Nursing 384: Nursing Care of Adults with Acute and Episodic Conditions Case Study: Mr. Love Scenario It is midmorning on the cardiac unit where you work, and you are getting a new patient. Mr. Love is a 60-year-old cement pourer, who is married and has three teenage children. As you take his health history, he tells you that he began feeling changes in his heart rhythm about 10 days ago and this morning had some tightness in his upper back. He has hypertension (HTN) and a 5year history of angina pectoris. During the past week he has had frequent episodes of mid-chest “discomfort.” The chest pain has awakened him from sleep but does respond to sublingual (SL) nitroglycerin (NTG), which he has taken about 8 to 10 times over the past week. During the week he has also experienced increased fatigue. He states, “I just feel crappy all the time anymore.” A cardiac catheterization done several years ago revealed 50% stenosis of the right coronary artery (RCA) and 50% stenosis of the left anterior descending (LAD) coronary artery. He tells you that both his mother was diagnosed with coronary artery disease at age 50, and his father died of a myocardial infarction at age 39. He is taking amlodipine, metoprolol, atorvastatin, and baby aspirin 81 mg/day. FOR THIS CASE STUDY, ANSWER EACH QUESTION. THIS IS IMPORTANT MATERIAL THAT ALL STUDENTS SHOULD UNDERSTAND. 1. What other information are you going to ask him about his episodes of chest pain? Initial group answer: Reviewer group answer: 2. What are common sites for radiation of ischemic cardiac pain? Initial group answer: Reviewer group answer: Pc 8.9.20 1 3. Which of the following anginas does Mr., Love have: Prinzmetal’s, microvascular, or unstable angina? Initial group answer: Reviewer group answer: 4. Give a brief definition of each of the anginas listed in #3. Initial group answer: Reviewer group answer: 5. You know that Mr. Love has atherosclerosis of the coronary arteries, but he has not told you about his risk factors. You need to know his risk factors for coronary artery disease (CAD) in order to plan teaching for lifestyle modifications. What will you ask him about? Initial group answer: Reviewer group answer: 6. Although he has been taking SL NTG for a long time, you want to be certain he is using it correctly. What information would you need to make certain he understands regarding the side effects, use, and storage of SL NTG? Initial group answer: Reviewer group answer: Pc 8.9.20 2 CASE STUDY PROGRESS When you first admitted Mr. Love, you placed him on telemetry and observed he was in atrial fibrillation (A-fib) at a rate of 120 and a BP of 86/60. He was given a diltiazem continuous drip for the a-fib and his cardiac rhythm changed to a bradycardic rhythm. He became dizzy and hypotensive. 7. What risks does bradycardia pose to Mr. Love? Initial group answer: Reviewer group answer: 8. What are your immediate interventions? Initial group answer: Reviewer group answer: CASE STUDY PROGRESS Mr. Love’s labs come back showing an elevated troponin level and his subsequent EKGs show ST elevation. He is taken to the cath lab for a percutaneous coronary intervention (PCI) and has 2 stents inserted. 9. List priority nursing interventions for Mr. Love before PCI and after PCI. Initial group answer: Reviewer group answer: Pc 8.9.20 3 CASE STUDY PROGRESS He recovers without incident in the ICU and is discharged home. 10. Mr. Love wants to return next to work. What discharge instructions do you anticipate giving Mr. Love in relation to work? Initial group answer: Reviewer group answer: 11. Identify technology that you can recommend to Mr. Love at the time of discharge that may assist him to know his physical activity limits? Are there any special considerations to these technologies if patients are taking a beta blocker? Initial group answer: Reviewer group answer: 12. What information regarding sexual activity will you include in the teaching plan to the patient and his partner after an acute coronary syndrome? Initial group answer: Reviewer group answer: End of Case study Thank you Initial group students’ name who participated in the discussion: Reviewer group students’ name who participated in the discussion: Pc 8.9.20 4