Solution Manual for Understanding the Essentials of Critical Care Nursing, 3rd Edition

DECISION-MAKING CASE SUMMARIES CRITICAL CARE NURSING #2: MYOCARDIAL INFARCTION CASE NAME OVERVIEW MAJOR CASE DECISIONS Duncan McLaughlin Mr. Duncan McLaughlin is a 64year-old man who presents to the ED front desk with diaphoresis, nausea, and chest discomfort extending down his left arm and into his jaw. Symptoms have been present for about one hour, and Mr. McLaughlin drove himself to the ED. He has a history of hypertension, hyperlipidemia, GERD, hypothyroidism, and Type II diabetes. Mr. McLaughlin is a 40-pack year smoker and consumes 1-2 beers on weekdays and 6-8 beers on weekend days. 1. Identifying and responding to symptoms of MI 2. Monitoring for side effects of medication 3. Assessing for and responding to complications of a medical procedure 4. Responding to patient questions 5. Identifying and responding to changes in patient condition 6. Recognizing a need for additional patient teaching Estimated Case Length: 1 hour Difficulty Level: High Learning Objectives: • • • • Prioritize nursing actions for the care of a patient with myocardial infarction. Identify and describe diagnostic findings associated with an ST elevation myocardial infarction. Discuss the nurse’s responsibilities when caring for a patient following cardiac catheterization. Identify essential discharge teaching for a client who has undergone coronary intervention. Questions Correct Answers 1. As Mr. McLaughlin’s Place Mr. McLaughlin on the continuous cardiac monitor triage nurse, which of the following actions should be Start oxygen via nasal cannula your priority? Select all that apply. 2. Which of the following diagnostic tests will most accurately and quickly Troponin and CPK determine whether acute coronary syndrome is the cause of Mr. McLaughlin’s symptoms? 3. The 12-lead ECG reveals Check the patient’s BP before and after medication ST segment elevations in leads I, aVL, and V2–V5. The ER physician writes the following order: “Nitroglycerin 0.4 mg SL for chest pain. May repeat q5 minutes x 3. Notify MD for ongoing chest discomfort.” What are the appropriate nursing actions for this medication? administration 4. Which of the following STEMI is considered a transmural infarction. statements is true regarding ST elevation myocardial infarction (STEMI)? 5. Mr. McLaughlin’s BP drops to 85/49 after the first dose of SL nitroglycerin. Mr. McLaughlin also continues to have chest pain. Given these circumstances, what should be your next course of action? 6. Which of the following Notify the healthcare provider and prepare to administer IV fluids PT/INR/PTT, CBC, and basic metabolic profile diagnostic tests would be essential to obtain before cardiac catheterization? 7. During the initial postcatheterization exam, you note that the fingers on Mr. McLaughlin’s right hand are cool and capillary refill is > 3.0 seconds. Mr. McLaughlin’s compression band has been in place for 1 hour. What is the priority nursing action? Notify the healthcare provider 8. The day after his cardiac catheterization, Mr. McLaughlin’s urine output is 10 ml/h and his creatinine is 2.4 (baseline 1.3). When told about these results, Mr. McLaughlin says, “My kidneys have always been fine. What happened?” What is your best response? 9. Which type of rhythm is “The dye from a cardiac catheterization can sometimes affect the kidneys.” Atrial fibrillation Mr. McLaughlin experiencing? 10. What should be the Synchronized electrocardioversion healthcare team’s immediate action to treat this unstable rhythm? 11. What specific information regarding clopidogrel (Plavix) should be reinforced with this patient? Select all that apply. You should not take omeprazole with this medication. You should take this medication with a baby aspirin. “Could you share with me why you were not taking the education, you note that Mr. medications that were prescribed for you?” McLaughlin had not been taking his preadmission prescribed medications. What is the best way for you to address this situation with Mr. McLaughlin? 12. As part of discharge