Planning of Care Presentation - NSTEMI
Clinical Assessment, Management & Interprofessional Care Plan for NSTEMI
Patient Assessment & Initial Findings
Patient Profile: 73-year-old female admitted with NSTEMI diagnosis.
Priority Focus: Cardiovascular stability, oxygenation, neurological status, allergies, and anxiety management.
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Initial Findings
- Airway: Patent with no obstruction.
- Breathing: Shortness of breath; monitor oxygen saturation closely.
- Circulation: Chest pain, diaphoresis, myocardial ischemia risk; continuous cardiac monitoring and BP checks.
- Disability: Risk of confusion/delirium; frequent AVPU/GCS assessments required.
- Exposure: Diaphoresis; monitor temperature and skin condition.
- Baseline Observations: HR, BP, temp, SpO₂, and pain score are essential.
Clinical Reasoning & Management
- Glucose Management: Stress response and comorbidities may affect blood glucose levels (Ibanez et al., 2017).
- Clinical Reasoning Cycle: Identify situation, gather cues, process information, and prioritize surveillance/cardiac care.
- Interventions: Oxygen therapy, pain relief, anti-ischemic medications, and psychological support.
- Monitoring: Continuous observation ensures rapid response to clinical deterioration (Levett-Jones, 2017).
Care Planning & Implementation
| Care Focus | Short-Term Interventions (Hospital) | Long-Term Goals (Recovery & Self-Sufficiency) |
|---|---|---|
| Cardiovascular Stability | Continuous cardiac monitoring, antiplatelet and anti-ischemic drugs, oxygen therapy if required. | Secondary prevention via cardiac rehabilitation, regular follow-ups, and lifestyle adjustments. |
| Vital Signs & Monitoring | Frequent checks of HR, BP, SpO₂, temp, and pain score to detect adverse changes early. | Patient education on recognizing warning signs of clinical deterioration. |
| Glucose Management | Close glucose monitoring to prevent stress-induced hyperglycaemia (Levett-Jones, 2022). | Long-term dietary planning and lifestyle modification to support cardiac recovery. |
| Fall Prevention | Accessible call bells, non-slip footwear, and mobility checks. | Ongoing fall risk assessments and home support services for safe living. |
| Anxiety & Emotional Care | Emotional reassurance, involvement in care decisions, spiritual support (Piepoli et al., 2016). | Continued psychological support, anxiety management, and maintaining community/church connections (Rao et al., 2021). |
| Functional Autonomy | Ensure safe mobility during hospital stay. | Referral to physiotherapy and dietitian services to promote self-management. |
| Rehabilitation & Lifestyle | Not applicable during immediate hospital stay. | Cardiac rehab, education on medication adherence, exercise, diet, stress reduction, and BP/lipid control. |
Interprofessional Team Collaboration
Interprofessional collaboration ensures safe and holistic care for Ms. Thomas following NSTEMI. Effective teamwork reduces errors, improves efficiency, and strengthens patient-centred recovery (Reeves et al., 2016).
- Cardiologist: Leads medical management, prescribes evidence-based treatment, focuses on acute and long-term cardiac health.
- Registered Nurse: Continuous monitoring, patient education, care coordination, and continuity of care.
- Physiotherapist: Supports mobility, safe exercise progression, and fall prevention strategies.
- Dietitian: Advises on nutrition strategies to manage hypertension and hyperlipidemia.
- Pharmacist: Ensures medication safety, reviews drug interactions, and promotes adherence.
- Psychologist / Counsellor: Manages anxiety and supports coping strategies (Headquarters, 2010).
- Chaplain / Pastoral Care: Addresses spiritual needs and emotional well-being.
- Communication & Discharge: All professionals contribute to discharge planning. The ISBAR framework is utilized for precise handover.
Developing effective patient care plans is an important part of Nursing Assignment, particularly when applying clinical reasoning and evidence-based nursing interventions
Patient Safety & Adverse Event Management
Elderly NSTEMI patients are at high risk of adverse events during hospitalization. Targeted safety interventions minimize complications and enhance outcomes (Vincent, 2010).
Risk Identification
- Fall Risk: Elevated due to age, hospital setting, antihypertensive side effects, and dizziness.
- Hypoglycaemia Risk: Resulting from stress-induced fluctuations or medication adjustments.
- Infection Risk: Associated with invasive devices (IV lines, urinary catheters).
Prevention & Mitigation Strategies
- Fall Prevention: Clutter-free environment, non-slip footwear, accessible call bells, mobility aids, and bed alarms if needed (NCQA, 2025).
