Patient Name : Dee Driskell DOB /Age

Patient Name : Dee Driskell DOB /Age : 46 yrs Gender: female Marital Status : married ​Occupation : Admit date: just transferred out from CCU Admitting MD : Chief Complaints:- post PTCA/ stent placement 24hours ago B Past history: Unstable angina, HTN, HLP Past medications: Toprol, Lisinopril and Atorvastatin Code status : Full code Acuity : Allergy: Current Medications: Smoking- none Alcohol- drinks alcohol occasionally Illegal drugs- none IV: Saline Lock Other data: Her chest pain usually occurs with exertion and resolves with rest. She exercises 3-4 times a week by walking on a treadmill for 30-45 minutes each time. Scenario prior to admission to ER: Two days ago she was walking on a treadmill for exercise when she experienced substernal chest pain that radiated to her back. She stopped walking and took a sublingual NTG. After 10 minutes her chest pain had not improved so her husband called EMS. She became very diaphoretic, nauseated, pale and dizzy. Upon arrival of EMS, the patient vomited copious amounts of bile colored emesis and felt faint. Her vital signs were: BP 80/50, HR 110, RR 24 at that time. Large bore IVs were started by paramedics and fluids given to stabilize her blood pressure. She had ST segment elevation in her lateral leads with flipped T-waves. She received 324mg of ASA, 10mg IV Retavase and a Nitroglycerin drip in the ambulance on the way to the ER. After the assessment, she was taken straight to the cardiac catheterization lab, once a 12 lead EKG, and blood specimens were drawn. Procedure: Her initial diagnostic cardiac images were done and it was found the Circumflex was 85% occluded at mid-vessel and the Diagonal was 75% occluded proximally. Her circumflex and first diagonal arteries were opened and stented with drug eluting coronary stents. She had TIMI III flow indicating that the newly stented lumen is greater than 80 percent open. She stated that her chest pain, dizziness, nausea and vomiting were relieved. Her blood pressure and heart rate are now stabilized. During the procedure, IV Integrelin was given by bolus and IV drip just prior to the start of the angioplasty and continued for 18 hours post procedure. She was given a loading dose of Plavix 300mg orally. Her catheterization site was closed with an Angioseal collagen device. Cardiac enzymes were negative for series of 3 sets. A Vital Signs : T= 98.7 P= 96 R= 18 BP=110/80 SpO2= 99 Pain= 4/10 Oxygen: Room Air Diet: Heart Healthy Activity: System Assessment: Her Integrelin drip was discontinued eight hours ago and she has been free of chest pain with stable vital signs Lab results: R Orders from physician: Up to Chair and BRP with assistance today. No ambulating in the hall today. Patient may be advanced to ambulating in the hall tomorrow if she tolerates increased activity today without adverse changes in blood pressure or heart rate. Have cardiac rehabilitation see patient to start inpatient rehab exercising on the nursing unit and set up for outpatient rehab. Maintain IV saline lock. Continue meds: ASA 325mg a day; Bystollic 20mg a day; Lisinopril 25mg a day; Plavix 150mg a day and Atorvastatin 20mg a day. Diet: Heart Healthy diet; Have the dietician see patient for dietary instruction; Remove Angioseal dressing if not already done and replace with band aid. Go over Angioseal site care with patient- see patient instruction booklet in front of patient’s chart. Make sure patient receives stent identification card to be kept in her wallet at all times. Patient may shower starting tomorrow if she tolerates increased activity today. Have someone stay with patient the first time she showers to provide safe environment for her. Lab/Imaging Pending – CBC, CMP, Cholesterol Profile- Fasting HDL, LDL, Triglycerides in am. 3-D Echocardiogram with colorflow today. AP and Lateral CXR today. Consults: dietician 1. Describe the importance of the priority concept (topic) to professional practice 2. Describe the importance of the priority concept (topic) to the health status of a patient population. 3. Include the potential negative effect(s) to professional practice if the priority concept (topic) is unresolved. 4. Include the potential negative effect(s) to the patient population if the priority concept (topic) is unresolved. SCIENCE HEALTH SCIENCE NURSING NUR NR325

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