Question

you are working as a nurse in the ED when a 42 year olf femal comes in complaining of chest discomfort. Although she states that she has been experiencing this discomfort on and off for a couple of weeks, today it is much worse. she says that today she is been anxious, fatigue and nauseated

Acute Cardiac Unfolding Case 5 Concept: Perfusion D when a 42 year old female comes in ff ays thafort on though she states that she has been appehat sheis today she haso for a couple of weeks, today it is much You are working as a nurse in the complaining of chest discomfort. A experiencing this discomfort on &o worse. She says that today she Other than that she is vague abouf for a been anxious, fatiqued and nauseated anterior che no hur questions, When she finally agrees to change into clumsy n t llhe has bruises, in various stages of healing across her anterior chest wall., You ask clumsy about her pain, she is very timid and appears afraid to answer your questions vafraid to dan you question mptoms and hesitant to get into a a gown, you notice that she has bruises, i ng into the shelf in her pantry*. Her husband is in the esaells you that he thinks that she is just compla she got awas runningait her how she got the bruises .she states "she is ap room, appears frustrated and of pain to get attention. you do you think could be the cause of her chest discomfort? Broten ribs As th e nurse, what are your priorities with this patient? What do you want to make sure happens and is documented?e Po domastic violen Le rt a Suspiciaus of Explain what diagnostic testing you think the MD will order, as well as the rationale behind when & why it should be d chest X-ran to chert te Patient's vital signs are: BP 104/62 HR 88 .RR 20 .T 100.4 . O2 sats 98% on room air .Pain States pain 2/10 when husband in r in room but when he steps into hall she confesses that it is closer to 7/10

Answer 1

●The cause of her pain is physical abuse (bruises on various stage of healing on her chest)

The symptoms also suggest she may have a cardiac issues (anxious, nausea,chest discomfort fatigue,

●The documentation of physical abuse /domestic abuse has to be reported

●The Blood investigation to rule out any cardiac value changes, blood sugar for fatigue

EKG ,to rule out the actual cause for chest discomfort and a base line test

Chest X Ray may be needed to identify any fracture

●The test investigation reveals she has acute inferior  wall myocardial infarction (ST elevation at lead2,lead 3 and aVf)

Increased CK MB :6% (3_5%),Trop 4.2 (0.00 _0.40), CK292(22_197U/L), Glucose 186 (70_140mg/dl)

This report strongly suggest she has cardiac muscle damage or an infarction

●The patient might have been taken on table to rule out any blockages in the blood vessels and whetger it is the leading cause for chest discomfort

●The orders are appropriate because changes in cardiac enzymes tretament are (aspirin,beta blocker, thrombolytics,blood thinners,analgesic, antiplatelets,ACE inhibitor)

As the patient glucose level is 186 ,a fast acting insulin may be needed to control with additional test to confirm if she hs diabetes or not

●The patients clotting factor reports are needed before starting the medication ,as the patient is supposed to be given blood thinners and antiplatelet ,the values are essential to avoid complications