Reference no: EM133296371
Case Study: Myocardial Infarction
SCENARIO
You are working in a small, rural hospital in Central California, when W.R., a 48-year-old plumber with a 36-pack-year smoking history, is brought to your emergency department (ED) shortly after 1330. His wife brought him to the emergency department after he complained of
unrelieved "indigestion", while eating at home. He is being admitted to the ED with a diagnosis of rule out myocardial infarction (R/O MI). His chest pain began at approximately 1300.
He has significant male-pattern obesity (a "beer belly," a 44-inch pant/waist circumference) and a barrel chest. He is 5'10" and weighs 216 pounds. You don't have any other information on W.R.s risk factors.
His admission vitalsigns (VS) are 178/98, 110, 22, and 98.2° F (36.8° C) and he is diaphoretic. The minute W.R. comes through the door of your unit, he demands a cigarette in a loud and angry voice. Looking dyspneic, he states his chest pain is an 8 out of 10 and is experiencing some left arm numbness.
Calculate his weight in KG
- According to the most recent guidelines from the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure, W.R.'s blood pressure (BP) falls under which classification?
- From the perspective of basic human needs, what is the first priority in his care?
- Are his admit VS reasonable for a man of his age? If not, which one(s) concern(s) you? Explain why or why not.
- As the nurse caring for W.R, assuming he is having an MI, what are your next initial actions? (Provide a detailed rationale for each action)
- Which risk factors are known, and which remain to be determined?
- How is a pack year calculated?
- Which laboratory tests might be ordered to investigate W.R.'s condition? If the order is appropriate, place an "A" beside it and provide your rationale. If inappropriate, mark with an "I," and provide rationales for your decisions.
- What significant lab tests are missing from the previous list? What do they measure? And how often should they be ordered
- How are you going to respond to W.R.'s angrydemands for a cigarette? He also demands something for his "heartburn." How will you respond?
- What special precautions should you follow when administering morphine sulfate IVP?
- The pharmacy supplies morphine for injection in vials of 5 mg/mL only. For the first dose, you will be giving4 mg of morphine. How many milliliters will you give for this dose? Mark the syringe with your answer.
- What will you do with the rest of the morphine in the vial? (Give a rationale for your choice) a. Discard it. b. Save it for the next dose. c. Return to pharmacy d. Discard it with a second witness.