Carl Shapiro PDF

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CONCEPT MAP WORKSHEET DESCRIBE DISEASE PROCESS AFFECTING PATIENT (Include Pathophysiology of Disease Process) Myocardial infarction (MI): a heart attack happens when a part or parts of the heart don’t get enough oxygen. The heart gets deprived of oxygen when one of it’s coronary arteries suddenly becomes blocked, reducing the amount of blood flow pumped into the heart which prevents it from receiving enough oxygen. An MI causes permanent damage either through coronary tissue death (necrosis), or scar tissue forming, this leaves the heart unable to pump blood as it should which can lead to Ischemia (decreased oxygen and nutrients due to insufficient blood flow). Ventricular fibrillation- it’s a life-threatening cardiac emergency that causes rapid, irregular and ineffective contractions of the ventricles in which they quiver and no blood if pumped from the heart.

DIAGNOSTIC TESTS (Reason for Test and Results) Continuos ECG- helps monitor for ischemic episodes (ST segment monitoring) Chest X-Ray- helps determine the severity of the MI. Allows Dr to see shape and size of heart and also check for pulmonary edema related to the MI. BMP, CBC, Troponin, CK-MB- Lab tests for biomarkers-- substances released into the blood with existing heart issues .

PATIENT INFORMATION Carl Shapiro Male DOB: 7/19/1966 (54y) Height: 175 cm Weight: 110 kg Allergies: No known Adm DX: Acute Myocardial Infarction Adm on: 2/27/2021

ANTICIPATED PHYSICAL FINDING Diaphoretic SOB Cool, moist skin w/ pale appearance ST elevation Elevated HR & RR (tachycardia & tachypnea) PT may experience chest pain, discomfort, jaw pain, left arm pain & anxiety

ANTICIPATED NURSING INTERVENTIONS Monitor continuos ECG Assess pain Auscultate lungs and heart, monitor vitals and O2 Monitor for SOB, dyspnea and crackles as this may signal pulmonary edema following the MI Administer nitroglycerin & other pain meds Administer oxygen Pt positioning (fowlers) to decrease chest discomfort and dyspnea Assess IV sites frequently- IO access is the route use for drug delivery in emergency situations when an IV access can’t be stablished

VSIM

ISBAR ACTIVITY

INTRODUCTION

Student Worksheet

RN Telemetry Unit

Your name, position (RN), unit you are working on

SITUATION

Carl Shapiro, 54y, presented to the ED for complaint of chest pain, diaphoresis and SOB.

Patient’s name, age, specific reason for visit

BACKGROUND Patient’s primary diagnosis, date of admission, current orders for patient

ASSESSMENT Current pertinent assessment data using head-to-toe approach, pertinent diagnostics, vital signs.

RECOMMENDATION

Admitted today Adm DX: Acute Myocardial Infarction Orders: N/S 25 mL/hour, Morphine IV push PRN Conitnious ECG and SpO2 monitoring Oxygen to maintain SpO2 >92% Chest X-ray BMP, CBC, Troponin, CK-MB Bed rest w/ bathroom priviledges Healthy heart diet

Vitals: HR 82 BP 122/73 RR 12 SpO2 97% Temp: 99 F Counscious state: appropriate ECG: sinus rhythm w/ anterior myocardial infarction

Physical activity

Dietary modification Any orders or recommendations you Follow medication therapy Smoking cessation may have for this Cardiac reha- helps educate and assists pt with safe exercise, diet choices, patient stress management

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: MORPHINE

CLASSIFICATION: OPIOID ANALGESICS

PROTOTYPE:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE 2 mg IV push PRN chest pain every 10 mins x3 as prescribed by physician

PURPOSE FOR TAKING THIS MEDICATION Pain management

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Take as directed, with water and food to avoid nausea, do not crush or chew. Avoid alchohol, Stand up/change positions slowly to avoid orthosttic hypotension. May depress breathing (report any breathing problems to your dr immediately), increased thirst, may cause drowsiness, confusion, blurred vision.

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: NITROGLYCERIN

CLASSIFICATION: VASODILATOR, NITRATES, ANTIANGINALS

PROTOTYPE:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE 0.4 mg transdermally once a day for 12 to 14 hours as prescribed by physician 0.6 mg sublingually every 5 minutes as needed, up to 3 doses

PURPOSE FOR TAKING THIS MEDICATION To treat chest pain by increasing blood flow through vasodilation (relaxing/widening the blood vessels to increase blood flow) and decreasing the heart’s demand for oxygen

PATIENT EDUCATION WHILE TAKING THIS MEDICATION

Sublingual pills go under the tongue, don’t chew or crush. Max 3 pills with 5 min intervals in between. May cause hypotension, change positions/get up slowly. May cause dizziness, blurred vision, dry mouth. No alcohol. Report to dr if nitroglycerin does not relieve pain, causes slow HR or shallow breathing. Transdermal patch- apply once a day in the morning. Rotate sites. Avoid hairy areas

PATIENT EDUCATION WORKSHEET NAME OF MEDICATION, CLASSIFICATION AND INCLUDE PROTOTYPE MEDICATION: ASPIRIN

CLASSIFICATION: NONOPIOID ANALGESIC, ANTIPYRETIC

PROTOTYPE:

SAFE DOSE OR DOSE RANGE, SAFE ROUTE 320 mg once orally as initial dose

PURPOSE FOR TAKING THIS MEDICATION To prevent blood clots

PATIENT EDUCATION WHILE TAKING THIS MEDICATION Take with food and water as instructed. May cause stomach discomfort, nausea, prolonged bleeding time

