MI and Complications The nurse is caring for a 59-year-old man…
Question MI and Complications The nurse is caring for a 59-year-old man… MI and ComplicationsThe nurse is caring for a 59-year-old man presenting to the emergency department with left shoulder and back pain. This case consists of six clinical judgment questions. Read each question carefully and select the best answer(s). Use the chart to help answer the question. The chart is dynamic and may change as the case progresses. Medical/Surgical history: Hypertension for 2 years, treated with medications. Prediabetes for 1 year. Colon polyps removed 3 years ago. Motor vehicle crash at age 17 resulted in multiple bone fractures and extended hospital stay. Social history: Smokes 2-3 packs of cigarettes per week because “smoking helps me relax from my high-stress sales job.” Drinks 2-3 alcoholic beverages a month. Denies illicit drug use. Family history: Mother died of a heart attack at age 53 years. Brother died at age 49 of heart disease. Father alive and healthy.Physical Assessment: Overweight male with a BMI of 37. Alert and oriented. Mild diaphoresis. Lungs clear; S1, S2 heart sounds with an occasional irregular beat. 2+ pedal pulses with 2+ edema of both lower extremities. Medications: Lisinopril 10 mg daily, atorvastatin 40 mg daily, baby aspirin daily. Nurses’ Notes Vital Signs Laboratory Results Nurses Notes2/23/XX0815Patient reports experiencing left shoulder and back pain over the last 2 hours that is unresolved with rest and positioning. States pain is “sharp” and a 7 on a scale of 0 to 10. Patient reports that the pain became worse as he walked from his car to the ED. Respirations labored but regular. Denies nausea, vomiting, or dizziness. Mild diaphoresis. Color pale.0830Vital signs obtained, oxygen applied; 18-gauge IV line placed in RFA. Serum blood drawn and sent to the lab. Preparing for medication administration.0855Lab results returned. Provider notified. 0945Lab and ECG results consistent with acute MI. Patient transferred to cardiac unit with oxygen and portable cardiac monitor. Provider orders reviewed in handoff report with cardiac nurse.0955Administered NTG and morphine for chest pain of 3 out of 10. Vital Signs 2/23/XX0830Temp. 99.6° F (37.5°C)HR 98 beats/min; irregularRR 20 breaths/minSpO2 95% on 2L/nasal cannula Blood pressure 147/92 mm HgPain 7 on 1-10 scale0855HR 108 bpm; irregularRR 20 breaths/minSpO2 95% on 2 L/nasal cannulaBP 132/84 mm HgPain 3 on 0 to 10 scale 0945Temp 99.6° F (37.5°C)HR 100 bpm; irregularRR 18 breaths/minSpO2 95% on 2 L/nasal cannula BP 128/80 mm HgPain 3 on 0 to 10 scale1000HR 68 bpm; regularRR 18 breaths/minSpO2 99% on 2L/nasal cannulaBP 90/65 mm HgPain 0 on 0 to 10 scale Laboratory Results 2/23/XX083012-lead ECG: Sinus tachycardia with ST elevation in leads V2-V4. Occasional PVC.0855WBC 4.6 103/mm3 (4.5-11.1 103/mm3)RBC 3.9 million/mm3 (males: 4.21-5.81 million/mm3; females: 3.61-5.11 million/mm3)Platelets 455,000/mm3 (150,000-450,000/mm3)BUN 25 mg/dL (8-21 mg/dL)Creatinine 1.4 mg/dL (0.5-1.2 mg/dL)Sodium 136 mEq/L (135-145 mEq/L)Potassium 3.3 mEq/L (3.5-5.0 mEq/L)Glucose 124 mg/dL (65-99 mg/dLCK-MB 3 ng/mL (0-3 ng/mL)Troponin 3.2 ng/mL (<0.4 ng/mL)Myoglobin 120 ng/mL (0-85 ng/mL) Question 1 of 6The nurse reviews the patient's history. Which factors increases this patient's risk for coronary artery disease (CAD)? Select all that apply. 1 Hypertension 2 Prediabetes 3 Colon polyps 4 Bone fractures 5 Cigarette smoking 6 2 to 3 drinks per month 7 Job stress 8 Family with heart disease 9 BMI 37 10 Age of 59 years Question 2 of 6 Determine the priority of each of the nurse's actions. For each action select high priority or low priority in each row. High PriorityLow PriorityAdminister oxygen Complete head-to-toe assessment Obtain vital signs Obtain copy of the living will Obtain a 12-lead ECG Draw cardiac enzymes Schedule a cardiac stress test Place an IV line Question 3 of 6 The nurse is documenting priority medication administration of the patient. Complete the sentences. Reports shoulder and back pain of 7 out of 10. Administered 1 aspirin 2 nitroglycerin 3 morphine 4 metoprolol. Pain reassessed and now 6 out of 10. Reassessed 1 platelet count 2 respiratory rate 3 heart rate 4 blood pressure Question 4 of 6Review the patient's labs and diagnostic tests. Select each result that indicates the patient is experiencing an acute myocardial infarction. Select all that apply.12-lead ECG Red blood cell count Platelet count BUN and Creatinine levels Potassium level CK-MB Troponin Myoglobin Question 5 of 6Which medical prescriptions by the provider should the nurse question? Select all that apply. Continuous cardiac monitoring Oxygen to keep saturations less than 95% Nitroglycerin 0.4 mg SL x 3 over 15 minutes for chest pain. Begin titrating nitroglycerin infusion if pain unrelieved. Aspirin 325 mg, chew and swallow, every 6 hours Morphine 4 mg IV PRN for pain unrelieved by nitroglycerin Metoprolol 5 mg IV every 2 minutes as tolerated for 3 doses Begin cardiac rehabilitation tomorrow. Prepare for cardiac catheterization this afternoon Chest x-ray Question 6 of 6The nurse documents the patient's response to the care provided. Select to highlight findings that require additional nursing action. Select all that apply. Pain free after delivery of nitroglycerin and morphine. // Blood pressure 90/65, heart rate 88 bpm, // respirations 18 breaths/min, // SpO2 99% on 2 L/nasal cannula. // Watching television and sipping water, // wife at bedside. // Normal sinus rhythm with an occasional PVC. // Scheduled for cardiac angiogram with PTCA in the next hour. // Consent signed. // Call light within reach, // bed in highest position. // Health Science Science Nursing NRSE 240 Share QuestionEmailCopy link Comments (0)
