Patient Profile D.M., a 51-year-old, white, successful executive,… P
Patient Profile D.M., a 51-year-old, white, successful executive,… Patient ProfileD.M., a 51-year-old, white, successful executive, is rushed to the hospital by ambulance after experiencing crushing substernal chest pain that radiates down his left arm. He also complains of dizziness and nausea. Subjective DataHas a history of unstable angina and hypertensionOverweight but recently lost 10 poundsRarely exercisesHas three teenage children who are causing “problems”Recently experienced loss of best friend and business partner, who died from cancer Objective DataDiaphoretic, short of breath, nauseousBP 165/100 mm Hg, pulse rate 120/min, respiratory rate 26/min Diagnostic Studies12-lead ECG shows sinus tachycardia with ST elevation in leads II, III, aVF, V5, V6 with occasional premature ventricular contractionsCardiac-specific troponin I level elevatedCholesterol 350 mg/dL (9.1 mmol/L) Collaborative Care: Emergency DepartmentOxygen 2 L/min via nasal cannula, titrate to keep O2 saturation above 93%Continuous ECG monitoringAspirin 325 mg (chewable)Weight-based heparin IVNitroglycerin IV, titrate to relieve chest pain; hold for systolic BP below 100 mm HgMorphine 2 to 4 mg IV q5min PRN for chest pain unrelieved by nitroglycerinVital signs, pulse oximetry every 10 minutesPreparation of patient for transfer to cardiac catheterization laboratory for possible Percutaneous transluminal coronary angioplasty (PTCA). Discussion s1. Which coronary artery(ies) is (are) most likely occluded in D.M.’s coronary circulation?2. Explain the pathogenesis of CAD. What risk factors contribute to its development? What risk factors were present in D.M.’s life?3. What is angina? How does unstable angina differ from myocardial infarction?4. Explain the significance of the results of the laboratory tests and the 12-lead ECG findings.5. Provide a rationale for each treatment measure ordered for D.M.6. Based on the assessment data presented, what are the priority nursing diagnoses?7. What are the priority nursing interventions for D.M. immediately after his MI? Immediately after his PTCA?8. Identify activities that can be delegated to unlicensed assistive personnel (UAP).9. Two days after an uncomplicated PTCA and the placement of two stents, D.M. wants to know what the most effective strategies are to prevent another MI. Based on his clinical situation, what would you tell him? Health Science Science Nursing NURS 206 Share EmailCopy link Comments (0)
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