Case Study Introduction: Mr Raj Kumar is

Case Study Introduction: Mr Raj Kumar is a 64-year-old male with no known allergies (NKA) Situation: Mr Raj Kumar arrived at the Emergency Department (ED) at 1130 hrs with central crushing chest pain radiating to his jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4. 300mg Aspirin administered en route to hospital. Background: Hypertension (Captopril 12.5mg bd) Hyperlipidaemia (Simvastatin 40mg nocte). Type 2 Diabetes Mellitus (DM) (diet controlled) Weight 88kg Assessment: Airway: Patent Breathing: Respiratory rate 18, bilateral air entry, breath sounds clear. SpO2 on room air 95% Circulation: Sinus Tachycardia 102bpm. BP 140/90. Diaphoretic and peripherally cool. Central crushing chest pain radiating to the jaw. COLDSPA: Character: crushing chest pain Onset: 11am Location: Central, radiating to jaw Duration: ongoing Severity: 7/10 Pattern: at rest, not relieved by SL Anginine Spray Associated symptoms: diaphoresis Disability: Alert & oriented. Pupils equal and reacting to light (PEARL). Pain score 7/10. Equal strength in all four limbs. Exposure: IVC Left cubital fossa. Fluid: NBM. NO IVF Results: Elevated Troponin 35ng/L troponin 12 lead ECG: ST elevation (>2mm) V2, V3, V4 A diagnosis of acute anterior STEMI is made Recommendations: Plan: Supplemental oxygen if SpO2 < 93% Continuous cardiac ECG monitoring 12-lead ECG now, then every 30 minutes Keep in resuscitation bay (Triage category 2) Blood tests: Troponin now, then again in 2 hours Medications: Morphine 2.5mg IVI 2/24 (PRN maximum dose 10mg) Nitro-glycerine 600mcg SL (PRN maximum 3 doses); if pain persists, consider IV Glyceryl Trinitrate infusion Clopidogrel 300mg PO STAT Heparin 5000IU IV STAT As per STEMI reperfusion flowchart: Transfer to Cardiac Cath Lab for urgent primary PCI when ready (<90mins). If PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1230pmYou are required to present the case study of Mr Kumar in an written presentation. The presentation should cover the following questions: Question 1: Explain the clinical manifestations that led to a diagnosis of acute anterior STEMI. Question 2: Provide a rationale for the nursing management of Mr Kumar in the Emergency Department. Question 3: Discuss the role and importance of reperfusion. Question 4: Discuss the nursing considerations of the medications given to Mr Kumar (Aspirin, Heparin, Morphine, Nitro-glycerine & Clopidogrel)

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