Question

Roger Peterson is a 78 year old male who was arrived at Harper Medical Center complaining of severe substernal chest pain lasting over 4 hours, severe dyspnea, and diaphoresis. The pain was not relieved by antacids or three Nitroglycerin tablets. Significant medical history includes stable exertional angina for 9 years, type 2 diabetes for 4 years, hypertension, and a 47 year history of cigarette smoking 2 packs/day.

Objective Data:

              Cardiovascular:               B/P 180/120, HR 132, O2 sat – 92% and temperature of 97.8                                    Monitor reveals sinus tachycardia with no ectopics. Heart tones normal and no edema noted.                 Respiratory:              Labored and rapid but lung sounds clear.                                                                                     Skin:      cool, pale and diaphoretic                                                                                                                              LOC:      alert and oriented X 3

Laboratory Values:

·       CPK

·       CPK-MB

·       Troponin

·       LDH, AST, and SGOT – normal

·       Serum glucose, triglycerides, and cholesterol – elevated

·       ABG’s – respiratory alkalosis with adequate oxygenation

1.           After the primary and secondary assessment is completed, what interventions would you expect the nurse to perform?

2.           Give an example of a blood gas that reveals respiratory alkalosis with adequate oxygenation.

3.           The physician determines that the patient has an acute anterior wall myocardial infarction (AWMI). How is the diagnosis of anterior MI made?

4.           What is the goal of treatment for an acute MI? What interventions are essential for this patient and what is the frequency of each intervention?

                             

After admission to the ICU, Roger complained of severe substernal chest pressure and rales are noted posteriorly.    His HR elevated to 140 and respiratory rate increased to 40. He was placed on a 40% face mask, a 12 lead EKG was obtained that showed sinus tachycardia with a new BBB, nitroglycerin infusion was started and titrated, and morphine was given IVP.

5.           What are the potential complications of an acute MI?

6.           What is the significance of a new BBB after an acute MI?

7.           What is cardiogenic shock and why does it occur after an MI?

8.           List the signs and symptoms of early and late cardiogenic shock.

9.           Interpret the data and explain the significance of each value.                                                                              CVP - 16              PAP - 50/24        PAWP -             30          CO - 2.0               CI – 1.03                                          SVR – 21 30              BP – 90/58         HR – 140             Urine output – 15ml/hr

10.         Continuous IV infusions of dopamine and dobutamine were initiated at 2.5mcg/kg/min. What are the therapeutic benefits of dopamine and dobutamine administration in cardiogenic shock?   

11.         Document your findings on the flow sheet and in narrative format.

Answer 1

1. Oxygen therapy
2. Respiratory alkalosis is where the pH level is 7.43 and paCO2 level is 35.
3. The physical examination shows that the patient is having acute anterior wall MI. The symptoms are chest pain, dyspnoea, diaphoresis.
4. The goal of treatment is to diagnosis the condition in a very rapid manner and to restore the perfusion as soon as possible. The treatment plan is performing a percutaneous coronary intervention or a coronary artery bypass graft.