Integrated Acute Care of the Adult

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The case study is of a 60-year-old woman named Fatima Begum, who presented to the hospital with the central chest pain radiating to the left arm, shortness of breath, and dizziness. Nausea and sudden fatigue also accompany her presentation. Apart from hypertension, her medical history is without significant comorbidities, pointing to the development of a myocardial infarction. The?????????? paper includes a thorough critical appraisal of the first nursing assessment and the following decision-making of a patient with a situation of acute cardiac symptoms in the emergency department. The paper describes using the AE framework as a well-organized method for a detailed clinical assessment which lead to the very early recognition of the patient's condition getting worse and also the initiation of the treatment.??????? ????

Pathophysiology of Myocardial Infarction

Myocardial?????????? infarction (MI) is the condition that follows a sudden failure of blood supply in the vessels around the heart. This usually happens after a ruptured atherosclerotic plaque and the thrombus formation (Zhu et al. 2025). Since the heart tissue is deprived of oxygen and nutrients, leading to anaerobic metabolism, lactic acid accumulation, and less contractility (Li et al. 2023). This further leads to a prolonged obstruction that is irreversible depending on the extent of the blockage and the collateral circulation (Mangiardi et al. 2023).

Fatima Begum has a central, pressure-like chest pain radiating to the left arm, shortness of breath, nausea, and dizziness, which are compatible with ST-elevation MI (Mountfort and Akbar 2024). The dizziness can be due to the low cardiac output, while the nausea or vomiting can be caused by vagal stimulation or inferior wall involvement (Mizrachi and Sitammagari 2023). The?????????? sympathetic activation causes tachycardia, pallor, and increased myocardial oxygen demand, which, therefore, can extend the injury (Capilupi et al. 2020; Heusch 2024). Continued chest pain is a manifestation of persistent tissue ischemia that must be solved immediately (Harjola et al. 2020). Using the A-E framework, nurses can keep the vital signs under close observation, be able to recognize early deterioration, and thus, request immediate referral and cardiac monitoring for the reperfusion therapy (Schoeber et al. ????????????????????2022).

A-E Evaluation and Primary Preliminary Evaluation

The?????????? A-E check is a staged scenery to depict the hierarchy of human organs capable of being in danger from the given immediate situation and to find a suitable measure in order to eliminate or reduce the risk. To Fatima Begum, a woman of 60 years old who came in with a heavy and sharp pain in her chest with radiation of the pain spreading to her left arm, difficulty in breathing, feeling sick to the stomach, dizziness, and an ECG-confirmed STEMI, the approach system of this kind is her nurse-saving guide.

Airway: The first step is to do the airway check-up as this helps to see whether the airway is open or not (Mouri and Maani 2020). However, if the heart attack is a source, it rarely affects the airway; still, the pain, feeling sick, or even reduced consciousness can be a threat for the airway. Fatima is quite aware of the situation and despite the discomfort, she speaks very well showing that the airway is not hindered. The state of her cardiovascular system should be always kept under review because it could get worse and thus, the protection of the airway could also be in danger.

Breathing: Investigating breathing is very important as cardiovascular disease leads to respiratory dysfunction. Shortness of breath may be one of the first signs of congestive pulmonary due to left ventricular failure. One can evaluate lung function by watching the respiratory rate, depth and effort, and listening for crackles in lung bases (Nicolo et al. 2020). Fatima's SpO2 is 95% in atmospheric air, thus she must be put under close observation as the oxygen drops could bring about an increase in cardiac work and exacerbate the ischemia. She should be given oxygen if the saturation falls below the level set as standard (Herbst et al. 2023).

Circulation: ST-segment elevation in the electrocardiogram (ECG) is suspected to use the A method in circulation. An elevated heart rate (124 bpm) can be a mode of compensation for the lowered cardiac output, and at the same time, borderline hypotension (110/60 mmHg) could be a sign of initial cardiogenic shock (Huber et al. 2019; Tehrani et al. 2020). The perfect assessment includes quick inspection and palpation to observe capillary refill and color; in addition, the temperature of the skin, and electrocardiogram should not be omitted. Confirming the chest pain stays is one of the signs of the ongoing ischemia and, therefore, a needle of the emergency and medical intervention must be fired instantly, e.g., applications of reperfusion therapy (Ojha and Dhamoon 2023).

