Acute Coronary Syndrome and Acute Myocardial Infarction: Case Study and Nursing Care, Exams of Nursing

Download Acute Coronary Syndrome and Acute Myocardial Infarction: Case Study and Nursing Care and more Exams Nursing in PDF only on Docsity! Jane | [School] AcuteCoronarySyndrome (ACS) My ocardialInfarction(MI): Latest Update 2024 Best Accurate AcuteCoronarySyndrome/AcuteMI History ofPresentProblem: JoAnnSmithisa68-year- oldwomanwhopresentstotheemergencydepartment(ED)afterhavingthreeday sof progressiveweakness.Shedenieschestpainbutadmitstoshortnessofbreath (SOB)thatincreaseswithactivity.Shealso hasepigastricpainwithnauseathathasbeenintermittentfor20- 30minutesoverthelastthreedays.Shereportsthather epigastricpainhasgottenworseandisnowradiatingintoherneck.Herhusbandcalle d9-1-1andshewastransportedto thehospitalbyemergencymedicalservices(EMS). Personal/SocialHistory: JoAnn is a recently retired math teacher who continues to substitute teach part-time.Sheisphysicallyactiveandlives independentlywithherspouseinherownhome.Shehassmoked1packperdaythe past40years.JoAnnappearsanxious andimmediatelyasksrepeatedlyforherhusbanduponarrival. WhatdatafromthehistoriesareRELEVANTandhaveclinicalsignifi cancetothenurse? Patientbeenhavingleftsidedweaknessforthreedays,shortnesso fbreathincreaseswithactivity,denieschestpain,shealsohasepig astricpain with nausea that has been intermittent for 2o-30 minutes over thelastthreedaysepigastricpainhasgottenworsenowradiatingi ntoherneckandshealsofeelsanxiousandshesmokesonepackper dayforthepast40years Thesesignsandsymptomsarerelatedtoacoronaryarterydisea seandshecouldbehavingaheartattack PatientCareBegins: CurrentVS: P-Q-R-S- TPainAssessment(5thVS): T:99.2F/37.3C(oral) Provoking/Palliative:Nothing/Nothing P: 128(regular) Quality:Ache Jane | [School] R:24(regular) Region/Radiation:Leftarmthatradiatesintoneck BP:108/58Severity:5/10 O2sat:99%roomair Timing:Intermittent-20-30"atatime WhatVSdataareRELEVANTandmustberecognizedasclini callysignificantbythenurse? P- 128irregularTachycardiaR- 24abnormal CurrentAssessment: GENERALAP PEARANCE: Anxious,appearsuncomfortable,bodytense RESP:Respirationslabored;coarsecracklespresentinbasesbilaterallya nterior/posterior CARDIAC:Pale,diaphoretic,noedema,heartsoundsregularS1S2withnoabnormal beats,pulses strong,equalwith palpat’vgd ionatradial/pedal/post-tibiallandmarks NEURO:Alert&orientedtoperson,place,time,andsituation(x4) GI:Abdomen soft/non-tender, bowelsoundsaudible perauscultation in all4quadrants GU:Voidingwithoutdifficulty,urineclear/yellow SKIN: Skin integrity intact,skin turgor elastic,notenting present WhatassessmentdataisRELEVANTandmustberecognizedasclinic allysignificantbythenurse? Anxious,appearsuncomfortable,bodytense,respirationscoarsec racklespresentinbasesbilaterallyanterior/posterior 12LeadEKG: Jane | [School] Thepathophysiologyheartmaynotprovidetissueswithadequatebloodformetab olicneeds,andcardiac- relatedelevationofpulmonaryorsystemicvenouspressures mayresultinorgancongestion.Thisconditioncanresultfromabnormalitiesofsyst olicordiastolicfunctionor,commonly,both. CollaborativeCare:MedicalManagement CareProviderOrders: Ration]ale:ExpectedOutcome: Establish2largebore morebloodlossnecessitatesagreaterPatientswithtwoIVlinesreceive danaverageof350mLmorefluid abilitytodelivervolumethanoneIV.c anaccomplish. peripheralIVs Metoprolol5mgIVpushx1 to reduce the risk of death from an acute heartattack. Reducetheriskofdeath Itisgiventopeoplewhohavealreadyhadaheart attack.No w NitroglycerinIVdrip-start at10mcgandtitratetokeep to control congestive heart failure in patients whohavehadaheartattack. lessenthedamagebythinningthebloodandbreakingupclots SBP>100 Clopidogrel600mgpox1 Itmakesyourbloodflowthroughyourveinsmoreeasily. Preventbloodclots Thismeansthatyourbloodwillbelesslikelyt omakeadangerousbloodclot. Now Aspirin324mg(81mgtabs to prevent heart attack or strokex4)chewx1now Heparin60units/kgx1now toprevent bloodclotsfrom forming Tocathlabassoonasteam toexamine thearteries of theheart andthechambersof theheart andtreat anystenosisorabnormality found. ready CollaborativeCare:Nursing 3. Whatnursingpriority(ies)willguideyourplanofcare? Jane | [School] (ifmorethanone-listinorderofPRIORITY) 4. What interventions will you initiate based on this priority? I will assesspatientvitalsigns,administeranti- anginamedicationsandadministerO2 Jane | [School] 4. What bodysystem(s) will you mostthoroughlyassessbasedontheprimary/priorityconce rn The lungs listen for signs of congestion and check for abnormalsounds, also examine the veins in patient neck and check for fluidbuildupinyourabdomen. 5. Whatistheworstpossible/ mostlikelycomplicationtoanticipate? Death,riskofbleeding,anotherheartattack,stroke 7. WhatnursingassessmentswillidentifythiscomplicationEARL Yifitdevelops? dyspnea,shortnessofbreath,fatigue,andedema. 8. Whatnursinginterventionswillyouinitiateifthiscompli cationdevelops? 9. Whatpsychosocialneedswillthispatientand/ orfamilylikelyhavethatwillneedtobeaddressed? Psychosocialneedstomeetbasicneedsincludestheiremotionala ndmentalwell-being ps 10. Howcanthenurseaddressthesepsychosocialneeds? Nursescanprovidebothcareandsupportwithverbalandwrittenadvi cetopatients,bybuildingdialoguewithpatient’snursescanbegintou nderstandhowpatientsviewthemselves as individuals, what isimportanttothem,andhowtheirrelationshipwithothersmayaffect theirdecisionsandtheirabilitytolivewiththosedecisionsduringthei rtreatment and Beyond. Good communication and assessment skills are essential tobuildingarapportwithpatientsandcanhelpthenursedevelopacl inicalrelationshipwiththepatientandtheirfamily.