Mr. K. Heart is a construction worker

Mr. K. Heart is a construction worker who lives with his wife and 3 children 17, 14, and 12 year old boys. Although his wife works part time Mr. Heart is the family’s main source of income. They currently live in the low-income and urbane side of the city. Mr. Heart’s primary concern is to keep his kids out of the streets so he is working extra hours at work to be able to afford to move out of their current residency to a safer area and to afford paying for his kids’ basketball teams to keep them off the streets. Consequently, this is very stressful for him which leads him to not pay much attention to his health and he continues to smoke as a coping mechanism. However, he greatly cares for his kids and is passionate about basketball and currently coaches his eldest son’s basketball team. Presentation: Mr. Heart comes to a community hospital where you work with a complaint of chest pressure and shortness of breath soon after his son’s basketball game approximately 40 minutes ago. 1). What are some actions the triage nurse should do? 2.) Once the patient is brought back for examination and treatment; what initial orders do you expect? And why? 3.) Who can initiate these orders? Initial Assessment: Vitals: ● BP 196/94 ● HR 116 ● RR 36 ● O2: 88% ● T: 36.7 Respiratory: Patient complains of dyspnea and increased work of breathing. Respirations 32 and shallow. O2 saturation is 88% on 5 liters Cardiovascular: S1/S2 present. Rapid pulse. 1+ radial pulses, weak pedal pulses. Capillary refill 5 seconds. No signs of clubbing. Skin cool and diaphoretic. Neuro: Oriented x4. Agitated. Pupils are equally round and reactive to light. Grip strong bilaterally. GI: Patient is nauseous and had small emesis x1 GU: WNL Integumentary: 0.5 cm ulcer on #1 left toe Musculoskeletal: WNL 4). What diagnostic tests do you expect? Please explain why each one is necessary. 5). What is the STEMI protocol? Name each step and provide a brief explanation and rationale for each. 6). What is the order in which you provide the STEMI core measures? The lab results come back as follows: Cl 1.8 L/min/m2 Troponin I 5.3 mg/L CK 350 U/L CK-MB 5.8 % LDH 680 U/L AST 52 U/L Myoglobin 125 ng/L Random Glucose 312 mg/dL Serum Creatinine 1.7 mg/dL GFR Calculated 44 mL/min/BSA BUN 38 mg/dL WBC’S AUTO 2.9 mcL RBC AUTO 3.28 Mill/mcL HGB 10.2 g/dL HCT AUTO 31.7 % NA 129 mEq/L K 5.1 mEq/L CL 98 mEq/L CO2 23 mEq/L 7). Find out if the labs are normal or abnormal. Briefly explain what each lab result means. ECG reveals ST- segment elevation in leads V2 and V3. 8). In one or two paragraphs please explain this EKG finding. 9). What does it mean when there is an ST depression and what are the probable causes? 10). What is worst and ST depression or and ST elevation. Please explain. Mr. Heart goes to the cardiac lab to undergo a Cardiac catheterization procedure. 11). Please explain the purpose of this procedure? 12). What can be accomplished in this procedure? 13). What are the roles of nurses in the cardiac catheterization process? The catheterization revealed the following: Ejection fraction of 45% 85% obstruction of left anterior descending coronary artery 90% to 95% obstruction of the circumflex artery 80% of obstruction of the right coronary artery 14). What does the ejection fraction measure? 15). What is angioplasty? 16). What is stenting? What type of stents are available? 17). How would you explain to a patient what cardiac stents are used for? After the procedure Mr. Heart is admitted to a telemetry unit for observation post cardiac catheterization procedure. He is stable in this unit. Now starts the medical management of the patient. His vital signs are: ● BP 138/82 ● HR 80 ● RR 18 ● O2: 99% on 2 L of oxygen ● T: 36.8 Cardiovascular: S1/S2 present. Rapid pulse. 1+ radial pulses, weak pedal pulses. Capillary refill 5 seconds. Skin cool and diaphoretic. ECG is sinus rhythm with occasional PVCs. The treatment includes medication management and dietary recommendations. Mrs. Heart wants to help her husband and has many questions about his diet. 18). What education can you provide her? 19). What are some methods of lowering cholesterol? 20). What are the normal cholesterol lab values for adults? Please explain each. According to his social history, Mr. Heart is a smoker. 21). What would you say to him about smoking cessation? 22). Can you give him a phone number for a state/county program for smoking cessation? 23). What information would you make sure to include in your patient education upon discharge? Please explain each point below. Exercise and diet Strict medication adherence Diabetic care (foot care) Smoking cessation support/resources 24). How would you educate on discharge medications for this patient? Explain the purpose of each medication. Antiplatelets: Aspirin, clopidogrel (Plavix), warfarin (Coumadin), Beta-blockers ACE-Inhibitors Statins 25). When should Mr. Kevin Heart call his health care provider? Explain the rationale for each one. Pain, pressure, tightness, or heaviness in the chest, arm, neck, or jaw Shortness of breath Numbness in arms sweaty or pallor Lightheadedness SCIENCE HEALTH SCIENCE NURSING MED SUR 24

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