Case Study - David Parker
1. Compile a health history for David
Patient is a 55-year-old male farmer lives in . Chest pain associated with S-T
elevation radiating to his left arm, neck, and teeth. He has a history of chest pain postexertion for two hours before collapsing. He is a known hypertensive but controlled, he has
Type 2 DM and hyperlipidaemia. Patient lives together with his wife.
2. Identify David’s cardiac risk factors
Non-modifiable
a. Age (55 years old)
Modifiable
a. Hypertension
b. Hyperlipidaemia
c. Type 2 Diabetes
3. Health history
a.
b.
c.
d.
e.
f.
Do you have any family members who have heart problems?
Do you smoke?
Have you experienced this before?
Have you had any heart surgery/problem before?
Do you have any food and drug allegies? If yes, what is the reaction?
Do you take maintenance medications and do you take it regularly?
4. Cardio and Respi assessment
a. Do primary assessment (DRSABCDE)
b. Do healthy history
c. Focused assessment (Inspection, Palpation, Auscultate)
a. Inspection - diaphoretic, ashen faced, weak-looking, in pain, tachypnoeic
b. Palpation - Check pulse rate (rate and rhythm)
c. Auscultation - Check for any abnormal heart sounds, check breath sounds for any
concomitant pulmonary problems
RN wants us to do a respiratory assessment to check for any concomitant pulmonary
problems.
5. Electrolytes such as potassium and calcium help trigger and send electrical impulses in
the heart. Electrolyte imbalance may interfere with the signals of the heart and lead to
irregular heartbeats.
6.
a. What type of medication is GTN? Nitrate.
b. Pharmacokinetics : provide exogenous source of nitric oxide.
c. How will it help with pain? It is a vasodilator which helps in reducing venous return
and preload to the heart reducing myocardial oxygen demand.
d. Assessment : ECG, blood pressure, complete blood count
Rationale : Hypotension is contraindicated in giving GTN, CBC to check for
anemia, ECG to check for any heart injury
e. Side effects: Headache, palpitation, orthostatic hypotension, fainting, peripheral
edoema
f. Education : Counselling
1. Patch - make sure that the area is clean and dry preferably at the chest area
or upper arm. Wear when symptoms of angina are most frequent. Make sure
to dispose of patches safely.
2. Sublingual - Use during episodes of angina or before an activity expected to
bring on angina. Sit or lie down before use as it may cause dizziness. Call an
ambulance if symptoms are severe, get worse quickly or last for 10 minutes.
https://amhonline-amh-netau.ap1.proxy.openathens.net/chapters/cardiovascular-drugs/drugsangina/nitrates/glyceryl-trinitrate
7. Review of David’s other regular drugs.
Medication
Drug class
Mechanism of action
Indication
Nursing
consideration
GTN
Nitrate
Provide exogenous
source of nitric oxide.
Angina
Check for
hypotension,
anemia
Morphine
Opiod
Act mainly at muopiod receptors in
the CNS, reducing
pain impulse.
Pain
Watch out for
respiratory
depression,
hypotension
Paracetamol
Acetaminophen
Inhibition of central
prostagalandin
synthesis.
Pain
Hepatotoxicity
Warfarin
Vitamin K
antagonist
Inhibits synthesis of
vitamin K dependent
clotting factors
VTE
prophylaxis
Risk of bleeding
Aspirin
Antiplatelet
Inhibits platelet
aggregation by
irreversibly inhibiting
cyclo-oxygenase.
ACS
Prophylaxis
Risk of bleeding
Clopidogrel
Antiplatelet
Inhibits platelet
aggregation.
ACS
Prophylaxis
Risk of bleeding
Atorvastatin
Statin
Inhibits HMG-CoA
reductase.
Hypercholes
terolemia
Watch out for
GI distrubances
Perondopril
8.
ACE inhibitors
Blocks conversion of
angiotensin I to
angiotensin II.
Hypertensio
n
Electrolyte
imbalance
Prepare an ISBAR handover for the nursing staff.
I - My name is ****. I am a student nurse. This is David Parke, 55yrs old admitted for ED,
complaining about chest pain.
S- David rated pain scale of 8/10. Tachycardic 108 bpm, RR, 24 breaths/min, O2 sat 95% on
room air, BP 150/90 mmhg, BGL 14.1 mmol/L
B- he collapsed at 1200 hours and the ambulance officer brought and they estimated his chest
pain started at 1000-hour. David has a history of Osteoarthritis, Hypertension,
Hyperlipidemia with Type 2 diabetes mellitus.
A- Upon admission in ED, he was pale and diaphoretic, alert and oriented, His ECG shows
ST elevation in the anterior leads. Morphine 2.5 mg via IV PRN, started rTPA and GTN
sublingual and transdermal for pain.
R- We need help to have him further assess his Cardiovascular and respiratory systems to
rule out the problems. Continue to monitor vital signs hourly, patient is considered falls risk,
follow up results for the CBC, UECs, VBG, CEs.
Reference:
GTN
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/cardiovascular-drugs/drugsangina/nitrates/glyceryl-trinitrate
Morphine
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/analgesics/drugs-painrelief/opioid-analgesics/morphine
Paracetamol
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/analgesics/drugs-painrelief/non-opioid-analgesics/paracetamol
Warfarin
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/bloodelectrolytes/anticoagulants/other-anticoagulants/warfarin
Aspirin
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/bloodelectrolytes/antiplatelet-drugs/other-antiplatelet-drugs/aspirin-antiplatelet
Clopidogrel
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/bloodelectrolytes/antiplatelet-drugs/p2y12-antagonists/clopidogrel
Atorvastatin
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/cardiovascular-drugs/drugsdyslipidaemia/statins/atorvastatin?menu=hints
Perindopril
https://amhonline-amh-net-au.ap1.proxy.openathens.net/chapters/cardiovasculardrugs/antihypertensives/ace-inhibitors/perindopril?menu=hints