increased likelihood of brain damage. At five minutes without oxygen, death becomes imminent. The observation caused the patient's brain to be presumed dead on her arrival at the hospital. Thus, the patient was in a coma on arrival, supported by a tracheostomy.
Key Nursing Priorities and Problem-Solving Approach
The application of a tracheostomy is because the patient could not breathe because of an underlying health condition. While there are several such conditions, PX's problem is that she was unconscious and in a coma due to her heart attack. On arrival, the patient was classified as GCS 3. GCS refers to the Glasco Coma Scale, a scoring system commonly used to describe the level of consciousness in a patient following damage to the brain (AL-Quraan & AbuRuz, 2015). The test was necessary for the current patient because staying over five minutes without oxygen supply may lead to the death of brain cells and damage of nerves. Thus, on arrival at the hospital, the patient was presumed to have brain damage due to a lack of oxygen. The GCS assesses patients according to three aspects of consciousness; verbal response, motor, and eye-opening (Jain & Iverson., 2021). A typical GCS score is 15, while a score of 3 indicates complete unresponsiveness (Gaines, 2017). Based on this unresponsiveness, the patient was placed on a tracheostomy to assist breathing.
Nursing Priorities for the Patient
The care of a patient with a heart attack and possible brain damage is multidisciplinary because it is associated with organ injuries (Shaikh et al., 2021). Such patients require immediate admission in an ICU setting where care can be provided effectively. Initial GCS scores are critical determinants of such a patient's outcomes. Patients with a GCS of 8 or less have a 30% mortality rate within two weeks (Magee, 2021). At a GCS score of less than 9, patients require assisted breathing and need tube feeding.
For PX, nursing priorities aim to optimize perfusion and oxygenation. Perfusion refers to the fluid through the lymphatic or circulatory system to a tissue or organ (Prabhakar et al., 2014). On the other hand, oxygenation is an oxygen therapy treatment in which a patient is provided with extra oxygen (supplemental oxygen) to breathe (Cooksley et al., 2018). Thus, the purpose of these nursing priorities is to keep the patient alive (even though in a coma) for as long as possible. Thus, the priority is ensuring that the patient's airway and breathing are not distracted by any condition (May 2013). It involves an initial assessment of the airway, breathing, and circulation to identify and manage the most immediate threats to life. In this case, the patient is already placed on endotracheal incubation. Thus, the nurse's priority is to ensure that the patient effectively breathes. According to Shaikh, Waseem, and Boling (2021), endotracheal intubation is considered where the GCS is equal to 8...