Reference no: EM133639489
Assignment:
Stanley, a 45 year-old male is evaluated in the emergency department for a 2-day history of substernal sharp intermittent chest pain that is not aggravated by deep breaths. He began experiencing severe chest pain 4 hours prior to his ED visit related to doing yard work. He has had hypertension for 12 years and his medications are HCTZ and amlodipine. He has a 40 pack-year cigarette smoking history.
On exam, T 99.0 degrees F, BP 168/100 mmHg, P 110 beats/minute and R 26/minute. Oxygen saturation is 96% on room air. The patient's face and chest appear diaphoretic. There is no jugular venous distension and no hepatojugular reflux. Cardiac examination discloses normal heart sounds and no murmur or extra heart sounds. Pulmonary exam discloses normal breath sounds and no crackles. There is no palpable chest wall tenderness. Initial serum troponin T is 0.6 ng/mL. Height: 5'10", Weight: 230 lbs.
Initial 12-lead ECG shows sinus tachycardia with no ST-segment elevation. Serial EKGs are order every 15 minutes x 4. The third EKG shows sinus tachycardia with no ST-segment elevation, but T wave inversion developed. Chest x-ray shows no infiltrates and normal cardiac silhouette.
To determine Stanley's risk for a major adverse cardiovascular event (MACE), a HEART score can be computed. calculate our patient's HEART score. This will help you determine the severity of illness for Stanley.
What is the relevant objective and subjective assessment data from the case study?
Amsterdam et al. (2014) CPG - 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes.
Please use this CPG for diagnosis, level of risk for MACE, and treatment for this case study patient. [Link for the CPG is in "References" section of the Module 3 CJW].
What conclusions can you make from the data? What is your preliminary diagnosis(es)?
What is the patient's risk for major adverse cardiovascular event (MACE)?
What non-pharmacologic and pharmacologic interventions would you consider?
How does each intervention treat the pathophysiology of the diagnosis(es)?
What is the priority for each intervention (which interventions are first versus later)?
Support your treatment decisions with citations from the CPG.
What are the important prescribing considerations for the pharmacologic interventions?
Write a prescription for each medication you would prescribe.
Include all elements for a prescription as if the patient was taking the Rx to the pharmacy.
What outcomes would you anticipate - therapeutic effects and adverse effects? How will you evaluate for these outcomes?
What patient education and follow up is required for the medications you have prescribed?
References:
Amsterdam, A.E., Wenger, N.K., Brindis, R.G., Casey Jr, D.G., Ganiats, T.G., Holmes Jr, D.R., Jaffe, A.S., Jneid, H., Kelly, R.F., Kontos, M.C., Levine, G.N., Liebson, P.R., Mukherjee, D., Peterson, E.D., Sabatine, M.S., Smalling, R.W., & Zieman, S.J. (2014). 2014 AHA/ACC Guideline for the Management of Patients With Non-ST-Elevation Acute Coronary Syndromes. Circulation, 130(25), e344-e426.