Client Profile Case Study Mrs. Darsana was sitting at a family cookout at approximately 2:00 P.M. when she experienced w

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Client Profile Case Study Mrs Darsana Was Sitting At A Family Cookout At Approximately 2 00 P M When She Experienced W 1 (66.02 KiB) Viewed 43 times

Client Profile Case Study Mrs Darsana Was Sitting At A Family Cookout At Approximately 2 00 P M When She Experienced W 2 (52.7 KiB) Viewed 43 times

Client Profile Case Study Mrs. Darsana was sitting at a family cookout at approximately 2:00 P.M. when she experienced what she hater describes to the nurse as nutise with some heartburn." Assuming the discomfort was because of something she ate, she dismissed the discomfort and took Tums. After about two hours, she explains, "My heartburn was not much better and it was now more of a dull pain that seemed to spread to my shoulders. I also noticed that I was a little short of breath." Mrs. Darsana told her son what she was feeling. Concerned, her son called emergency medical services En route to the hospital, emergency medical personnel established an intravenous access. Mrs. Darsana was given four children's chewable aspirins and three sublits. gual nitroglycerin tablets without relief of her chest pain. She was placed on oxygen 2 liters via nasal cannula. Upon arrival in the emergency department, Mrs. Darsana is very restless. She states, "It feels like an elephant is sitting on my chest" Her vital signs are blood pressure 160/84, pulse 118, respiratory rate 28, and temperature 99.5F (57.4°C). Her oxygen saturation is 98% on 2 liters of oxygen. A 12-lead elec trocardiogram (ECG, EKG) shones senus tachycardia with a heart rate of 120 beats per minute. An occasional premature ventricular contraction (PVC). Twave inversion, and ST segment elevation are noted. A chest X-ray is within normal limits with no signs of pulmonary edema. Mrs. Darsana's laboratory results include potassium (K) 10 mEq/L, magnesium (Mg) 1.9 mg/dL, total creatine kinase (CK) 157/L CK-MB 7.6 ng/ml. relative index 1.8%. and troponin 12,8 ng/mL. Her stool tests negative for occult blood. Questions 1. What are the components of the initial nursing Z Identify which of Mrs. Darsana's presenting assessment of Mrs. Darsana when she arrives in the symptoms are consistent with the profile of a client emergency department? who is having an MI 2. Mrs. Darsana has a history of unstable angina. 8. The nurse overhears Mrs. Darsana's son asking Explain what this is his mother sternly. "Mom. Why didn't you tell me 3. Briefly discuss what causes an M1. Include in the that you were having chest pain sooner? You should discussion the other terms used for this diagnosis have never ignored this. You could have died right 4. The nurse listens to Mrs. Darsana's heart sounds there at my house." How might the nurse explain Mrs. Darsana's actions to the son? to see if S, S, or a murmur can be heard. What would the nurse suspect if these heart sounds were 9. Provide a rationale for why Mrs. Darsana wa heard? given sublingual nitroglycerin and aspirin en route 5. What factors are considered when diagnosing an to the hospital acute myocardial infarction (AMD 10. Briefly discuss the laboratory tests that are sig 6. Besides her unstable angina, what factors nificant in the determination of an acute myocardial increased Men. Daruna's risk for an MI? infarction (AMI) 11. Laboratory results follow April 1 at 1645 Toul CK - 216 units/L. CK-MB - 5.6 ng/mL relative index = 2.2% Troponin 1 = 2.8 mg/ml April 2 at 0045 Total CK = 242 units/L. CK-MB = 8.1 ng/ml relative index = 3.3% Troponin I = 52 ng/ml
CASE STUDY 6 MRS. DARSANA Questions (continued) April 2 at 0615: Total CK = 298 units/L. CK-MB = 9.2 ng/ml. relative index = 3.0% Troponin I = 4.1 ng/ml April 3 at 0615: Total CK = 203 units/L CK-MB = 6.1 ng/ml. relative index = 3.0% Troponin I = 1.7 ng/ml Are Mrs. Darsana's laboratory results consistent with those expected for a client having an acute myocardial infarction? 12. Describe four pharmacologic interventions you 16. Rank the following five nursing diagnoses for anticipate will be initiated/considered during an Mrs. Darsana in priority order. acute MI. • Decreased Cardiac Output related to (1/1) 13. Identify five criteria that could exclude an indi- ineffective cardiac tissue perfusion secondary vidual as a candidate for thrombolytic therapy with to ventricular damage, ischemia, dysrhythmia. a tissue plasminogen activator (tPA). • Deficient knowledge (condition, treatment, 14. An echocardiogram reveals that Mrs. Darsana prognosis) r/t lack of exposure, unfamiliarity has an ejection fraction of 50%. How could with information resources. the nurse explain the meaning of this result to • Risk for Injury r/t adverse effect of pharmaco Mrs. Darsana logic therapy. 15. Identify three appropriate nursing diagnoses • Acute Pain T/t myocardial tissue damage from for the client experiencing an AMI. inadequate blood supply. • Fear r/t threat to well-being.