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Introduction: Mrs Helen Georgopoulos is a 64-year-old lady.

Situation: Mrs Georgopoulos arrived at the Emergency Department at 1130 hrs with central crushing chest pain radiating to her jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4. Aspirin 300mg administered on route to hospital.

Background: Hypertension (Captopril 12.5mg bd); Hyperlipidaemia (Simvastatin 40mg nocte); Type 2 Diabetes Mellitus (DM) (diet controlled) and Allergy – Penicillin.

Assessment:

–  Airway patent

–  Breathing: Respiratory rate 24, bilateral air entry, breath sounds clear. SpO2 on

room air 91%

–  Circulation: Sinus Tachycardia 120 bpm. BP 110/60. 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: 8/10
Pattern: at rest, not relieved by SL Anginine Spray x 2 Associated symptoms: diaphoresis

–  Disability: Alert & oriented. Pupils equal and reacting to light (PEARL); Equal strength in all four limbs.

–  Exposure: IVC Left cubital fossa.

–  Fluid: NBM. NO IVF

–  Glucose: 14.0 mmol/l

–  Weight 88kg –

Nursing Interventions:

Perform venepuncture to collect pathology – Troponin, UEC, FBC, TFTs, LFTs, BSL

Initiate supplemental oxygen if SpO2 < 93% Attach Continuous Cardiac Monitoring Record a 12-lead ECG Monitor blood pressure and report systolic BP <100 mmHg Pathology Results: -  Elevated Troponin 35ng/L troponin -  12 lead ECG: ST elevation (>2mm) V2, V3, V4

The diagnosis of Acute Anterior STEMI is made

Medications:

Morphine 2.5mg IVI 2/24 (PRN maximum 4 x 2.5mg doses = 10mg total) Nitro-glycerine 600mcg SL (PRN maximum 3 doses); monitor systolic BP >100 mmHg 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 @ 1230pm Short Answer Questions: Complete the answers for the questions in a Word document. Please list each question and then your answer. Question 1: You are the registered nurse caring for this patient. List and prioritise the order that you will complete each of the five Nursing Interventions (indicated above): (i) (ii) (iii) (iv) (v) Question 2:  Critically analyse, and then concisely explain using your own words, each of the clinical manifestations and related pathogenesis for the following: (vi)  Central crushing chest pain with radiation to the jaw (vii)  ST elevation (viii)  elevated Troponin (35ng/L) Question 3:  (i)  Select one Category only, from the three (3) categories in the Table 1 below. (ii)  Provide a rationale for each of the interventions listed for the category that you have selected. (iii)  You must critically analyse the available evidence-based literature and/or pathophysiology texts to support your rationale. You must then concisely explain the rationales using your own words. Table 1 Category 1 Category 2 Category 3 Pharmacological Reperfusion interventions interventions Non-pharmacological intervention . SCIENCE HEALTH SCIENCE NURSING NURSING RN NURS7072

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