Kiana Iglesia
Question 1: What interventions do you anticipate being ordered by the provider?
Interventions that should be anticipated by the provider are getting X-rays, and an EKG and
auscultate the patients chest to see if they can catch anything that may be heard as abnormal.
Question 2: What medication should be the first one administered to this patient? Why? How
often?
-The medication that should be the first to be given is Nitroglycerin. This will treat the chest pain
he is experiencing. 1 tab should be given and may be placed under the tongue or between cheek
and gum. This may be used every 5 mins up to at least 15 mins.
Question 3: What is the significance of the ST-segment changes on Mr. Salazar's 12-lead EKG?
-A blockage .
Question 4: Based on the results of Mr. Salazar's labs and his response to medications, what is
the next intervention you anticipate? Why?
-As the nurse I will keep up with my patients ABCs and by doing that I will administer oxygen
and manage their oxygen saturation through their pulse ox due to Mr. Salazar complained of
chest pain and having a pale tone which can indicate lack of blood flow as evidenced by his
shortness of breath.
Question 5: What is the expected outcome of a PCI? What do you expect to see in your patient
after they receive a heart catheterization?
-The expected outcome for PCI is to discover a blocked blood vessel that can be lethal to the
patient's health. I expect the patient to be very weak and tired after a heart catheterization
ARTICLE
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).
Question 1: What interventions do you anticipate being ordered by the provider?
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:
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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%.
Question 2: What medication should be the first one administered to this patient? Why? How
often?
Question 3: What is the significance of the ST-segment changes on Mr. Salazar's 12-lead EKG?
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.
His cardiac enzyme results were as follows:
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CK 254 U/L
CK-MB 10%
Troponin I 3.5 ng/mL
Question 4: Based on the results of Mr. Salazar's labs and his response to medications, what is
the next intervention you anticipate? Why?
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.
Question 5: What is the expected outcome of a PCI? What do you expect to see in your patient
after they receive a heart catheterization?