A 52-year-old man presents with complaints of chest pain, rating the pain as a 9 on a 10-point scale. He states that the pain began suddenly about 30 minutes before arriving to the emergency department. He states that he cannot do anything to relieve the pain and describes it as “crushing.” The patient states he visited his doctor 4 days earlier with a complaint of pain in his left leg. He was given a prescription for Motrin, 800 mg orally every 3 to 4 hours as needed, and returned home to rest. He has been taking the Motrin as prescribed.
Question Answered step-by-step A 52-year-old man presents with complaints of chest pain, rating… A 52-year-old man presents with complaints of chest pain, rating the pain as a 9 on a 10-point scale. He states that the pain began suddenly about 30 minutes before arriving to the emergency department. He states that he cannot do anything to relieve the pain and describes it as “crushing.” The patient states he visited his doctor 4 days earlier with a complaint of pain in his left leg. He was given a prescription for Motrin, 800 mg orally every 3 to 4 hours as needed, and returned home to rest. He has been taking the Motrin as prescribed. 1. Based on the presenting information, what do you think is going on with this patient? 2. What are risk factors for coronary artery disease? 3. What other symptoms would you like to ask the patient about? 4. When completing your initial assessment, the patient states, “I feel a little light-headed.” He also states, “I feel short of breath and I have pain in my left shoulder.” He appears to be very anxiouse espresses. What else do you want to know about his past medical history? Medical history reveals the following:He has a 40 pack/year history of smoking.His blood pressure has been “a little elevated,” somewhere in the range of 148/92 mm Hg on his last two visits to his medical practitioner.He admits to eating fast food three to five times per week but is proud that his total cholesterol “hovers” around 242 mg/dL.His father has angina that began at age 53 years but is alive and well. His mother has no known medical history.He exercises regularly and recently noticed a couple of episodes of shortness of breath while jogging but attributed it to “getting old.”He was hospitalized 3 years ago for influenza complicated by pneumonia.He perceives himself as being healthy, takes no routine medications, and has no known drug allergies.5. What medications might someone take who presents with a similar picture? Physical AssessmentPhysical AssessmentRationale Use this column to describe the link between assessment findings and related pathophysiology. Indicate the pertinent positives and pertinent negatives of the condition using the information presented.Vital signs:T 37 °C P 100 with an occasional premature beat RR 24 BP 130/70 O2 saturation on room air 96% Height, weight, and waist circumference:5′11″, 220 lb, 40″ waist General appearance:Alert, moderately anxious, appears to be in moderate distress Skin Eyes:PERRLA Ears and hearing:Denies hearing loss or drainage Nose and sinuses:Clear without tenderness Mouth:Teeth in good condition Neck:Supple without thyromegaly, no bruits,< 2 cm jugular vein distention Lymph nodes Thorax and lungs:Tachypneic, with mild use of accessory muscles of respiration No tenderness upon palpation of the chest wall Slight inspiratory crackles (rales) heard at both bases No rubs Heart:Tachycardia with occasional premature beat Apical pulse at 5th intercostal space lateral to midclavicular line Soft S3, no S4, no murmurs No rubs Peripheral circulation:Extremities with full symmetric pulses, mild edema LLE Abdomen:Abdomen with bowel sounds throughout, no tenderness Musculoskeletal Neurologic:Alert and oriented, neurologic examination intact to cognition, strength, sensation, gait, and deep tendon reflexes 6. What is the main priority for this patient?AdmissionThe patient is admitted with the following orders:ECG statCT pulmonary angiogram (CTPA) to rule out pulmonary embolismLeft lower extremity ultrasoundChest xrayEchocardiogram to look for wall motion abnormalities and ejection fractionOxygen 2 L via nasal cannula IVF with NS at rate of 10 mL/hrASA 325 mg orally nowClopidogrel 75 mg oral dailyMorphine sulfate 2 mg IV every 10 minutes as needed for pain Furosemide 40 mg IVNitroglycerin 0.3 mg sublingual every 5 minutes × 3Complete metabolic panel (CMP)Complete blood count (CBC) Prothrombin time/international normalized ratio (PT/INR) to determine clotting timesTroponinCreatine kinase myoglobin (CK-MB)Brain natriuretic peptide (BNP)7. Develop three nursing diagnoses related to the pathophysiology of this patient, as informed by the findings of your assessment and the preceding lab values. In other words, link the pathophysiology to what you anticipate will happen with the patient. Use the following table to guide the process.Alteration in Condition (Pathophysiology) Critical Thinking and Clinical Decision MakingApply your knowledge of pathophysiology to the clinical decisions you will make as you plan for client care. Using critical thinking to guide the process, link the pathophysiology to the clinical plan of care. Consider, "What do I anticipate will happen with this patient?" Health Science Science Nursing NURS 440 Share QuestionEmailCopy link Comments (0)