NUR2300 Evidence Based Nursing Practice


Provide a summary of the major health and social issues in contemporary medical surgical nurse practice.

Your research findings will be used to care for Mr Brown, ensuring the best patient outcomes.



Nursing skills are often ignored in healthcare.

While their skills and knowledge are important, the communication skills of nurses often get overlooked.

Poor communication between patient and nurse can result in poor patient care.

Excellent communication skills by the nurse can foster dialogue and get the message across the patient’s family (McCabe & Timmins (2013)).

The importance of communication in nursing is discussed in the report.

The report also explains the care that Mr. Brown must receive to keep him healthy.

He should be trained in the proper procedures to be done at home, such as blood monitoring and insulin injections.

Family members participate in the care and sharing their opinions.

They receive training on how to manage the patients (Arnold & Boggs (2015)).


Mr. Brown is 66 years old and suffers from chest pain, breathing difficulties, Type 2 Diabetes, hyperlipidaemia, obesity, and other health issues.

He consumes many cigarettes and beers daily.

To ensure his survival, he must be provided with proper clinical care and skilled nursing techniques.

A set of recommendations for clinical care that assures all patients with similar medical conditions receive the appropriate care regardless of their location.

The Acute Coronary Syndrome clinical care standard (ACS), supports healthcare workers and improves healthcare quality.

In this article, we will discuss the best nursing care for Mr. Brown.

Symptoms in patients with Hyperglycaemia or Coronary Heart Disease

Diabetes is a serious disease that can have a profound impact on the lives of many people.

It is found in nearly 90% of patients with diabetes.

Multiple organs can be affected by type 2 diabetes, such as the liver and pancreas, kidneys, brain, and gastrointestinal tract.

A decreased insulin sensitivity and reduced beta-cell function in the pancreas are signs of type 2 diabetes mellitus.

This causes hyperglycaemia (Bell and co., 2014).

In the case Mr. Brown, the ideal weight would be between 53 and 65kg. However, he is now 143kg which clearly shows that he’s overweight.

His diet is also unhealthy as he drinks a few beers every day and smokes a pack of cigarettes daily.

Brown suffered from acute chest pain and difficulty breathing when he was admitted to hospital.

These are symptoms of Acute Coronary syndrome (ACS).

Hospital Provides Mr. Brown With the Best Nursing Care

Hyperglycaemia is not just about renal failure. It can also lead to cardiovascular diseases, blindness, and even heart disease.

Mr. Brown should be examined twice a year for high levels of glycated blood sugar.

A nurse must make sure Mr. Brown is properly diagnosed and maintain a medical record when he’s in hospital.

The blood and urine tests should be completed (Martin-Gronert & Ozanne (2012)).

A variety of tests can be done on the patient.

They include the urine test, HbA1c, and eye dilation tests.

For diabetes to be confirmed, it is necessary to perform a thorough eye dilation test.

An HbA1c blood test should be done on the patient.

This is a test that checks the amount of hemoglobin in glycosylated plasma.

For checking the levels of sugar and ketones in urine, it is necessary to perform a urine test.

A sample of urine from the patient is collected. Then, a strip is placed in the urine.

Any change in color will indicate the presence of ketones.

This type of test is also used to detect microalbumin.

This protein can be found in diabetic patients’ urine.

Troponin testing is also used to determine if there has been a heart attack.

This type of test is done when the patient has chest pain, shortness, cold sweat, nausea and/or chest discomfort.

Troponin I (and T) are heart muscle proteins that are released into the blood when there is heart damage.

Troponin levels that are high in the blood must indicate that the patient had suffered from a heart attack or other type of heart disease.

Troponin levels may rise after a heart injury and can remain elevated for as long as 10-14 days.

A patient suffering from a heart attack can have both non-invasive or invasive tests performed.

Imaging with a needle stick is non-invasive. Invasive tests require the placement of a tube.

