Question

Scenario:

J.T. a 48-year-old construction worker with a 25-pack-year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male-pattern obesity and reports a dietary history of high-fat food. His wife brought him to the emergency department after he complained of unrelieved “indigestion.” His admission vital signs (VS) were BP 202/124, pulse 106, respirations 18, and oral temperature 98.2°F (36.8 ° C). J.T. was put on oxygen (O2) by nasal cannula (NC) titrated to maintain Spo2 over 92% and started on an IV nitroglycerin (NTG) infusion. He was given aspirin 325 mg to chew and swallow and was admitted to Dr. K.’s service. There are plans to transfer him to the regional medical center for a cardiac catheterization in the morning. J.T is brought into your room and is angry and stating “he does not want to be here and needs a cigarette”.

Questions to Answer:

1. What is the first priority in his care?
2. Are these VS typical for a man of his age? If not, which one(s) concern(s) you? Explain why or why not.
3. Identify 5 priority problems associated with the care of a patient such as J.T.
4. Which lab tests might be ordered to investigate J.T.’s condition?
5. If the order is appropriate, place an A in the space provided. If inappropriate, mark with an I. Provide rationales for your decisions and the significance of each lab test.
   • Complete blood count (CBC)_____
   • Electroencephalogram (EEG) in the morning_____
   • Basal metabolic panel (BMP)_____
   • Prothrombin time (PT) and partial thromboplastin time (PTT)_____
   • Bilirubin_____
   • Urinalysis (UA)_____
   • STAT 12-lead electrocardiogram (ECG) and repeat in the morning_____
   • Type and crossmatch for 2 units of packed red blood cells (PRBCs)_____
   • Chest x-ray on admission and in the morning___   
6. The family asks you, “If he can’t smoke, why can’t you give him one of those nicotine patches or some nicotine gum?” How will you respond?

The physician prescribes morphine sulfate 4 mg STAT IV push (IVP), then 2 to 4 mg IVP q1h prn for pain (burning, pressure, and angina) and to increase the nitroglycerin as ordered.  

7. Explain two reasons for this order.

When you come into J.T.’s room at 2130 hours to answer his call light, you see he is holding his left arm and complaining about aching in his left shoulder and arm.

8. Using SBAR (Situation, Background, Assessment, Recommendation), what information would you provide to the physician when you call?

W.R.’s chest pain subsides after the dose of morphine and he settles down for the night. You monitor him closely and watch for side effects of the NTG infusion.

9. What side effects of NTG should you be on the lookout for?

J.T. is transferred to the medical center for a cardiac catheterization. It is determined that J.T has coronary artery disease (CAD) but has not had an MI.

Answer 1

What is the first priority in his care?

As per the data given J.T. is receiving medication for all the persisting symptoms.Such as IV nitroglycerin is used to treat hypertension and to control congestive heart failure in patients who have had a heart attack. Aspirin 325 tablets are given orally to minimize the risk of blood clotting triggered by plaque ruptures by inhibiting platelets.J.T. was put on oxygen by nasal cannula titrated to maintain Spo2 over 92%. As a nurse, the first priority will be to convince the patient to cooperate with the treatment. For that, we should explain to him why not to smoke now and what is going to happen once he undergonne proper treatment.

Are these VS typical for a man of his age?

As per the data, BP 202/124 is typically high. Uncontrolled hypertension may lead to serious health problems such as  Heart attack, stroke, Aneurysm, Heart failure, weakened and narrowed blood vessels in kidneys and so on.

Identify 5 priority problems associated with the care of a patient such as J.T.

1.Acute Pain
2.Activity Intolerance
3.Fear and anxiety
4.The risk for Decreased Cardiac Output
5.The risk for Ineffective Tissue Perfusion

Which lab tests might be ordered to investigate J.T.’s condition?

STAT 12-lead electrocardiogram (ECG) should be ordered to rule out myocardial infarction. As the vital signs of the patient suspect MI.