- Glucose Control: Frequent monitoring, appropriate diet, and tailored medication adjustments.
- Infection Control: Strict hand hygiene, aseptic technique, and prompt removal of unneeded invasive devices.
- Patient Empowerment: Educated on early infection signs to actively participate in care.
Mindful Communication & Documentation
Mindful Communication Strategies
- Build a strong therapeutic relationship with Ms. Thomas by respecting her holistic values and individual needs.
- Practice active listening, show empathy, and maintain eye contact to foster trust and comfort.
- Acknowledge spiritual beliefs and provide access to pastoral care services.
- Use calm, reassuring language to ease anxiety and address fears about living independently.
- Promote autonomy by involving her in shared decision-making and care planning.
- Avoid medical jargon; explain diagnosis, treatment, and recovery using simple language.
- Use open-ended questions to explore her concerns and personal preferences.
- Deliver clear, organized information to boost self-management confidence (Xu et al., 2019).
Clinical Documentation Standards
- Maintain accurate, relevant, and timely documentation of all assessments, nursing interventions, and patient responses.
- Comprehensive record-keeping ensures continuity of care across the interprofessional care team.
- Documentation upholds key professional, legal, and ethical standards in healthcare practice (Granero-Molina et al., 2020).
References
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Granero-Molina, J., Torrente-Sánchez, M. J., Ferrer-Márquez, M., Hernández-Padilla, J. M., Ruiz-Muelle, A., López-Entrambasaguas, O. M., & Fernández-Sola, C. (2020). Sexuality amongst heterosexual men with morbid obesity in a bariatric surgery programme: A qualitative study. Journal of Clinical Nursing, 29(21–22), 4258–4269. https://doi.org/10.1111/jocn.15461
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Headquarters, W. (2010, September 1). Framework for action on interprofessional education & collaborative practice. World Health Organization. https://www.who.int/publications/i/item/framework-for-action-on-interprofessional-education-collaborative-practice
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Ibanez, B., James, S., Agewall, S., Antunes, M. J., Bucciarelli-Ducci, C., Bueno, H., Caforio, A. L., Crea, F., Goudevenos, J. A., Halvorsen, S., Hindricks, G., Kastrati, A., Lenzen, M. J., Prescott, E., Roffi, M., Valgimigli, M., Varenhorst, C., Vranckx, P., Widimský, P., . . . Metzler, B. (2017). 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. European Heart Journal, 39(2), 119–177. https://doi.org/10.1093/eurheartj/ehx393
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Levett-Jones, T. (2017). Clinical reasoning: Learning to Think Like a Nurse. Pearson.
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NCQA. (2025, September 11). Quality Compass - NCQA. https://www.ncqa.org
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Piepoli, M. F., Hoes, A. W., Agewall, S., Albus, C., Brotons, C., Catapano, A. L., Cooney, M., Corrà, U., Cosyns, B., Deaton, C., Graham, I., Hall, M. S., Hobbs, F. D. R., Løchen, M., Löllgen, H., Marques-Vidal, P., Perk, J., Prescott, E., Redon, J., . . . Verschuren, W. M. M. (2016). 2016 European Guidelines on cardiovascular disease prevention in clinical practice. European Heart Journal, 37(29), 2315–2381. https://doi.org/10.1093/eurheartj/ehw106
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Rao, S. V., Vidovich, M. I., Gilchrist, I. C., Gulati, R., Gutierrez, J. A., Hess, C. N., Kaul, P., Martinez, S. C., & Rymer, J. (2021). 2021 ACC Expert Consensus Decision Pathway on Same-Day Discharge After Percutaneous Coronary Intervention. Journal of the American College of Cardiology, 77(6), 811–825. https://doi.org/10.1016/j.jacc.2020.11.013
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Reeves, S., Fletcher, S., Barr, H., Birch, I., Boet, S., Davies, N., McFadyen, A., Rivera, J., & Kitto, S. (2016). A BEME systematic review of the effects of interprofessional education: BEME Guide No. 39. Medical Teacher, 38(7), 656–668. https://doi.org/10.3109/0142159x.2016.1173663
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Vincent, C. (2010). Patient safety. BMJ Books.
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Xu, H., Zhang, X., Wang, D., Xu, L., & Wang, A. (2019). Factors influencing medication-taking behaviour with adjuvant endocrine therapy in women with breast cancer: A qualitative systematic review. Journal of Advanced Nursing, 76(2), 445–458. https://doi.org/10.1111/jan.14253