Mahar (2012). A pain assessment instrument should be accurate and reliable to give the correct amount information.

Both the patient and staff should be able to use the tools.

Nursing’s acronym PQRST is Provoke. Quality. Radiates. Severity. Time.

Provokes include the question, “What caused the pain?”. Quality refers to how the pain feels and Radiates refers the place where the pain originated.

Time and severity refer to the intensity of the pain.

PQRST is used by nurses to analyze the patient’s entire situation when he is admitted to the hospital (D’Arcy (2013)).

The patient is asked a series of questions to determine his medical condition.

There are many pain scales, such as the Numerical Rating Scale or Visual Analog Scale (NRS), and an image- or pictorial scale.

NRS asks the patient to rate their pain on a scale from zero to 10, with 10 being the worst and zero the best.

VAS asks the patient to describe his pain using an image scale. In this case, there is a variety of faces available. A smiling or crying face can be used to convey the pain.

For heart attack patients, a 10-minute window is permitted for treatment. A paramedic experienced can perform an ECG.

The primary treatment should include intravenous (IV), Nitro-glycerine, and soluble aspirin.

You must carefully observe Mr. Brown’s symptoms to determine the best medication to give him.

Low-risk patients should be evaluated using biomarkers. Patients suffering from high-risk symptoms should receive aspirin, Clopidogrel, and Beta-blocker.

Abbate et. al. (2012) consider angiography as an option.

It is necessary to make a significant change in your lifestyle and weight.

A thorough check-up, self-management and self-monitoring of glucose are all necessary.

There are a few steps the nurse can teach patients about self-monitoring their blood sugar. In this instance, Mr. Brown.

The first is to use a meter.

The patient will need to poke his finger with the needle, then place the drop on a strip.

The patient then places the strip on a meter to display his blood sugar count.

You can find these meters at your local pharmacy. They are portable, small, cost-effective, and easy to use.

The results are displayed in approximately 15 seconds. They can also be stored for future reference. Some meters even come with a software package that allows you to input the data and display charts and graphs.

This method is the best and most common way to test glucose.

The patient can now check his blood sugar with new devices.

The results will vary depending on whether blood was taken from the thumb or arm.

Insulin pumps are instruments that monitor the blood sugar level and allow you to see the changes.

The nurse should show Mr. Brown how to properly monitor his blood sugar levels.

A patient with type 2 diabetes should monitor his sugar levels at least twice a day.

Before eating or drinking, this type of monitoring should take place in the early morning.

Patients should be awakened at 3:00 am in the morning to determine if their sugar levels are high.

Because it gives a baseline reading of sugar levels before meals, pre-meal testing is crucial.

Diabetes is a complex condition that affects different people. It is essential to understand the relationship between food, blood sugar and insulin.

It is important to conduct post-meal blood checks.

Proper management is key in managing and caring for hyperglycaemic crises.

A nurse should teach Mr. Brown how to inject insulin at-home if necessary.

The Inzucchi (2015) method of determining insulin therapy should be used.

A fixed rate insulin combination, which is not required for the initial dose, is the best option to suppress liver glucose production, ketogenesis, and lipolysis.

Insulin injection is not recommended for type 2 patients.

Insulin injections are not recommended for type 2 patients. However, lifestyle changes and medications can help lower blood sugar levels.

Insulin is a cheaper option than other diabetes medicines and can be taken by patients who are diabetic.

Insulin should be administered at a level between 100 and 250 mg/dL.

A patient with uncontrolled diabetes should have an insulin level of 0.3 units for every kg.

The doctor or nurse will calculate the correct insulin dose for Mr. Brown based on weight, age, diet and body mass.

The insulin can also be injected at the hips or thighs (Pledger and co., 2012).

Patients should not have any moles, scarring or broken blood vessels during an injection.

It is not a good idea to use the same injection site repeatedly.

Insulin, when injected into the abdomen, is quickly absorbed and works fast.

