This research study expressed a content validity which per Grove & Grey (2019), examines the extent to which a measurement method includes all the major elements relevant to the construct being measured which was the occurrence of dyspnea and nausea and/or vomiting in the prehospital phase of a suspected ACS and the associations with patients’ outcome.The strengths of the research study were that there was documented evidence from current EMS patient records collected during the randomized control study and also patient demographics that was collected from hospital records that included previous medical history, complications that required treatment, final diagnosis, mortality and length of hospitalization. The medical records are vital in assessing whether the occurrence of dyspnea, nausea/vomiting inpatient with ACS resulted in the patient being diagnosed with an AMI and a higher mortality rate. The prehospital run sheets show all documentation of EMS providers which included main
5Running head: ACUTE CORONARY SYNDROMEcomplaint as well as all associated symptoms. Symptoms such as chest pain, dyspnea, nausea and vomiting are all addressed in any standard head-to-toe assessment. In the interventional study the presence of dyspnea, nausea and/or vomiting (yes/no) was assessed by ANs on three occasions: on the arrival of the ambulance team, 15 min later and on arrival in hospital (Andersson et al., 2017). Weaknesses included in any medical research is the unpredictability of any disease process. One can easily go into the hospital free of any complaints of dyspnea, nausea of vomiting and have an AMI. Nursing guidelines for caring for a patient with ACS vary from hospital to hospital based on policies and procedures within that establishment. While chest pain is the most common symptom reported with ACS, nurses must also recognize the atypical symptoms of chest pain, which include epigastric pain, indigestion, stabbing or pleuritic pain, and increasing dyspnea in the absence of chest pain. An atypical presentation is most likely to occur in female patients, older patients (>75 years), and patients with diabetes mellitus, renal insufficiency, and/or dementia (Dziados, 2018). In the prehospital and hospital setting aside from patients verbal complaints, AHA guidelines suggest the 12-lead ECG (electrocardiogram) is pivotal in the decision pathway for the evaluation and management of patients presenting with symptoms suggestive of ACS and recommend an ECG should be performed and interpreted within 10 minutes of arrival to the emergency department/office or arrival or an EMS agency (heart.org).
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