The Impact Of Gender Differences For Patients - Nursing Assignment Help

Assignment Task

Title:The impact of gender differences for patients presenting to the Emergency Department with suspected or confirmed acute coronary syndrome:A critical review 
Background
Patients with symptoms suspicious of acute coronary syndrome (ACS) presenting to the Emergency Department (ED) in Australia each year represent a burden of nearly 650,000 visits (Australian Institute of Health and Welfare, 2015). Acute coronary syndrome is a potentially life-threatening condition encompassing all diagnosis relating to reduced venous blood flow to the myocardium (American Heart Association, 2015). Timely recognition of ACS is vital to positive outcomes for patients found to be suffering an acute coronary syndrome, especially those with the time critical ST-elevation myocardial infarction (STEMI) and those with non-ST-elevation myocardial infarction (NSTEMI). The National Heart Foundation Guidelines for the Treatment of ACS (2016) recommend any patient presenting to the ED with symptoms suspicious of ACS have an electrocardiogram (ECG) interpreted within 10 minutes of presentation (Chew et al, 2016). Unfortunately, some of those symptoms can be more difficult to detect than a complaint of chest pain (Allabban et al, 2017; Ruane et al, 2017; Kuhn et al, 2017; Rosenfield et al, 2015; van der Meer et al, 2015; Gimenez et al, 2014; Pour et al, 2014; Rezaee et al, 2013; Khan et al, 2013; O’Donnell et al, 2012).
Women are more likely than men to havevarying presenting symptoms including back pain, nausea and vomiting and also more likely to be suffering ACS despite reporting no chest pain (Canto et al, 2007). This can make appropriate triage allocation a difficult task when women and men present to the ED with atypical symptoms of ACS (Kuhn et al, 2014). Allocating an insufficient lower triage score can reduce the time to treatment (Kuhn et al, 2014) and in turn reduce the time to definitive invasive treatment such as primary percutaneous intervention (PPCI) to restore blood flow to the myocardium (Kuhn et al, 2014). This is especially important as women tend to be older and have worse outcomes from acute coronary syndromes (Davis et al, 2017). The findings of this critical review may assist in promoting adherence to the Acute Coronary Syndrome Guidelines (2016), which state patients with symptoms suspicious of ACS should have an ECG reviewed by an expert clinician within ten minutes (Chew et al, 2016). Examination of a timely ECG could therefore assist in reducing the time to diagnosis and definitive treatment, improving patient outcomes.

Triage Decisions and Time to Treatment
The National Heart Foundation of Australia and New Zealand Guidelines for Treatment of Acute Coronary Syndrome (2016) recommend a patient presenting with symptoms suspicious of ACS have an ECG interpreted by an expert clinician within 10 minutes (Chew et al, 2016). To enable this, Australian ED triage nurses often allocate an Australasian Triage Scale (ATS) 2, meaning a patient should receive medical treatment within 10 minutes (Department of Health and Ageing, 2009). The Australasian Triage Scale is a five-point scale with incrementing time guidelines to medical treatment. An ATS 1 requires immediate treatment, ATS 3 requires medical treatment within 30 minutes, ATS 4 requires medical treatment within 60 minutes and ATS 5 requires medical treatment within 120 minutes (Department of Health and Ageing, 2009).
Kuhn et al (2017) produced an exceptional quality study which found that when compared to men, women were less often assigned the recommended ATS category 2 (71.5% vs 58.3%; P=0.026). Ryan et al (2016), had similar findings in their high quality study and found that women in their study were allocated ATS 3-5 more often than men (63.0% vs 32.0%). Further Kuhn et al (2014), in their exceptional quality studyalso found that more men with ischaemic heart disease were triaged correctly when compared to women (61.0% vs 51.4%; P<0.001). However, Saunders et al (2016) in their high quality study found that age and gender were not predictive values in terms of triage scoring accuracy, although they did not specify the data.
Time to treatment was also longer for women. Three studies found that compared to men, women waited longer for their initial ECG (Kuhn et al, 2017; Choi et al, 2016 & Pelletier et al, 2014). Kuhn et al (2017) report on average both genders did not meet the local guideline recommendation of ECG within 10 minutes with men receiving their ECG 3.5 minutes before women (15.0 mins vs 18.5 mins) (Chew et al, 2016). Choi et al (2016) in their intermediate qualitystudy found that, although by Australian and Unites States standards, both genders received ECGs within the recommended time by the guidelines (Chew et al, 2016;Amsterdam et al, 2014).On average, women still waited 3.6 minutes longer than men (4.0 mins vs 7.6mins) (Choi et al, 2016). This delay is ECG times is also reported in Pelletier et al (2014), who describe their high quality observational study thatwomen waited an average of 6 minutes longer than men for their initial ECG (21.0 mins vs 15.0 mins).