The insulin can be injected using syringes, needles, and pens.

The needle should not exceed 12mm in diameter.

The insulin pump is another innovation in this area that administers insulin to the body (Savage, et al. (2012)).

It’s a type of device that can be worn externally.

It has a tube with a needle that delivers insulin to the body.

It takes a lot of training to perform this task.

Here’s a detailed description of how insulin is administered.

After washing his hands with soap, the patient should hold the syringe and adjust the dose level.

To inhale the air, he should first remove the caps on the insulin vial and needle.

The patient must then turn the needle upside down, and push the plunger to the dose level.

The patient should tap the needle gently to release any bubbles from the syringe.

The insulin vial should be kept down with the syringe, with the finger lifted off the plunger.

You will need to replace the insulin vial with an alcohol pad. A one-to two inch section of skin needs to be pulled off the plunger. Next, insert the needle at a 90 degree angle.

After the needle is inserted, it must be pulled all the way down. This should take about 10 seconds.

The needle is then removed.

A bandage may be used if bleeding occurs.

If bleeding occurs, the nurse can provide tips such as numbing the skin with ice before applying alcohol or not injecting at the root of the hair.

There are several types of insulin that can each be used depending on the purpose or speed of the action.

They come in a variety of forms, including short acting, intermediate and long-acting, as well as pre-mixed.

It is necessary to make some changes in the diet to heal the patient (Hayashino (2012)

Brown should eat small meals, replace high-calorie foods with vegetables and fruits, eat whole grains and pulses, and avoid salt and added sugar (Mohamed 2014).

It is important to exercise as part of the patient’s treatment.

Both aerobic and strength training should be done by the patient.

Aerobic activities include walking, swimming and dancing.

Strength training involves lifting free weights, as well as using weight and resistance machines.

The patient must check his glucose levels before he begins to exercise.

Patient and family-centered care

Communication is an important part of family and patient care.

It is a two-way relationship.

Patients are valued for their decision, while relatives are considered to be advisors on health care practices (Flynn & Preuster (2014)).

Patients’ relatives and family members are invited to give their views on the care of their loved ones.

In an emergency, the family members of the patient can help the nurses.

These caregivers are the ones who work with the doctors and nurses to provide the best possible care for their loved one (Reinhard Levine & Samis (2012)).

They spend lots of time with their patients and are educated on the best techniques to use after they have been discharged.

For caregivers, a pain education program is arranged where they are trained in pain assessment, pharmacologic and other non-pharmacologic treatment (Kim & Rich 2016).

Safe medication management and problem solving skills are taught to caregivers by nurses.

The caregivers learn how to manage the patient’s various behaviour changes.

This methodology was developed by Anthony M.DiGioia (University of Pittsburgh Medical Centre) in 2012.

It is a six-step procedure. The first step is to describe the entire program with its start and end. The second step is to create a council that will lead the process.

The third step is to define the current situation. The fourth step involves expanding the council into a group.

The fifth step is to create a perfect story from the patient’s or family’s point of view. The sixth step is to form teams to bridge any gaps between the actual and ideal situation.

This allows for accountability and ethical value to be maintained since family members are seen to be partners in the patient’s care system (Gillick 2013).


According to the above discussion, nurses should be able to follow certain protocols when treating patients.

Due to Mr. Brown’s obesity and poor diet, he was diagnosed with both type II diabetes and heart disease.

For his treatment, a holistic nurse care is required.

The nurse will create a healthy diet and exercise plan for patients and establish a good relationship with them and their families.

The nursing workforce takes many steps to provide patient-oriented care.

Nursing is both science as well as art.

Nursing is both science and art. Nurses must educate patients about insulin usage and how to monitor blood sugar levels.

Families who serve as caregivers for the patient are included in the care and are given their opinion.

Caregivers are essential to the healthcare system. They need to interact with nurses in order to access information, equipment and services.

This will allow for a good relationship between patients, their families and nurses.


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