Acute Coronary Syndrome Acute MI Exam 1 2023, Exams of Microbiology

Download Acute Coronary Syndrome Acute MI Exam 1 2023 and more Exams Microbiology in PDF only on Docsity! [Date] Acute Coronary Syndrome/Acute MI History of Present Problem: JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of progressive weakness. She denies chest pain but admits to shortness of breath (SOB) that increases with activity. She also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to the hospital by emergency medical services (EMS). Personal/Social History: JoAnn is a recently retired math teacher who continues to substitute teach part- time. She is physically active and lives independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears anxious and immediately asks repeatedly for her husband upon arrival. What data from the histories are RELEVANT and have clinical significance to the nurse? Patient been having left sided weakness for three days, shortness of breath increases with activity, denies chest pain, she also has epigastric pain with nausea that has been intermittent for 2o-30 minutes over the last three days epigastric pain has gotten worse now radiating into her neck and she also feels anxious and she smokes one pack per day for the past 40 years These signs and symptoms are related to a coronary artery disease and she could be having a heart attack Patient Care Begins: Current VS: P-Q-R-S-T Pain Assessment (5th VS): T: 99.2 F/37.3 C (oral) Provoking/Palliative: Nothing/Nothing P: 128 (regular) Quality: Ache [Date] R: 24 (regular) Region/Radiation: Left arm that radiates into neck BP: 108/58 Severity: 5/10 O2 sat: 99% room air Timing: Intermittent-20-30" at a time What VS data are RELEVANT and must be recognized as clinically significant by the nurse? P-128 irregular Tachycardia R-24 abnormal Current Assessment: GENERAL APPEARANCE : Anxious, appears uncomfortable, body tense RESP: Respirations labored; coarse crackles present in bases bilaterally anterior/posterior CARDIAC: Pale, diaphoretic, no edema, heart sounds regular S1S2 with no abnormal beats, pulses strong, equal with palpat’vgd ion at radial/pedal/post-tibial landmarks NEURO: Alert & oriented to person, place, time, and situation (x4) GI: Abdomen soft/non-tender, bowel sounds audible per auscultation in all 4 quadrants GU: Voiding without difficulty, urine clear/yellow SKIN: Skin integrity intact, skin turgor elastic, no tenting present [Date] What diagnostic results are RELEVANT and must be recognized as clinically significant to the nurse? The ejection fraction of 25% Lab Results: Complete Blood Count (CBC): Current: High/Low/WNL? [Date] WBC (4.5-11.0 mm 3) 10.5 WNL Hgb (12-16 g/dL) 12.9 WNL Platelets(150-450x 103/μl) 225 WNL Neutrophil % (42-72) 70 WNL What lab results are RELEVANT and must be recognized as clinically significant by the nurse? All labs are within normal limits. Basic Metabolic Panel (BMP): Current: High/Low/WNL? Sodium (135-145 mEq/L) 135 WNL Potassium (3.5-5.0 mEq/L) 4.1 WNL Glucose (70-110 mg/dL) 184 HIGH Creatinine (0.6-1.2 mg/dL) 1.5 HIGH Misc. Labs: Magnesium (1.6-2.0 mEq/L) 1.8 WNL What lab results are RELEVANT and must be recognized as clinically significant by the nurse? The patient glucose is high and creatine the patient kidney function is decreasing. Cardiac Labs: Current: High/Low/WNL? Troponin (<0.4 ng/mL) 1.8 HIGH BNP (B-natriuretic Peptide) (<100 ng/L) 1150 HIGH [Date] What lab results are RELEVANT and must be recognized as clinically significant by the nurse? High troponin and a high BNP can indicate a problem with the heart, heart failure or it can indicate the patient already had a heart attack Clinical Reasoning Begins…. 1. What is the primary problem that your patient is most likely presenting with? Heart failure 2. What is the underlying cause/pathophysiology of this primary problem? The underlying cause results from the buildup of fatty deposits in your arteries, which reduce blood flow and lead to heart attack. [Date] 4. What body system(s) will you most thoroughly assess based on the primary/priority concern The lungs listen for signs of congestion and check for abnormal sounds, also examine the veins in patient neck and check for fluid buildup in your abdomen. 5. What is the worst possible/most likely complication to anticipate? Death, risk of bleeding, another heart attack, stroke 7. What nursing assessments will identify this complication EARLY if it develops? dyspnea, shortness of breath, fatigue, and edema. 8. What nursing interventions will you initiate if this complication develops? 9. What psychosocial needs will this patient and/or family likely have that will need to be addressed? Psychosocial needs to meet basic needs includes their emotional and mental well-being [Date] ps 10. How can the nurse address these psychosocial needs? Nurses can provide both care and support with verbal and written advice to patients, by building dialogue with patient’s nurses can begin to understand how patients view themselves as individuals, what is important to them, and how their relationship with others may affect their decisions and their ability to live with those decisions during their treatment and Beyond. Good communication and assessment skills are essential to building a rapport with patients and can help the nurse develop a clinical relationship with the patient and their family. [Date] Caring and The ART of Nursing What is the patient likely experiencing/feeling right now in this situation? The patient can be experiencing pain and is scared What can you do to engage yourself with this patient’s experience and show that she matters to you as a person? I will use the 5c’s of caring (Compassion, Competence, Confidence, Conscience and Commitment), knowledge, skills and experience make caring unique. Use Reflection to THINK Like a Nurse Reflection-IN-action (Tanner, 2006) is the nurse’s ability to accurately interpret the patient’s response to an intervention in the moment as the events are unfolding to make a correct clinical judgment. What did I learn from this scenario? I learn that Metoprolol 5 mg IV push x1 is use to reduce the risk of death from an acute heart attack. How can I use what has been learned from this scenario to improve patient care in the future? I can improve my medication knowledge and get a full understanding of vitals sign and labs