Question

Brief Patient History

Mrs. G is a 54-year-old African American woman who has been having intermittent indigestion for the past month. She has a history of hypertension and hyperlipidemia. She was admitted as an inpatient on a medical floor for management of her blood pressure and is scheduled to undergo endoscopy tomorrow. Mrs. G suddenly becomes diaphoretic and complains of nausea and epigastric pain. Clinical Assessment The rapid response team is called to evaluate Mrs. G. When the team arrives at her bedside, she continues to complain of pain, which now radiates to her neck and back. She has some slight shortness of breath and is vomiting.

Diagnostic Procedures The admission electrocardiogram (ECG) shows ST-segment elevation in II, III, and AVF. Baseline vital signs include the following: blood pressure of 160/90 mm Hg, heart rate of 98 beats/min (sinus rhythm), respiratory rate of 18 breaths/min, temperature of 99°F, and O2 saturation of 94%.

Medical Diagnosis Inferior myocardial infarction is diagnosed.

Questions 1. What major outcomes do you expect to achieve for this patient? 2. What problems or risks must be managed to achieve these outcomes? 3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified? 4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient? 5. What possible learning needs do you anticipate for this patient? 6. What cultural and age-related factors may have a bearing on the patient’s plan of care?

Answer 1

Ans:

1. DESIRED OUTCOMES

*verbalise relief / control of chest pain within appropriate time frame for administered medication.

*Display reduced tension, relaxed manner, ease of movement.

*Demonstrate use of relaxation techniques.

2 . A myocardial infarction requires immediate medical attention. Treatment aims to preserve as much heart muscle as possible, and to prevent further complications. Treatment depends on whether the myocardial infarction is a STEMI or NSTEMI, Treatment in general aims to unblock blood vessels reduce blood clot enlargement, reduce ischaemia and modify risk factors with the aim of preventing future MIs . In addition the main treatment for myocardial infarctions with ECG evidence of ST elevation (STEMI) include thrombolysis or percutaneous coronary interventions.

3.*Monitor and document characteristics pain, BP and heart rate changes

*Provide antianginal drugs, analgesics, anticoagulant, fibrinolysis and angiogram as prescribed.

*administer oxygen.

4.*provide calm and quiet environment.

*Instruct the patient to report pain immediately.

*provide calm activities and comfort measures.

*maintain interpersonal relationship.

*avoid cardiac workload activities.

5.*educate the patient and family about exercise, diet, regular medical check up and take medication as per doctor prescrib.

6.Patient is 54yrs old African American women. Provide care to patient with values, beliefs and behaviours.