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Lab assignment for Jack Schustun case data...

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DOCUMENTATION LAB ASSIGNMENT: JACK SCHUSTUN

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Based on the current acute situation as outlined in the case study on Docucare, what diagnostic tests does the RPN anticipate the physician to order for Mr. Schustun? 1. 12-lead Electrocardiogram 

The physician want to assess the electrical activity of Mr. Schustun’s heart to see if a myocardial infarction has occurred or is developing. The electrocardiogram also allows the doctor to monitor and assess any changes to his heart rhythm (American Heart Association, 2017).

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After an MI, there are characteristic changes that would appear an ECG. If Mr. Schustun has suffered from an MI, the doctor would expect to find T-wave inversion, ST-segment elevation, and a possible Q-wave. These characteristics are evidence of myocardial ischemia, injury and infarction (Timby & Smith, 2014, p. 395).

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The doctor would order this test to either confirm that a myocardial infarction has occurred, or rule it out.

2. Chest X-ray 

In order for the doctor to determine the cause of the chest pain, he might order a chest x-ray. A chest x-ray would allow the doctor to assess the size of Mr. Schustun’s heart, his blood vessels as well as his lungs (American Heart Association, 2017). This would allow the doctor to assess whether the heart is enlarged, or if there is fluid accumulating in Mr. Schustun’s lungs as a result of a myocardial infarction.

3. Blood work to assess Serum Cardiac Markers 

In order to diagnose a myocardial infarction, lab tests need to be done to assess a series of serum cardiac markers; when myocardial infarction occurs, the damaged myocardial cells release these substances into the bloodstream (Timby & Smith, 2014, p. 395). Serum cardiac markers after an MI include: myoglobin, troponin T,

DOCUMENTATION LAB ASSIGNMENT: JACK SCHUSTUN

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troponin I, creatine kinase and its isoenzyme CK-MB, asparate aminotransferase, lactate dehydrogenase and its enzymes LDH1 and LDH2 (Timby & Smith, 2014, p. 395). 

These serum markers are present in different levels, depending on when the myocardial infarction occurred. By determining the levels of these markers, the health care team will be able to assess whether the patient has suffered an MI, when the MI occurred, and treat the patient accordingly.

Based on the current information provided, what treatment would the health care team initiate at this time? 1. Administer nitroglycerin 

Nitroglycerin relaxes the arterial and venous smooth muscle, and results in vasodilation. This reduces the amount of blood returning to heart, and consequently the ventricles have less blood available to pump. This reduces cardiac output and the workload of the heart, which lowers myocardial oxygen demand (Adams et al., 2010, p. 290).

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Nitroglycerin alleviates the chest pain associated with angina.

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Nitroglycerin improved blood flow through the coronary arteries, and also lowers the blood pressure (Timby & Smith, 2014. p. 400).

2. Administer oxygen 

The pain Mr. Schustun is experiencing may be due to diminished myocardial oxygenation.

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By supplying him with extra oxygen, it will raise hemoglobin saturation and oxygen in plasma. Adequate oxygen to myocardial tissue diminishes angina (Timby & Smith, 2014, p. 400).

3. Administer morphine sulfate

DOCUMENTATION LAB ASSIGNMENT: JACK SCHUSTUN 

Morphine reduces perception of pain (Adams et al., 2010, p. 219).

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Morphine reduces anxiety, which can decrease the heart rate and blood pressure

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(Timby & Smith, 2014, p. 400). This will help alleviate the heart’s demand for oxygenation (Timby & Smith, 2014, p. 400). What are the predisposing factors for Jack’s Coronary Artery Disease? 1. Physical Inactivity 

Jack’s chart states he is physically active only once per week, when he plays golf with his friends.

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Physically inactive people have lower HDL levels and higher LDL levels which increases clot formation.

2. Previous Smoking History 

Although he has quit, Jack smoked 0.5 packs per day for 20 years.

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Tobacco use increases the risk of coronary artery disease two to six times more than non-smokers.

3. Age 

The risk for developing coronary artery disease increases after age 45 for men (NIH, 2016).

4. Unhealthy Diet 

Mr. Schustun’s stated that since his wife died, he eats out a lot. “"I don't pay much attention to my diet really. My wife used to make most of the meals - I miss that."

5. Stress 

Mr. Schustun’s wife died two years ago.

DOCUMENTATION LAB ASSIGNMENT: JACK SCHUSTUN References Adams, M., Holland, L., Bostwick, P., King, S., (2010). Pharmacology for Nurses: A Pathophysiological Approach. Toronto, Ontario: Pearson Canada. American Heart Association. (2017). Heart Attack: Non-Invasive Tests and Procedures. Retrieved July 23rd from, https://www.heart.org/HEARTORG/Conditions/HeartAttack/DiagnosingaHeart Attack/Non-Invasive-Tests-and-Procedures_UCM_303930_Article.jsp National Heart, Lung, and Blood Association. (2016). Who is at Risk for Coronary Artery Disease? Retrieved July 23rd from, https://www.nhlbi.nih.gov/health/healthtopics/topics/cad/atrisk Timby, B., Smith, N., (2014). Introductory Medical-Surgical Nursing (11 ed.). Philadelphia, PA: Wolters Kluwer

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