Question

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 wears around her neck. When the emergency response system called, she stated in gasping words, “I can’t get my breath!” She denies any chest pain or abdominal pain. The vital signs at the scene were T, 96° F; BP, 190/100 mm Hg; HR, 100 beats/minute; RR, 30 breaths/minute. She is diaphoretic and pale. The emergency response team placed oxygen at 2 L per nasal cannula on her and had her take an 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 WNL; 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/LVN working on the telemetry unit needs to closely manage the client’s care, watching for potential complications.

Explain the client’s symptoms and the rationale for the treatment the client received. (Provide detailed responses in bullet format.)

Answer 1

• The patient has complaints of difficulty in breathing- The emergency treatment of breathing difficulty is oxygen administration before identify the cause, for the purpose of maintain sao2 within normal limit. So oxygen given at 2L via nasal cannula.
• The patient is diaphoretic, pale, Elevated Blood pressure and pulse- it may be the symptoms of myocardial infarction. So as a emergency dose Aspirin was given.
• There is need of Intravenous administration of emergency drug - So two 18 gauge venflon had inserted
• Nitroglycerin IV given for vasodilation - to improve perfusion.
• Morphine is given for consideration of chest pain and make the patient rest.
• ECG reveals ST elevation in anterior and inferior areas - So identify the block Cardiac angiogram was done. Angiogram is a diagnostic test using contrast to view arteries and its blockage and uses x rays to take pictures of blood vessels.
• The patient had blockage in the right coronary artery and left anterior descending artery. There is need of immediate surgery or stent placement for the purpose of allow the perfusion to the heart and other areas. That way the patient had angioplasty ( the procedure to insert a thin tube through a blood vessel in the arm or groin region towards heart is called angioplasty) with two stent placement in affected arteries.