Question

Case Study, Chapter 25, Caring for Clients with Disorders of Coronary and Peripheral Blood vessels Antonique Badie April Smith, an 82-year-old female client, is at the independent living facility and had planned on going to a senior outing when she activated her emergency alert button she was around her neck. When the emergency response system called, the stated in gasping words, breatht" She denies any chest pain or abdominal pain. The vital signs at the scene were T.98°F, BP, 190/100 mm Hg, HR, TOO beats/minute: R 30 breathminute. She is diaphoretic and pale The emergency response team placed oxygen at 2 L per nasal cannula on her and had be taken aspirin per emergency physician's orders. They inserted two 18-gauge IVs and had normal saline at keep vein open rate. The labs obtained by the squad were as follows: the CBC within normal limits (WNL); coagulation profile WNL; renal profile WNI, and the first set of cardiac enzymes, which consisted of Troponin T and I and CK-MB, were WNL. The client had food earlier today, so the lipid profile was scheduled in the morning. The initial ECG reveals ST elevation in the anterior and inferior areas. The oxygen did not help alleviate the shortness of breath, but the SaO2 remained 98%. At the emergency department, the nurse reviewed the client's past medical history, noting she had an ischemic stroke 3 months ago. She had received tPA for this incident, and the symptoms had resolved. She was taking an aspirin a day, a beta-blocker for her hypertension, atenolol 25 mg once a day, and atorvastatin 20 mg once daily. The client received nitroglycerin IV and morphine IVP with some relief of the symptoms. The cardiologist evaluated the client via a cardiac angiogram and discovered 99% blockage in the right coronary artery and 95% blockage in the left anterior descending artery. The client had an angioplasty with two stents placed in the two affected coronary arteries. The client was monitored closely in the coronary care unit for 24 hours and then transferred to the telemetry unit. The LPN/LUN

Answer 1

a.Shortness of breath due to blocked artery, the treatment is application of stent in the blocked artery

This blockage will raise the pressure in the blood vessels resulting in increased blood pressure ,nitroglycerin will relax the blood vessels and decrease the blood pressure

The increased heart rate is decreased by blocking the action of epinephrine, this is done by atenolol.

The presence of cholesterol in the blood vessels are reduced by statin drugs like atorvastin

The extreme anxiousness can be reduced by morphine

b.The nursing management which can be received by patient in telemetry unit are

• Monitoring vital signs (T,P,R,BP,SPO2)
• ECG monitoring
• Assess for dysrhythmia