Difference in Presenting Symptoms of Women compared to Men 
Acute coronary syndrome can present with varying symptoms (Davis et al, 2017; American Heart Association, 2016; Canto, 2012). These symptoms include chest pain or discomfort, chest tightness or pressure, pain or discomfort in one or both arms, jaw, neck, back or stomach, shortness of breath, dizziness, light-headedness or syncope, nausea and diaphoresis (American Heart Association, 2016). A summary of these findings can be seen in (Table 3).
Women presenting with ACS have been reported as having more varied symptoms and a higher incidence of reporting no chest pain than men, although they report suffering other symptoms of ACS (Canto et al, 2007; Canto et al, 2012). This finding is supported by Khan et al (2013) in theirhigh-quality paper reporting when compared to men, women were more likely to present without chest pain (13.7% vs 19.0%; P=0.03). Further, women without chest pain had a greater number of presenting symptoms than men (Khan et al, 2013).
Of the ten studies including analysis of symptoms based on gender, back pain and nausea and/or vomiting were the only two symptoms with persistently higher percentages reported by women than men (Allabban et al, 2017; Ruane et al, 2017; Rosenfeld et al, 2015; Gimenez et al, 2014; Pour et al, 2014, Khan et al, 2013& O’Donnell et al, 2012). Further, diaphoresis was the only associated symptom consistently reported more often in men than women (Allabban et al, 2017; Ruane et al, 2017; Rosenfeld et al, 2015; van der Meer et al, 2015; Pour et al, 2014 and Khan et al, 2013). The remaining common presenting symptoms for ACS were reported with conflicting results for higher percentage of men and women in each symptom such as palpitations, shortness of breath, dizziness, light-headedness, syncope, throat pain, neck pain, jaw pain, shoulder or arm pain, epigastric pain, indigestion and fatigue (Allabban et al, 2017; Ruane et al, 2017; Kuhn et al, 2017; Rosenfield et al, 2015; van der Meer et al, 2015; Gimenez et al, 2014; Pour et al, 2014; Rezaee et al, 2013; Khan et al, 2013; O’Donnell et al, 2012). These results can be viewed on (Table 3).

Invasive Procedures and Time to Treatment of Women compared to Men
Women also waited longer for revascularisation treatment. In the five studies included with gender related data, revascularisation initiation was described as Time to STEMI Activation, IV thrombolytic drug administration, known as Door to Needle, coronary artery stent insertion in the catheter laboratory known as, Door to Balloon or primary percutaneous intervention (PPCI)(Chew et al, 2016). Choi et al (2016) report women waiting seven minutes longer than men for STEMI activation (25.5 mins vs 18.5 mins). Pelletier et al (2015) report women waiting eight minutes longer than men for thrombolysis (36.0 min vs 28.0 min) and 13 minutes longer for coronary stenting (106.0 min vs 93.0 min).Door to Balloon time is also reported as longer by Rezaee et al (2013) in their high-quality paper reporting Door to Balloon time as 16.5 minutes longer for women when compared to men (92.5 mins vs 76.0 mins). A longer time for Door to Balloon is also supported by Greenberg et al (2012), in their sub-optimal study they found women waited an average of two minutes longer than men with Door to Balloon time (81.0 mins vs 79.0 mins). Finally, Lambert et al (2014) report a 13-minute discrepancy in transferring women to a PPCI centre when compared to men (61.0mins vs 49.0mins) in their high-qualitystudy.
 

This Nursing Assignment has been solved by our Nursing Experts at My Uni Paper. Our Assignment Writing Experts are efficient to provide a fresh solution to this question. We are serving more than 10000+ Students in Australia, UK & US by helping them to score HD in their academics. Our Experts are well trained to follow all marking rubrics & referencing style.

Be it a used or new solution, the quality of the work submitted by our assignment experts remains unhampered. You may continue to expect the same or even better quality with the used and new assignment solution files respectively. There’s one thing to be noticed that you could choose one between the two and acquire an HD either way. You could choose a new assignment solution file to get yourself an exclusive, plagiarism (with free Turnitin file), expert quality assignment or order an old solution file that was considered worthy of the highest distinction.