MS -10-Melody Dixson PDF

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Simulation Admission Ticket

Session: NUR 201 Scenario: Myocardial Infarction/Management of Stable Patient MS-10-Melody Dixon-Myocardial Infarction/Management of Stable Patient OBJECTIVES:  

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Date:

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Instructor:

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Admission Ticket Grade: Medication Card Grade: Average:

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Discuss current nursing research and its relationship to clinical practice with individual’s experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems (SLO- 2) Recognize and respect the individual’s and family’s cultural beliefs when providing nursing care. (SLO 3, 6) Apply knowledge from the health sciences and humanities in the care of adults experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems. (SLO – 1,2,) Demonstrate effective communication skills with individuals, families, peers, and other health care providers. (SLO – 3, 6) Develop, implement, and evaluate individualized teaching plans for individuals in acute and community based settings. (SLO -4, 5, 6) Collaborate with individuals, families, and other health care providers in planning and implementing nursing care. (SLO - 6 ) Identify legal and ethical issues having impact on the care of individuals experiencing surgery, and sensory, immunologic, integumentary, acid-base, and oxygenation problems. (SLO - 7 ) Demonstrate responsibility and accountability in the provision of nursing care. (SLO -7, 8)

Please review the following PRIOR to your simulation experience: Medical Surgical Nursing Textbook Page 720 Clinical Manifestations of MI Page 721 Diagnostic Studies Page 726 Nursing Management of ACS Page 727 Nursing Implementation of ACS Page 725 Drug therapy

MEDICATIONS:

Metoprolol 5 mg IV x 1 dose, Nitroglycerin 0.4 mg every 5 minutes SL x 3 doses, Morphine sulfate 2 mg IV every 15 minutes x 3 doses

Answer these questions prior to Simulation Session (Attach answers to this ticket for admission to simulation session. Without this ticket and completed questions you will not be allowed to participate in the scheduled scenarios). 1. 2. 3. 4. 5. 6.

What questions should the nurse ask a patient having problems with chest pain? Why is pain management vitally important for this patient? Based on the EHR history and physical, what are the health promotion areas that need to be addressed? What predisposed this patient to coronary artery disease? What diagnostic studies assist in diagnosing acute myocardial infarction (AMI)? What priority nursing intervention should be implemented for the management of a patient with AMI?

Simulation Admission Ticket 1. What questions should the nurse ask a patient having problems with chest pain? Questions that should be asked to a patient having problems with chest pain would include: Describe the location of the pain. Does the pain radiate to other areas of the body? Rate your pain on a scale of 0-10. What were you doing before the pain started? 2. Why is pain management vitally important for this patient? Pain management is vitally important because it interrupts the infraction process. This can allow the heart’s arteries to relax so that blood can flow easily through the narrowed spaces. 3. Based on the EHR history and physical, what are the health promotion areas that need to be addressed? Based on the HER history and physical, the areas of health promotion that need to be addressed would include: Reports that she cannot tolerate much exercise because she "tires easily." Feels "indigestion" with onset yesterday evening. Discomfort constant but varies in intensity. Gastroesophageal reflux for 3 years. Diabetes is being well managed and blood sugar levels are staying within normal range.

4. What predisposed this patient to coronary artery disease? Patient has an increase in B/P as well as having type 2 diabetes. Patient also has gastroesophageal reflux. “GERD and coronary heart disease (CHD) can interact with each other to produce chest pain. Studies have shown that esophageal stimulation can cause cardiac pain by inducing cardiac dysrhythmia or coronary spasm to compromise coronary blood flow” (Chien-Hua Chen, MD, MPH, Cheng-Li Lin, MSc, and Chia-Hung Kao, MD. 2016)

Chien-Hua Chen, MD, MPH, Cheng-Li Lin, MSc, and Chia-Hung Kao, MD. July 2016. US National Library of Medicine National institutes of Health. “Association between gastroesophageal reflux disease and coronary heart disease A nationwide population-based analysis” Retrieved on 05/31/2021 https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5058831/

Simulation Admission Ticket 5. What diagnostic studies assist in diagnosing acute myocardial infarction (AMI)? Diagnostic studies that would assist in diagnosing AMI would include blood studies (biomarkers, Lipids, C-reactive protein, Homocysteine, Cardiac Natriuretic peptide markers), ECG, Event monitor or loop recorder, 6. What priority nursing intervention should be implemented for the management of a patient with AMI? Monitoring vital signs and O2 every hour, Obtain 12 lead ECG (and monitor) and draw serial cardiac biomarkers. Maintain bed rest and limit activity for 12 to 24 hours. Pain management with NTG. Morphine, and supplemental O2 as needed. Reduce anxiety, emotional, and behavioral reactions....