Question

A 70 year old man has been having periods of chest pain and pressure that have been ignored until he became SOB and diaphoretic with the episode of chest pain. The patient called 911 and was taken via ambulance to the emergency department.

1. As his ED nurse, what is your first action in response to his report of chest pain? What evidence supports this decision.
2. The provider prescribes nitroglycerin for pain. What assessment will you perform before administering this drug and why? What administration route would you anticipate?
3. What other drugs might the provider prescribe at this time and why?
4. The patient's ECG indicated ST elevation and troponins are elevated. What does the nurse anticipate in the care of this patient?
5. What will you document in the electronic health record about this patients care?

Answer 1

As the patient complains of chest pain, SOB and excessive sweating, my first reaction will be to provide 1 adult aspirin, 325 mg, after ensuring that the patient is not allergic to it. If the patient becomes unconscious, I will perform CPR. The reason for providing aspirin is to avoid blood clotting and easy flow. Also, as the patients complain SOB, there are chances of patient becoming unconscious.

AS per the given data the provider prescribes nitroglycerin (NTG) for pain. The first assessment which I will make before administering NTG will be to check the blood pressure and pulse of patient and hold the dose if there is any abnormality in the blood pressure values, since every dose of NTG may cause unexpected drop in blood pressure.

Normally NTG is administered orally as a tablet, which gets absorbed sublingually. But in emergency situation, I will anticipate an intravenous route as 5% dextrose in water drip to administer NTG. Acetaminophen can generally be given after NTG if there is a complain of headache.

As the ECG suggests an elevated ST and troponins are elevated, the role of nurse is critical. The nurse should religiously monitor vitals like blood pressure, pulse rate. The nurse should also assess the pain relieving after medication, nausea, vomiting, SOB. The intravenous sites should also be observed time and again. The patient should be encouraged by providing education related to self care, should be provided proper bed rest and change in positions and sticking to dietary plan.

The electronic health record shall include the patients history of any similar condition, the diagnosis of patient in present case, medications provided, ECG details and condition of patient post therapy.