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Question Description

Part IV

Mr. Smith is brought in by ambulance for complaints of unrelieved chest pain.

Patient:Mr. Smith

Age:56 years old

Chief Complaint:“My chest is hurting really bad and my nitroglycerin did not work this time. I feel like I can’t breathe and like I am going to pass out.” (He is pale and diaphoretic.) I took three NTG at home 5 minutes apart. When that didn’t work my wife called the ambulance.

Assessment: BP 182/90. HR 112. RR 26. T 98.6F. O2 sat 86% on RA. Weight: 280lbs (BMI 38 kg/m2).

12 lead: ST- segment elevation

PMH:Usually my chest pain goes away after I rest on my couch. But today, it started when I was just sitting around watching TV. I was already here in the hospital visiting a friend, and I only had one nitro with me. I took it but it didn’t help at all. It’s hurting so bad I can hardly talk. I feel like I can’t breathe. It starts in the middle of my chest, goes all the way down my arm, and even up my neck into my jaw. I am so scared.

The physician diagnosis Acute Coronary Syndrome (ACS).

The ACS protocol is immediately initiated.

I: IV access

M: morphine (reduces preload and afterload. Relieves anxiety and pain) and monitor (obtain a 12-lead and start continuous tele)

O: oxygen (2-4L/min to keep saturation >95%. Position in upright position)

A: aspirin (chewable 325mg)

N: nitro (S/L nitro)

S: statin (within 24 hrs.)

The first line of treatment is percutaneous transluminal coronary angioplasty(PTCA) and must be done within 90 minutes of arrival.

The PTCA is successful and the patient is transferred to the cardiac care unit. After a week the patient is ready for discharge. Please discuss the patient teaching on the following topics:

  1. Cardiac diet.
  2. Rationale for outpatient cardiac rehabilitation.
  3. Pulse taking; what is the maximum heart rate.
  4. Sexual activity.
  5. Discuss what members of the interdisciplinary health care team would be part of his discharge planning.

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