Disability: Information about the brain functions and neurological illnesses med by the fifth point in A-E acronym (Issimdar et al. 2025). One possible explanation of Fatimas dizziness could be brief cerebral hypoperfusion. In addition, another indicator for neurological assessment is AVPU, which, in Fatimas case, determines her alertness status, besides which pain-related anxiety or agitation may impact her focus (Choi et al. 2023; Martins and Augusto 2024). The eyes are normal and reactive, while the sugar in the blood is 6.4 millimol/L, thus hypoglycemia is ruled out (Zhang et al. 2023).

Exposure: The being of the pale face as well as the sticky sweat on Fatimas skin might be attributed to the activation of the sympathetic nervous system during STEMI (Slavich et al. 2021). The reason for the temperature of 36.2 degrees Celsius might be the lack of a fever condition (Cramer et al. 2022). Looking for peripheral edema or any kind of trauma is imperative, at the same time, it would be really nice if her distress and pain could be relieved and still give her the dignity and calmness she deserves (Bruinink et al. 2024; Abassi et al. 2022).

Fatima can rest assured that the A-E tool will help the nurses quickly recognize any worsening of the situation, will be a guide to monitoring vital signs, oxygenation, neurologic status, and changes in the ECG, and will support escalation to reperfusion therapy. Signs like Fatima's ongoing chest pain, tachycardia, borderline hypotension, SpO2 of 95%, vomiting, and diaphoresis are contributing factors to nurses' intervention and thus they are capable of providing holistic, patient-centered, and safe ??????????care.

Priority of Clinical Needs

Following?????????? the structured A-E assessment, the nurse identifies Fatima's acute needs and thus, decides on the most immediate actions, among which are: the relief of the severe chest pain, the optimisation of oxygenation, and the rapid escalation of the case. Chest pain is a sign of ongoing myocardial ischaemia, therefore, preparation for the interventions such as analgesia, antiplatelet therapy, or nitrate administration after medical examination, is guided by the information (Ojha and Dhamoon 2023). It is very important to constantly check vital signs, oxygen saturation, and cardiac rhythm, because any changes in these parameters may signal the occurrence of dysrhythmias, circulatory collapse, or cardiac arrest (Okolo et al. 2025). Continuous monitoring together with controlling the use of supplemental oxygen help in the oxygenation process (Weekley and Bland 2025). Furthermore, the nurse is also monitoring Fatima's condition which includes her SpO? of 95% and ECG-confirmed STEMI, and based on that she is adapting all the interventions ??????????accordingly.

Escalation and Communication With SBAR

Communicating?????????? effectively is a must during a crisis if a nurse needs to be able to escalate the care. SBAR?????????? (Situation, Background, Assessment, Recommendation) is a systematic instrument that aids in the storage of clinical information and hence, it is implemented for prompt decisions that are usually of a high accuracy level and entail the correct option (Shrivastava et al. 2025). In the case of Fatima Begum, the Situation indicates her severely acute chest pain of a crushing nature that was going to the left arm, shortness of breath, vomiting, and ??????????fainting. The Background gives information about her age (60), hypertension, and no other medical history. The Assessment gives the A-E examination findings with the example of tachycardia (124 bpm), borderline hypotension (110/60 mmHg), SpO? 95%, and STEMI confirmed by the ECG. The Recommendation expresses the urgency of the situation requiring immediate physician review, cardiac monitoring, and probably transfer for reperfusion therapy (Fernndez et al. ??????????2022).

Acculturation of Clinical Judgement in Early Identification of Chest Pain

A mixture of patient examination, awareness of risk factors and pathophysiology make up clinical judgement. The ability to identify the evidence of myocardial infarction, both subtle and overt, is one of the abilities that any nurse should have when working in emergency departments (Sachdeva et al. 2023). Symptoms like chest pain, nausea, dyspnea and dizziness can be presented in a variety of conditions and, therefore, it is important to read them in the larger context of the description of the patient. The organization AE testing helps nurses to prioritize life-threatening complications without neglecting the rising complications (Lee et al. 2025).