Nursing Narriative Note: Include initial head to toe assessment which includes Mentation/LOC, eyes, ears, scalp, skin, neck, heart, lungs, abdomen, pelvic, peripheral, ortho, gait. Date/time Carl Shapiro, 54 YOM was seen today in the ED for treatment of chest pain accompanied by dyspnea and diaphoresis. Treatment for his chest pain included aspirin therapy and two doses of sublingual nitroglycerin. Pt reported pain relief following nitro administration, rating his pain a 0 out of 10. Per physician’s orders, IV infusion of NS was started and labs were drawn. Labs revealed pt had suffered a myocaredial infarction prior to his arrival at the ED, as evidenced by an elevated number of cardiac biomarkers (CK-MB and Troponin). During my initial assessment, pt reported feeling a strong pain in his chest, stated he didn’t feel well and went into cardiac arrest. Code team was activated and CPR was started. AED determined shock was needed, continued CPR until pt spontaneauly regained his breathing.

_ NURSING DIAGNOSIS: Pain, acute. Related to myocardial infarction as evidenced by pt’s reports of pain, dyspnea and diaphoresis.

GOAL: relief of chest pain and establish stable rhythmic heartbeat OUTCOME CRITERIA

NURSING ORDERS

RATIONALE

DOCUMENTATION/ EVALUATION

1.pt will report pain is relieved

2. follow prescribe medication order

3. educate pt on relaxation techniques that may help alleviate discomfort

Monitor non verbal pain and changes in BP

Pts may not specifically verbalize their pain but rather express it through their behavior

Review pt cardiovascular hx and compare to previous chest pain episodes

May help distinguish pain source and also identify worsening or progression of a pre existin condition

1.administer supplemental O2 via nasal cannula

Makes more oxygen available to the heart which might help relieve discomfort

2.administer medications as indicated

Nitroglycerin helps control pain by its vasodilating effects which decreases heart’s o2 demand

1. assist pt in performing relaxation techniques like deep breathing

May positively affect pt’s response to pain or decrease pt’s perception of it. Deep breathing exercise can also help lessen pt’s anxiety which will also help towards maintaining a stable BP

Pain may cause RR to increase due to the pain and anxiety, thise will also increase pt’s BP

Pt reported no pain after taking aspirin and nitro. Rated his pain as a 0 out of 10

CLINICAL WORKSHEET Dat 02/27/2021 e:

Initia ls:

CS

Ag 54 e: M/ M F: Code Status:

Student Name:

Diagnosis: ACUTE MYOCARDIAL INFARCTION

HCP:

Length of Stay: 1 DAY

Assigned vSim:

Isolation: NO

IV Type: RIGHT

Fall Risk:

Location:

Consults: Allergies: NO KNOWN

Transfer:

FULL

Fluid/Rate:

Carl Shapiro

Critical Labs: CKMB-20 TROPONIN2.2 HCO3- 18

Other Services Smoking cessation support group

Consults Needed: CARDIAC REHAB DIETICIAN

N/S 25 ML/HR

Why is your patient in the hospital (Answer in your own words and include the History of present illness)? PT came into the ED with complaint of chest pain, SOB and diaphoresis. Pt reported not feeling any pain following aspiring and nitroglycerin rated his painrelate a 0 on to a scale of 0 10 Pt developed V Fib shortly after and went into cardiac Health History/Comorbidities (that this hospitalization): Hx of coronary artery disease, hypertension and angina. Current smoker, smokes ½ pack a day. Drinks 1-3 drinks a week Shift Goals/ Patient Education Needs: 1. Manage pain 2. Maintain BP and cardiac output w/in normal range 3. Pt’s O2 saturation will remain at or >92% 4. Eduate patient of disease process, and recommended life style changes to improve pt condition or help slow down disease progression

Path to Discharge: Pt will have a stable heart beat, absence of chest pain and normal biomarker levels upon discharge

CLINICAL WORKSHEET Alerts: What are you on Alert for with this patient? (Signs & Symptoms) 1. Angina, cardiac arythmias 2. Dyspnea, productive cough w/ blood tinged frothy sputum , cold clammy skin, cyanosis 3. Rapid weight gain, elevated BP

Management of Care: What needs to be done for this Patient Today? 1. Monitor ECG 2. Monitor SpO2 saturation 3. Patient education 4. Pain management 5. Monitor for possible complications/prevention

What Assessments will you focus on for this patient? (How will I identify the above signs & symptoms?) 1. ECG 2.

Auscultate lungs (crackles), chest x-ray, assess respiration, pulse ox

3.

Weigh daily, monitor input/output

List Complications may occur related to dx, procedure, comorbidities: 1. Cardiac arrest 2.

Pulmonary edema

3.

Fluid overload/hypervolemia

What nursing or medical interventions may prevent the above alert or complications? 1. Obtain a 12-lead ECG if pt experiences angina. 2.

Pt medication to prevent clotting that could lead to a

Priorities for Managing the Patient’s Care Today 1. 2. 3.

Monitor continuos ECG, identify any disrythmias Monitor O2 levels, ensure it remains at or >92 to prevent further taxing the heart Pain management

What aspects of the patient care can be Delegated and who can do it? 1. Nurse aid can help position pt as needed, can also assist with ambulation to the bathroom 2. Lab tech can draw labs

myocardic ischemia, which could further lead to pulmonary edema. 3.

Offer and educate on low sodium diet. Administer diuretic

3....