Question

You are working as a nurse in the ED when a 42-year-old female comes in complaining of chest discomfort. Although she states that she has been experiencing this discomfort “on & off” for a couple of weeks, today it is much worse. She says that today she has also been anxious, fatigued and nauseated. Other than that, she is vague about her symptoms and hesitant to get into a hospital gown. When you question her about her pain, she is very timid and appears afraid to answer your questions. When she finally agrees to change into a gown, you notice that she has bruises, in various stages of healing across her anterior chest wall. You ask her how she got the bruises…she states “she is clumsy and always running into the shelf in her pantry”. Her husband is in the room, appears frustrated and tells you that he thinks that she is just complaining of pain to get attention.

Patient’s vital signs are:

• BP = 104/62
• HR = 88
• RR = 20
• T = 100.4
• O2 sat = 98% on room air
• Pain = States pain 2/10 when husband in room but when he steps into hall, she confesses that it is closer to 7/10

Test results:

• Her EKG shows ST elevation in leads II, III, AVF Hct/HgB = 39.3/13.1
• CK = 292
• CK/MB = 6%
• Troponin I = 4.2
• Sodium = 142
• Potassium = 3.1
• Glucose = 186
• BUN/CR = 8/.8

Question: You are working at a small community hospital that does not have a cardiac catheterization lab. Therefore, the physician can only treat this patient medically. If this hospital had a cardiac cath lab, what are some of the interventions that may be done to treat this patient? List 4 interventions

Answer 1

Some of the intervention which can be done to treat this patient are

• The patient will be taken for cardiac catheterization and a angioplasty would have been performed to relieve any block
• Similarly the patient can be placed with a stent to relieve the block in the cardiac blood vessels
• The procedure like fraction flow reserve and intravascular ultrasound can be done to rule out the block by pressure and measure the intensity in the blood vessels
• Thrombolytic treatment will be done to relieve the block by dissolving the clot