NVQ evidence

Gerry was a 45 year-old gentleman who had been admitted with chest pain. He called me over and said that he had some chest pain. I immediately called my assessor who asked me to place a non-rebreath Oxygen mask with 10 litres per minute blowing throught it. I checked the mask prior to application so see that the valve was working properly. I asked Gerry if he did not mind if I put the mask on. I explained that it was important as he had chest pain and this was very helpful. He agreed. My assessor gave him some GTN spray which had been prescribed previously. My Assessor asked me to perform electrocardiogram.

I had already introduced myself to Gerry at the start of the shift. I asked him if he did not mind me undertaking an ECG. I explained the procedure to him. He consented as he had had several in the past as he had a previous cardiac history.

I carry out the following procedure, explaining each step before I carried it out:- I drew the curtains around the bed for privacy and dignity maintenance.
I asked Gerry to lie down and making him comfortable. My manner was calm as to put him at ease. He was wearing a gown and so when I lifted it up, I ensured that I maintained his dignity with the use of the sheets. I placed the ECG stickers in the following places:-

Chest leads
Lead One-4th intercostal space right of centre of midline.
Lead two-4th intercostal space left of centre of midline fit.
Lead three-I left this lead until I had placed lead four. This was placed directly in the middle of leads two and four.
Lead four-5th intercostal space, mid-clavicle
Lead five-5th intercostal space, anterior axilla.
Lead six-5th intercostal space, mid-axilla

Limb leads
Arms:-I asked Gerry to place his arms relaxed by side, it and placed the stickers on the palm side of his wrists. Each sticker was at exactly the same place on the arm as the other.
Legs:-the I placed the stickers on top of his legs at the same parent on each leg. I placed listed where there was little subcutaneous fat has to aid conduction.

I checked the ECG machine:-
I switched it on to see if it is working properly I checked the paper supply to see if it was not going to run out.
I checked that the leads were not broken and I attach the leads to the appropriate sticker explaining what I was doing to Gerry.
I ensured that the filter was switched on.
I asked Gerry to lie very still while I took the reading

When the reading was produced, I checked to see that:-
were no life threatening rhythms ,
was no wonder in the tracing,
was no interference in the tracing.

I asks Gerry if he was in pain at all or if he had any discomfort. He said that he had central chest pain that was:-
5/10 (I asked him to give this score suggesting that 0 was absolutely not pain and 10 was the worst pain ever.
A crushing pain
Not increase on inspiration.

I placed a sticker on the ECG tracing for Gerry, having checked it against his name and date of birth. I also wrote on the tracing that Gerry’s pain was as described above at time of the ECG as well as the filter being selected. I then told Gerry that it was my role to show the ECG to the doctor. I told him also that I was not able to interpret his ECG at this level. It had took the ECG, with Gerry's notes, to show the doctor. The doctor looked at the ECG and said that were there some acute changes on it. He recorded this on the ECG and signed it. He requested that Gerry was monitored. I took a cardiac monitor when I returned Gerry. I turned off the ECG machine, removed the leads, removed the stickers. I placed the leads of the cardiac monitor on his shoulder joints and one on his abdomen on the left hand side at the base of the ribcage. I then attached the monitor leads as follows:-

Red lead - right shoulder
Yellow lead - left shoulder
Green lead - abdomen

I ensured that the hospital gown was back in place and made sure that Gerry was comfortable. I left Gerry comfortable and as happy as he could be. He had a the call bell to hand and knew how to use it. I reiterated that it was very important that he should inform us if the pain increased or moved it position. I recorded that I had taken an ECG in Gerry's care plan. I made sure that the ECG machine was put away properly in that the leads were not untidy and mixed up. I made sure that there were stickers for the next person to use it. I pluged in the machine and saw that it was charging.

Gerry
Reflections
Feelings.
Jerry was quite anxious because he was in pain. Again i remained very calm despite Gerry's anxiety. J it reported that it got chest pain so it was quintessential that the EC G and a he was undertaken as fast and as effectively as possible. Oxygen masks can be quite claustrophobic so it was very important for me to remain calm when I put it on him. He did not report to me that this was making him feel claustrophobic. I feel that the continued it explanation was helpful to him because it what gave him something to focus upon other and his pain.


Evaluation
When the individual says that they had chest pain, it is very important that a registered practitioner is informed immediately. As a care assistant, I am not allowed to prescribe oxygen. It must be a registered practitioner who says if a client can have oxygen or not. If an individual has chronic obstructive pulmonary disease, and other respiratory problems, extra oxygen can cause problems as in the former especially, a good brain requires a a level of carbon dioxide to continue the breeding process. Super saturating the blood with oxygen can be very very dangerous.

Analysis
I ensured that the situation was dealt with quickly and effectively as best I could within the remit of my role. It was important that I carried out the procedure with confidence as Gerry would have become more stressed and his pain could have increased if I had fumbled is about.

Conclusion

I feel that this situation was carried out in a manner that was satisfactory. Gerry was left comfortable and his position was monitored so he did not come to any further harm.