Rapid Reasoning: Myocardial Infarction Chief complaint/History of…

Question Answered step-by-step Rapid Reasoning: Myocardial Infarction Chief complaint/History of… Rapid Reasoning: Myocardial InfarctionChief complaint/History of Present Illness:Mr. Miller is a 58 year old man who has no previous history of heart disease, who presents to the ED with chest pain that he describes as an achiness/pressure 5/10 across his mid-chest and radiates to his left arm. He also becomes SOB but not diaphoretic with episodes of pain. Last night the chest pain came on at rest and lasted throughout the night. He decided to come to the ED for evaluation when it was not gone by morning. You are the nurse caring for him and you collect the following assessment data.Past Medical History:? Diabetes II? HTN? Hyperlipidemia? Obesity: 320 lbs-BMI 35? Obstructive Sleep Apnea Your Initial VS:T: 99.2P: 108R: 20BP: 164/86O2 sats: 96% RAYour Initial Nursing Assessment:RESP: breath sounds clear with equal aeration bilat., non-laboredCARDIAC: pink, warm & dry, S1S2, no edema, pulses 3+ in all extremitiesNEURO: alert & oriented x4, though anxiousGI/GU: active BS in all quads, abd. soft/non-tender, voiding without difficulty, frequency of urination, though has no burning/painful urination, urine clear/pale-clear colorMISC: pale, beads of sweat forehead Lab/diagnostic Results:? CXR…clear with no infiltrates. Heart is moderately enlarged? EKG…2 mm ST elevation across leads V1-V4 (anterior leads)? Troponin: 1.6? CK: 588? CK-MB: 85 Physician Orders:? NTG 0.4 mg subl. every 5″ X3…follow with NTG gtt. Titrate to pain relief and SBP >90? ASA 325 mg? Plavix 600 mg? Heparin gtt and bolus per protocol? Metoprolol 5 mg IV every 5″ x3 Hold if HR <50 or SBP <90? Transfer to CV lab ASAP for coronary angiogram Questions1. What is the medical problem that your patient is most likely presenting with?2. What is the underlying cause /pathophysiology of this concern?3. Based on the data you have collected, what is your primary concern right now?4. What interventions will you initiate based on this primary concern? (start with A-B-C priorities)5. What body system will you most thoroughly assess based on the patient's chief complaint and primary/priority concern? (start w/A-B-C body systems)6. What is the worst possible complication to anticipate? (start with A-B-C priorities)7. What nursing assessment(s) will you need to initiate to identify and respond to quickly if this complication develops?8. What VS & assessment data is RELEVANT that must be recognized as clinically significant to the nurse?RELEVANT VS/assessment data: vs. Relationship to primary medical problem:9. What lab/diagnostic results are RELEVANT that must be recognized as clinically significant to the nurse?RELEVANT Diagnostic results: vs. Relationship to primary medical problem:10. What is the relationship between the following physician orders/meds and your patient's primary medical problem?(How will mech. of action of these meds/treatments impact this patient at a pathophys. level to help resolve primary problem?)Physician orders: vs. How it will help resolve primary problem:NTG 0.4 mg subl.ASA 325 mgPlavix 600 mgHeparin gtt and bolus per protocolMetoprolol 5 mg IV every 5" x3 Hold if HR <50 or SBP <90Transfer to CV lab ASAP for coronary angiogram11. What is the patient likely experiencing/feeling right now in this situation?12. What can you do to engage yourself with this patient's experience, and show that they matter to you as a person? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)