The symptoms of Fatima represent the high-risk cardiac event, which needs to be recognized urgently. The skills in recognizing such patterns make sure that relevant measures are taken at an appropriate time. Nurses?????????? must be taught to understand the various diagnostic measures like ECGs and vitals and how they relate to the pathology. Although nurses might not interpret the same way ECGs as highly skilled doctors, it is still very important to be able to recognize that any significant changes or patterns that indicate the body is getting ??????????worse (Jalal and Salih 2024).

Decision-Making?????????? and Clinical Reasoning

Decision-making in an emergency situation is very judicative work and it has to be done at the same time a lot of data are collected and analysed. In the case of Fatima, it was her symptoms that were so extreme that she required an urgent intervention, and therefore it was a situation of emergency. Clinical reasoning in this case means that only oxygen saturation and respiratory effort should be considered as the evidence when deciding on oxygen therapy (Abdulmohdi and Mcvicar, 2022). In?????????? addition, upon the care environment assessment, nurses must ensure the quick transfer of the patient to a specialist centre for reperfusion therapy, thereby showing their accountability and efficient prioritization skills (Cimmino et al., 2022; Cunha et al., ??????????2025).

Scope of practice for student nurses

The immediate intervention for a patient experiencing an acute chest pain is a teamwork strategy comprising nurses, student nurses, healthcare assistants, physicians, and paramedics (Samardzic et al. 2020). Student nurses have a capacity of carrying out their professional scope by performing assessments, participating in clinical observations, recording clinical findings, delivering the delegated interventions, and communicating effectively with the senior staff (Ominyi and Alabi, 2025). Recognition?????????? of limits, asking for help when necessary and the provision of culturally sensitive, patient-centred care are the three main aspects that nursing students should always keep in mind. They should also make sure that care is given with privacy, use of unambiguous communication and professional accountability while at the same time safety is upheld in their ??????????role.

Conclusion

The first and quick intervention is critical in handling the patient who presents with chest pain that is indicative of myocardial infarction. An efficient A-E test allows nurses to state instant dangers to life, rank the interventions and escalate as needed. In the situation with Fatima Begum, the cardiac symptoms that were the severe chest pain and the radiation into the left arm and breathlessness and related symptoms indicated a possible time-sensitive cardiac event that needed acute intervention. The knowledge of the underlying pathophysiology is concerned with clinical reasoning and assist a nurse in predicting complications. SBAR communication has the potential to improve the clarity of the process of escalation and provide prompt decision-making by senior clinicians. In the process, safety and clinical effectiveness should be ensured although compassionate care, dignity and cultural sensitivity should be upheld. Nurses also have a key role to play in enhancing patient outcomes in people with suspected myocardial infarction by incorporating systematic examination, clinical judgment, and collaboration.

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Appendix: SBAR Communication on Escalation of Care that was completed.

S Situation
I received a call at the Urgent Treatment Centre with respect to a 60-year old patient, Fatima Begum, who has been presenting with central chest pain with an extension into her left arm. She reports having breathlessness, nausea and vertigo. She has been experiencing all these symptoms since morning.

B Background
Fatima has hypertension history with no other known medical problem. She is independent and is not a smoker. The pain in the chest had started at around 9 to 10 am, and she denotes that the pain is heavy and crushing. She complains that she is becoming out of breath and more exhausted.

A Assessment
Airways are patent. Gasping when straining herself. The look of her skin is pale and clammy. She still complains of severe pain in the central chest. The ECG results and observations are in keeping with possible cardiac event. She is seen to be anxious and uneasy with the dizziness indicating less perfusion.

R Recommendation
I require an acute physician checkup. She needs more examination, heart watch, blood work and transfer to a suitable treatment center where cardiac treatment is specialized. I suggest an urgent visit by the emergency team to establish further treatment and examine the ECG results and decide whether reperfusion therapy or transfer to the cardiac department is necessary.