Question

Brief Patient History: Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)- sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes diabetes mellitus type 2, heart failure, hypertension, and osteoarthritis. Home medications include furosemide Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), Glucophage (metformin), and Motrin (ibuprofen). Clinical Assessment: Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free. His only complaint is shortness of breath and swelling in his ankles, feet, and hands. Physical assessment reveals bilateral breath sounds with basilar crackles; dressing at catheter site; right femoral clean, dry, and intact; peripheral pulses 2+ bilaterally; and 2+ edema noted in lower extremities. Mr. X has a body mass index (BMI) of 35 kg/m2 and weighs 100 kg. IV fluids have been discontinued and saline lock is in place in preparation for transfer to the telemetry unit. Diagnostic Procedures: Admission diagnostic studies: Electrocardiogram (ECG) with ST segment elevation in V1-V4; elevated cardiac enzymes; electrolytes and glucose within normal limits; blood urea nitrogen (BUN), 26 mg/dL; serum creatinine, 1.8 mg/dL; cholesterol, 250 mg/dL; and serum B-type natriuretic peptide (BNP), 300 pg/mL. Current vital signs are as follows: blood pressure of 138/80 mm Hg, heart rate of 108 beats/min (sinus tachycardia), respiratory rate of 28 breaths/min, temperature of 99F, and O2 saturation of 92% on oxygen at 2 L per nasal cannula. Urine output for the past 6 hours is 100 mL. The health care provider is notified of Mr. X’s urine output, and repeat diagnostic studies are ordered that reveal the following: BUN, 56 mg/dL; serum creatinine, 5.6 mg/dL; and potassium, 5.8 mEq/L. Medical Diagnosis Acute anteroseptal myocardial infarction STEMI (ST elevation myocardial infarction) Contrast-induced nephropathy (CIN) Major Outcomes Expected for Patient: Prevention of complications from contrast agent, nephrotoxic agents, and acute kidney injury. Fluid and electrolyte Balance Body weight and vital signs are stable and consistent with baseline Patient and family can participate in informed decision making related to patient care Increase knowledge base related to prevented of chronic kidney disease.

What possible learning needs would you anticipate for this patient? Include two learning needs.

Answer 1

PRIORITIZED LEARNING NEEDS OF PATIENT Mr.X WITH A/C AMI WITH STEMI AND CONTRAST INDUCED NEPHROPATHY

Patient need to know the following :

• Measures to prevent development of chronic kidney diseases
• Complication associated wih Left side heart catheterization and measures to prevent the development of further complications
• Each medication, its side effect and general rule for taking medication
• Signs and symptoms of worsening condition of MIMI especially shortness of breath , swelling ankle and hand
• Life style changes for controlling symptoms associated with MI and nephropathy.