cardiac

​SCENARIO

​

A 59 year old female is admitted at midnight with a diagnosis of Chest Pain.

She complains of a squeezing type pain across her chest and into her left jaw area.

Vital signs are: Blood Pressure-200/110; Pulse-128 beats per minute; Respirations- 26 per minute; Temperature-37.6; Saturation of Oxygen-86% on room air; pain level 9/10.

​

During your initial assessment she is rubbing her mid-chest, grimacing and is diaphoretic. The pain has been occurring intermittently throughout the evening and night. Her colour is pale except around her lips which are bluish. Cardiac auscultation reveals a rapid regular rhythm

​

​She has never had this pain before. Lungs sounds are crackles in both bases with clear upper lobes. She is afraid she is going to die. Per standing orders, a nurse administers & administers Nitroglycerin 0.4mg sublingually; applies cardiac electrodes for an ECG

Positions patient in low fowlers.

The patient’s current medication includes Warfarin PO daily for a past history of DVT

​

Poll

Is the type of pain this patient is having typical of cardiac type of chest pain.

• YES

• NO

Open Ended

What will the nitroglycerin do for this patient?

Open Ended

What side effects will the nurse have to assess for and manage with the ntroglycerin?

Open Ended

What other types of pain would indicate a cardiac type problem but would not be specifically in the chest area?

Multiple Choice

What “abnormals” are present in the patient's vital signs (first set)?

• TACHYCARDIA,

  HYPERTENSION,

  HIGH TEMPERATURE

• LOW O2 SATS, BRADYCARDIA,

  HYPERTENSION, HIGH RR

• LOW O2 SATS, TACHYCARDIA,

  HYPERTENSION, HIGH RR

• HIGH PAIN SCORE, BRADYCARDIA,

  HYPERTENSION, HIGH RR

Open Ended

What health information would the nurse need to acquire after the patient's pain is relieved?

Open Ended

A Dr orders Aspirin 300mg tabs orally. What is the rationale for this order?

​Pt was diagnosed as having an AMI. She was admitted to the ward and a week later she is still in your care.

On assessment vital signs are Blood Pressure-180/95; Pulse-108 beats per minute; Respirations- 22 per minute; Temperature-37; Saturation of Oxygen-90% on 2 litres per minute; Pain level 8/10. She says her some chest pain remains. Heart and lung sounds are unchanged with crackles in both bases and clear upper lobes. Colour is pale without previous blue changes.

​

The doctor prescribes Frusemide 80mg IV stat, and propranolol 40mg PO bd

​

Poll

Does this patient need a change to their oxygen?

• Yes

• No

Open Ended

Why has Frusemide been prescribed? What condition is it for and what is the relationship to her original presentation?

Open Ended

Explain the action of Propranolol. Why may this medication be contraindicated in a client with heart diseases

Open Ended

The doctor changes the beta blocker order to an ACE inhibitor, Lisinopril 10mg PO daily. Discuss the actions of an ACE inhibitor.

Open Ended

Heparin 5000 units subcut bd is commenced.

Which of the patients current medications should be ceased when heparin is commenced and why?

Open Ended

Use the data in the case study to write 2 nursing diagnosis (include problem, goal and two appropriate interventions)