- Information
- AI Chat
Case Study 2
Medical Surgical (NUR425)
Arizona College of Nursing
Recommended for you
Preview text
Ana Alvarez Cohort 46 Case Study 2
Case Study Chapter 23 Management of Patients with Coronary Vascular Disorder
A- What first actions should the nurse take after the patient has arrived in the ED? The first action the nurse should take is to asses the patient status and check the vitals including assessing pain, checking the spO2 and then place the patient on supplemental oxygen, as well as continuous cardiac monitoring and perform ECG, ask pertinent questions about the medical history/ allergies. The nurse should start two IVs line for administering any emergency medications that would be needed. Following that the patient should receive morphine to decrease the pain and anxiety of the patient, always monitoring vitals signs, focusing mainly on respirations and blood pressure. Following that the patient should have blood work obtained and processed including complete blood count (CBC), troponin I and T levels, prothombin time (PT), partial thromoplastin time (PTT), creatine kinase MB and internalized normalized ratio (INR). Then the patient should be given nitroglycerin which is a vasodilator and it will decrease blood pressure, we need to monitor vitals while being administered. Nitroglycerin is started sublingually at 0 doses every 5 minutes for up to 3 times or it can be given IV. The nurse should reassess the patient for pain level and the patient should be made NPO in case of an emergency surgery.
B- The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention PCI in less than 60 minutes from the door-to-ballon time. Explain the reasoning for this action based on evidence based guidelines and considering the clinical manifestations and the pathophysiology of the STEMI.
A PCI is a procedure in which a catheter is used to place a stent to narrow blood vessels in the and it is the preferred treatment for a patient experiencing a STEMI. The catcher has a tiny folded balloon on its tip and is threaded though a blood vessel until it reaches the site where plaque buildup is causing a blockage. At that point the balloon is inflated to compress the plaque against the walls of the artery. This widens the passageway restoring blood flow. The balloon is then deflated and removed. The PCI is ordered immediately in order to open an occluded coronary artery in order for perfusion to occur in the area that has been oxygen deprived. During the period of oxygen depravation a number of myocardial cells can die and that is the reason for the importance and emphasis on the less than 60 minute door to balloon time, by opening the artery quickly as much as the myocardium can be saved.
A- Nitroglycerin is a vasodilator and reduces ischemia and anginal pain. Metoprolol is a beta blocker slows down the heart rate and decreases the blood pressure improving the oxygen demand to the heart. Cardizem is a calcium channel blocker by preventing calcium from entering the cells of the heart and arteries allow blood vessels to relax and open, it can slow the heart rate and decrease blood pressure. Ticlopidine inhibits the binding of ADP to platelet receipts and triggers pathways that lead to activation of the glycoprotein llb/lla complex which causes a change in the shape of platelets and their aggregation. Is a blood thiner preventing blood clots from forming.
B- Smoking increases the workload of the heart including blood pressure and pulse and decreases the amount of oxygen that can be delivered to the heart leading to angina. It also causes artery damage and constriction.
C- The patient should take 1 sublingual tablet and let it dissolve under the tongue, if no relief the patient can repeat after 5 minutes taking up to 3 times if the patient still have pain after 3 tablets they should call 911. The medicine should be kept in the original glass bottle at room temperature away from direct light, and it should not be exposed to extreme heat or cold.
D- The nurse is assessing the provocation (what relieves it? What aggravates it?, quality what does it feels like? Sharp, dull, burning, radiation factors where is the pain located? Does the pain radiate? Does it feel like it travels around?, severity how severe is the pain on a scale of 0 to 10? and time when at what time did the pain start? How long does it last? How often does it occurs?
Case Study 2
Course: Medical Surgical (NUR425)
University: Arizona College of Nursing
