Case Study Acute Coronary Syndrome and Myocardial Infarction Part 1
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Case Study Acute Coronary Syndrome and Myocardial Infarction Part 1
HPI: JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of progressive weakness. She denies chest pain but admits to shortness of breath (SOB) that increases with activity. She also has epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to the hospital by emergency medical services (EMS).
Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She
is physically active and lives independently with her spouse in her own home. She has smoked 1 pack per day for the past 40 years. JoAnn appears anxious and immediately asks repeatedly for her husband upon arrival.
PMH:
Type 2 DM, Hypertension, Hyperlipidemia, CVA with no deficits, GERD. Anemia
Home Medications
: Iron 325 mg daily, Lisinopril 5 md daily, Simvastatin 20 mg daily, Aspirin 81 mg daily,
Clopidogrel 75 md daily, Omeprazole 20 mg daily, Metformin 500 mg twice a day Vital Signs and Physical Exam Temp 99.2 F/37.3 C
HR 128 Regular
Resp 24 Regular
BP: 108/58
02 Sats: 99% on room air
Pain: 5/10 Left arm that radiates into neck General Appearance: Anxious, uncomfortable, body tense
Resp: Labored, coarse crackles in bases bilaterally anterior/posterior
Cardiac: Pale, diaphoretic, no edema, S1 S2 normal, pulses strong Neuro: A/O x 4
GI: Bowel Sounds x 4 Abdomen soft/non tender
GU: Voiding without difficulty, urine clear/yellow
Skin: Skin intact
EKG: ST elevation in the inferior leads of II, III, and AVF (Inferior STEMI is usually caused by occlusion of the right coronary artery, or less commonly the left circumflex artery, causing infarction of the inferior wall of the heart. Upon ECG analysis, inferior STEMI displays ST-elevation in leads II, III, and aVF.)
Chest X-ray: Scattered bilateral opacities consistent with atelectasis or pulmonary edema Echo: EF of 25% (heart failure)
LABS: WBC 10.5
NA+: 135 Hgb 12.9 (slightly low)
K+: 4.1 Plt: 225
Glucose: 184 (high-normal for DM2)
Neutrophils: 70%
Creat: 1.5 (elevated)
Mag 1.8
BNP 1150 (high)
Troponin: 1.8 (high)
Discussion Questions:
1. Based on the information given to you, what Medical Diagnosis do you suspect? What clinical manifestations led you to this conclusion? In this case, I suspect the medical diagnosis of Mrs. Smith is Acute Coronary Syndrome (ACS) with Myocardial Infarction (MI). These clinical manifestations have led me to this conclusion:
ST elevation in the inferior leads of II, III, and AVF
Elevated BNP and Troponin
Intermittent nausea
HR 128
Resp 24
Pale, diaphoretic
Intermittent epigastric pain that is radiating to neck
MI and going into cardiogenic shock
2. What is the underlying cause of Mrs. Smith’s primary problem? The underlying cause of Mrs. Smiths primary problem is likely a myocardial infarction. The ST elevation indicates ischemia or injury to the heart muscle, which is commonly caused by a blockage in the coronary arteries.
Diabetes or hypertension leading to ACS
3. What concepts will you focus on for this patient? What are the top 3 priorities you will have for this patient? List 3 Nursing Diagnosis for this patient? Priority concepts:
Oxygenation (assess lungs, ABGs, give oxygen)
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than one block. The chest discomfort is diffuse, and he cannot localize it; sometimes it radiates to his
lower jaw. The discomfort is more severe when he walks after meals but is relieved within 2-3 minutes
when he stops walking.
A 74-year-old man presents with a history of anterior chest pressure whenever he walks more
Questions:
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HISTORY OF PRESENT ILLNESS: Edith Martens is a 66-year-old female who is recovering fromviral pneumonia. When her daughter came to check on her, she found Edith in bedcomplaining of weakness, constant fatigue and abdominal pain.For the past few days, Edith has been complaining of thirst and frequent urination. She alsoreports that she cannot see very well. Edith has lost approximately 4 lbs over the last week.Her daughter brought Edith to the ER.
PAST HISTORY: There is a history of osteoarthritis that responds well to ASA. Edith wasdiagnosed with Type 2 diabetes approximately two years ago. She takes glyburide 10 mg everymorning before breakfast and is on an 1800 calorie diet, which she follows closely.
SOCIAL HISTORY: Edith has lived alone since the death of her husband. She is not physicallyactive; her activities consist of light housework and occasional shopping trips.
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Section
I. Draw and Label the Circle of Willis
II. Choose any of the 4 main divisions of the Arterial System
and illustrate the Arterial and Venous Supply of that
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Amelia is a 68-year-old woman who was brought into ED by herneighbour. She woke this morning at 0600 hours with a 5/10 headache.At 0700 she called her neighbour and asked her to bring her to hospitalwhen she began to feel weak, and her headache increased to 7/10. Atthis time, one side of her face began to “feel strange”.She has past medical history of Atrial fibrillation (AF), hypertension (HT)and dyslipidaemia which she manages with Apixaban 2.5mg BD, Sotolol80mg daily, Amlodipine 5mg daily, Irbesartan/hydrochlorothiazide300/25mg daily, Rosuvastatin 10mg daily.Amelia used to smoke 20 cigarettes/day but states she quit 5 years ago.When she was brought into ED, she told staff that she did not take hermedications this morning as she was too distracted by her increasingheadache.You are assigned to care for Amelia. As you are about to enter her room,you overhear Amelia crying to her neighbour, explaining that she isworried as her mother had died of a stroke.
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What forms of heart activity pathology has a patient?
What caused its development?
Is it connected with ventricular overload? What? Overload with volume or pressure?
What is a trigger mechanism of contractile myocardial function by its overload?
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skin. Respiration is frequent, superficial, arterial pressure 90/60 mm Hg, pulse - 110 beats / min (normal 60-90 beats per minute). The
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