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Myocardial Infarction (MI) Case Study (45 min)

myocardial infarction nursing case study
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Mr. Salazar, a 57-year old male, presents to the Emergency Department (ED) with chest pain. He reports that the pain started about an hour after dinner, while he was working. He describes the pain as a “crushing pressure” located midsternally and radiating down his left arm and to his back. He rates the pain a 4/10. On assessment, Mr. Salazar is diaphoretic and pale and complains of shortness of breath (SOB).  

Critical Thinking Check
Bloom's Taxonomy: Application

What further nursing assessments need to be performed for Mr. Salazar?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What interventions do you anticipate being ordered by the provider?

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Upon further assessment, the patient has no jugular vein distention (JVD), and no edema. His heart sounds are normal S1 and S2 present and lungs are clear with scattered wheezes on auscultation.  His vital signs were as follows:

BP 140/90 mmHg SpO2 90% on Room Air

HR 92 bpm and regular Ht 173 cm

RR 32 bpm Wt 104 kg

Temp 36.9°C

His 12-lead EKG report reads: “Normal sinus rhythm (NSR) with frequent premature ventricular contractions (PVCs) and three- to four-beat runs of ventricular tachycardia (VT)”. ST-segment elevation in leads I, aVL, and V2 through V6 (3-4mm). ST-segment depression in leads III and aVF.”


Cardiac enzymes were drawn, results are still pending. A chest x-ray was ordered as well.

The provider orders the following: Aspirin 324 mg PO once, Nitroglycerin 0.4 mg SL q5min for up to 3 doses, Morphine 4 mg IVP PRN unrelieved chest pain, Oxygen to keep SpO2>92%.

 

Critical Thinking Check
Bloom's Taxonomy: Analysis

What intervention should you, as the nurse, perform right away? Why?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What medication should be the first one administered to this patient? Why? How often?

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Critical Thinking Check
Bloom's Taxonomy: Analysis

What is the significance of the ST-segment changes on Mr. Salazar's 12-lead EKG?

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Mr. Salazar’s chest pain was unrelieved after three (3) doses of sublingual nitroglycerin (NTG). Morphine 5 mg intravenous push (IVP) was administered, as well as 324 mg chewable baby aspirin. His pain was still unrelieved at this point

Mr. Salazar’s cardiac enzyme results were as follows:

CK 254 U/L

CK-MB 10%

Troponin I 3.5 ng/mL

Critical Thinking Check
Bloom's Taxonomy: Analysis

Based on the results of Mr. Salazar's labs and his response to medications, what is the next intervention you anticipate? Why?

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Mr. Salazar was taken immediately to the cath lab for a Percutaneous Coronary Intervention (PCI). The cardiologist found a 90% blockage in his left anterior descending (LAD) artery. A stent was inserted to keep the vessel open.

Critical Thinking Check
Bloom's Taxonomy: Comprehension

What is the purpose of Percutaneous Coronary Intervention (PCI), also known as a heart catheterization?

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Critical Thinking Check
Bloom's Taxonomy: Application

What is the expected outcome of a PCI? What do you expect to see in your patient after they receive a heart catheterization?

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Mr. Salazar tolerated the PCI well and was admitted to the cardiac telemetry unit for observation overnight. Four (4) hours after the procedure, Mr. Salazar reports no chest pain. His vital signs are now as follows:

 

BP 128/82 mmHg SpO2 96% on 2L NC

HR 76 bpm and regular RR 18 bpm

Temp 37.1°C

 

Mr. Salazar will be discharged home 24 hours after his arrival to the ED and will follow up with his cardiologist next week. 

Critical Thinking Check
Bloom's Taxonomy: Application

What patient education topics would need to be covered with Mr. Salazar?

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