CASE STUDY #2 Week 1
Read the case study, answer the questions, and write nursing diagnosis as
directed. You can work together as a group. Use a concept map format for the
nursing diagnosis.
A 59 year old black female is admitted at midnight with a diagnosis of Chest Pain. She
complains of a squeezing type pain across her chest and into her left jaw area. Vital
signs are: Blood Pressure-200/110; Pulse-128 beats per minute; Respirations- 26 per
minute; Temperature-99.8; Saturation of Oxygen-86% on room air; pain level 9/10.
During your initial assessment she is rubbing her mid-chest, grimacing and is
diaphoretic. The pain has been occurring intermittently throughout the evening and
night. Her color is pale except around her lips which are bluish. Cardiac auscultation
reveals a rapid regular rhythm and a murmur, no pulse deficit. She has never had this
pain before. Lungs sounds are crackles in both bases with clear upper lobes. She is
afraid she is going to die. Per standing orders, a nurse administers & administers
Nitroglycerine 0.4mg sublingually; applies cardiac electrodes for continuous cardiac
monitoring; obtains an electrocardiogram; places a peripheral intravenous catheter with
saline lock; positions patient in low Fowlers. On assessment vital signs are Blood
Pressure-180/95; Pulse-108 beats per minute; Respirations- 22 per minute;
Temperature-99.0; Saturation of Oxygen-90% on 2 liters per minute; Pain level 8/10.
She says her chest pain hasn’t changed. Heart and lung sounds are unchanged. Color
is pale without previous blue changes.
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Is the type of pain this patient is having typical or atypical of cardiac type of chest
pain.
What other types of pain would indicate a cardiac type problem but would not be
specifically in the chest area?
Describe how women often present with cardiac problems and how they are
different from men.
What health history information would the nurse assess after the patient's pain is
gone.
What abnormals are present in the patient's vitals signs (first set)?
What statements by the patient depict extreme anxiety and feelings of doom?
What labs would be drawn for this patient that would identify if the pain is from
cardiac origin?
What would the results be if the patient is having cardiac damage?
A provider orders Aspirin 81 mg x 3 tabs by mouth chewed. What is the rationale for
this order?
What is the reason for the diaphoresis?
The patient's skin color is abnormal, describe this in medical terms?
Does this patient need oxygen? If so what type of oxygen administration device
would be applied and what rate of flow?
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Describe how you assess JVD in this patient?
What results would indicate that the patient has JVD?
If JVD is present this would indicate right or left sided heart failure?
The patient has lung crackles: Is this right or left sided heart failure?
What type of heart sound would the nurse listen for to indicate that the patient might
have left sided failure?
A nurse would expect the provider to order what type of medication if the patient has
congestive heart failure?
Describe the rationale for your answer as well as what labs you would check before
you give this medication?
The nurse administers one nitroglycering tablet sublingually. What will this
medication do for this patient? What side effects will the nurse have to assess for
and manage?How many doses of Nitroglycerin can be given and within what time
period? The pain assessment must be conducted before and after each dose. The
desired outcome is for the pain to decrease.
Identify and prioritize the problem list for this client.
Use the data in the case study to write 2 nursing diagnosis (include and prioritize 2three part assessment diagnoses w/at least 4 interventions each)