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B. W., a
62-year old African American psychologist is admitted to the ER with
complaints of chest pain. B. W. states that she began feeling the pain
after eating lunch about 4 hours ago. She described the pain as
pressure, which radiated to her jaw and left arm. It is accompanied by
“choking feeling,” severe shortness of breath, and diaphoresis.
1.
What questions will you ask B. W.?
2.
She tells you she has taken NTG to relieve the pain. What is the
recommended dosing schedule for someone experiencing chest pain?
3.
She tells you she has taken NTG to relieve the pain. What is the
recommended dosing schedule for someone experiencing chest pain?
4.
B. W. now tells you that the pain is unrelieved by rest, antacids or 3
sublingual NTG tablets. She rates the pain as a 8/10 on the pain
scale. What should be done next?
5.
What history is significant for B. W.?
6.
What further questions are needed?
7.
Her lab results return with the following:
HGB
= 14.2 g/L (12-16g/L women),
HCT =
53% (38-47% women) .
CK-MB
= 8.2 ng/ml, (> 7.5 indicates MI)
Troponin I = 3.ng/ml (,0.1-3.1ng/ml)
LDL =
150 mg/dl (< 130mg/dl),
HDL =
90 mg/dl (women 40-88 mg/dl).
ABG’s
are: pH = 7.42 (7.35-7.45)
PaO2 = 75 (normal = 80-100)
PaCO2 = 38 mm Hg (normal =
35-45 mmHg)
SaO2 = 96% with O2
HCO3 = 23 (normal = 22-26)
Cholesterol = 410 mg/dl (140-200 mg/dl),
LDH =
125 U/L (<100 U/L)
Electrolytes: Na = 150 mEq/L (normal =
135-145mEq/L)
K = 3.0 mEq/L (3.5-5.5 mEq/L)
Ca = 10 mg/dl (9-11 mg/dl)
Mg = 2.5 mEq/L (1.5-2.5 mEq/L)
EKG
shows sinus tachycardia of 120 with multifocal PVC’s and an ST
segment elevation with a U wave.
8.
What do these results indicate? What is her cardiac risk factor?
9.
Her history, EKG results and lab work point toward an
acute anterior wall MI. What collaborative action should follow?
10. B. W. is
now in ICU, and is A & O X4. Her VS on arrival are 172/92,
99.6-118-24. Auscultation reveals S4 and she has fine crackles in the
bases of both lungs. The EKG continues to show sinus Tachycardia with
occasional PVC’s. Her skin is cool and diaphoretic. Capillary refill
is < 2 seconds and peripheral pulses are 2+ and equal. Her nail beds
are pink. A triple lumen central line is in place with no redness or
swelling. NTG is infusing at 200 micrograms/minute in the distal
lumen. The alteplase infusion is in the middle lumen and the heparin is
going into the proximal lumen. The peripheral IV line infusion is D5W
in ¼ NS at 50 cc/hr. Mrs. Willisack states “The pain is better since
the ER nurse gave me the shot.” She rates the pain as a 4/10 and states
that it comes and goes. “The doctor told me that the drugs I’m getting
will help to open up the artery that is blocked. I hope it works. Do
many people get this drug?”
11.
Based on the assessment findings, what are the priority nursing
diagnoses?
12.
What discharge teaching would be most appropriate?
13.
B. W. states emphatically “I have been smoking for over 45 years and I
am not going to stop now! Besides it calms me down when I am feeling
anxious.” How would you respond to this statement?
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