Question

Brief Patient History

Mrs. G is a 54-year-old African American woman who has been having intermittent indigestion for the past month. She has a history of hypertension and hyperlipidemia. She was admitted as an inpatient on a medical floor for management of her blood pressure and is scheduled to undergo endoscopy tomorrow. Mrs. G suddenly becomes diaphoretic and complains of nausea and epigastric pain.

Clinical Assessment

The rapid response team is called to evaluate Mrs. G. When the team arrives at her bedside, she continues to complain of pain, which now radiates to her neck and back. She has some slight shortness of breath and is vomiting.

Diagnostic Procedures

The admission electrocardiogram (ECG) shows ST-segment elevation in II, III, and AVF.

Baseline vital signs include the following: blood pressure of 160/90 mm Hg, heart rate of 98 beats/min (sinus rhythm), respiratory rate of 18 breaths/min, temperature of 99°F, and O₂ saturation of 94%.

Medical Diagnosis

Inferior myocardial infarction is diagnosed

1. What major outcomes do you expect to achieve for this patient?

2. What problems or risks must be managed to achieve these outcomes?

3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

4. What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?

5. What possible learning needs do you anticipate for this patient?

Answer 1

Myocardial infarction

1. What major outcomes do you expect to achieve for a patient?

• Relief of pain or ischemic signs (eg: ST segment changes) and symptoms
• Prevention of myocardial damage
• Absence of respiratory dysfunction
• Maintenance or attainment of adequate tissue perfusion
• Reduced anxiety
• Adherence to the self care program
• Absence or early recognition of complications

2. What problems or risks must be managed to achieve this outcomes?

• Acute pain
• Ineffective cardiac tissue perfusion related to reduced coronary blood flow
• Risk for imbalanced fluid volume
• Risk for ineffective peripheral tissue perfusion related to decreased cardiac output from left ventricular dysfunction
• Death anxiety
• Deficient knowledge about post ACS self care.

​​​​​​​3. Interventions

a) relieving pain and other symptoms of ischemia

• administer oxygen in tandem with medication therapy to assist with relief of symptoms
• Assess vital signs frequently
• Assist patient to rest with back elevated or in cardiac chair to decrease chest discomfort and dyspnea

​​​​​​​b) improving respiratory function

• assess respiratory function to detect early signs of complications
• Monitor fluid volume to prevent overloading of heart and lungs
• Encourage patient to breathe deeply and change position often to prevent pooling of fluid in lung bases

​​​​​​​c) promoting adequate tissue perfusion

• keep patient on bed or chair rest to reduce myocardial oxygen consumption
• Check skin temperature and peripheral pulses frequently to determine adequate tissue perfusion

​​​​​​​d) reducing anxiety

• develop a trusting and caring relationship with patient
• Provide information to patient and family in an honest and supportive manner
• Ensure a quite environment
• prevent interruptions that disturb sleep
• Teach relaxation techniques
• Provide frequent and private opportunities to share concerns and fears

​​​​​​​d) monitoring and managing complications

• ​​​​​​​monitor closely for cardinal signs and symptoms that signal onset of complications.