Question

Concept: Perfusion (Cardiac) Case Study A 59-year-old black female presents to the Emergency Department with complaints of Chest Pain. She complains of a squeezing type pain across her chest and into her left jaw area and down her left arm. She is also complaining of epigastric pain. The pain has been occurring intermittently throughout the evening and night. She states, “she has never felt this type of pain before and is afraid she is going to die.” Vital signs are: Blood Pressure-196/106 Pulse-110 beats per minute Respirations- 26 per minute Temperature-99.8 Oxygen Saturation-86% on room air Pain level 9/10 During your initial assessment she is rubbing her mid-chest, grimacing and is diaphoretic. Her color is pale except around her lips which are bluish. Cardiac auscultation reveals a rapid regular rhythm. Lungs sounds reveal crackles in lower lobes. Per standing orders Nitroglycerine 0.4mg sublingually is administered. Cardiac monitoring is initiated. An electrocardiogram is obtained. An 18-gauge saline lock is placed in left arm. Patient is positioned in low Fowlers. After following the initial orders, she states her chest pain hasn’t changed. Heart and lung sounds are unchanged. Color is pale without previous blue changes.

After following the initial orders and initial assessment, what other priority cares and assessments would the nurse need to complete?

What labs would be important to her care and diagnosis and why?

What is the significance of the crackles in the patient’s lungs?

Is this right or left sided heart failure? What is causing this to occur?

What is the significance of administering Nitroglycerine and what is the correct way to administer it?

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

What important information is needed if administering this medication to a male?

How can the concept of fluids and electrolytes tie into this case study and why?

What nursing diagnosis can be used for both concept of perfusion and fluids & electrolytes?

Answer 1

1) The chest pain that is not relieve from nitroglycerine is diagnosed to be myocardial infarction.The pain often occurs at rest and accompanies with diaphoresis. Once the initial order of nitroglycerine fails to relieve pain the next line of management is to rule out ECG findings.Oxygen administration is initiated to perfuse myocardial tissues. Narcotic analgesics can be used to treat MI pain. Early initiation of thrombolytic agents streptokinase to treat blockage in coronary vessels.

2) Cardiac enzymes also refers to biomarkers plays a key role in identifying myocardial damage. Cardiac markers like Troponin, myoglobin, and creatine kinase helps to rule out MI. Troponin is most specific myocardial biomarker.

3)Crackles in lungs occurs secondary to collection of fluid in the tiny air sacs. The most common etiology is pulmonary edema, heart failure,acute respiratory distress syndrome. Heart failure is defined as inability of the myocardium to pump blood. Right side heart failure occurs when the right ventricle pumps the blood back to the lungs leading to overload of lungs with excess blood.The symptoms are shortness of breath, severe weakness, fainting, irregular heart beat, chest pain

4) Nitroglycerine is a potent vasodilator that dilates coronary vessel and improves myocardial perfusion. It is administered sublingually or under the tongue or in the buccal pouch and ask patient not to swallow and gibe some time for the tablet to dissolve.

5)The common side effects includes flushing, light headedness, nausea, burning of oral cavity.Irregular heart beat and pouring heart beat must reported to the provider.