CXA240 - Lucy Ng Chest Pain Case Study, Pathophysiology for Health Care, Myocardial Function & Tissue - Nursing Assignment Help

Assignment Task -         

Aim

In this assessment task, you will be provided with suggested therapeutic approaches fora case study which includes relevant patient information. You should apply clinical reasoning to explain the rationale for therapy.       

Task description

This individual assessment will require you to submit a video (5 mins) of communication with another professional within a multi-disciplinary health care team.
To complete this task, you need to explain, using language appropriate for a health professional, the rationale for therapeutic approaches for that patient (these have been highlighted in the case scenario) referring to the pathophysiological basis of the patient's health condition.

Case Scenario
Lucy Ng, a 58-year-old aged-care worker, presents to the emergency department with complaints of severe substernal chest pain. Mrs. Ng states that the pain began after lunch, about 4 hours ago. She initially attributed the pain to indigestion. She described the pain, which now radiates to her jaw and left arm, as  ‘really severe heartburn’. It is accompanied by a ‘choking feeling’, severe shortness of breath, and  diaphoresis. The pain is unrelieved by rest, antacids, or three sublingual glyceryl trinitrate tablets (0.4 mg). 
Mrs. Ng’s medical history includes type 2 diabetes, stable angina, and hypertension. She has a 25-year history of cigarette smoking, averaging 1.5 to 2 packets per day. Family history reveals that Mrs. Ng’s father died at age 42 of AMI and her paternal grandfather died at age 65 of AMI. Mrs. Ng is taking the following medications: metformin, hydrochlorothiazide, atorvastatin, and isosorbide mononitrate.  
IMMEDIATE INTERVENTIONS 
Oxygen is started through a Hudson mask at 5 L/min because SpO2 is noted to be 92%. Central and peripheral intravenous lines are inserted. Glyceryl trinitrate is infusing at 200 ?g/min. A 12-lead ECG is obtained. The registrar requests the following tests: cardiac troponins, CK and CK isoenzymes, VBGs, FBC,  urea and electrolytes, and coagulation profile. Intravenous morphine relieves Mrs. Ng’s pain.  
Based on ECG changes and cardiac markers, an acute anterior MI is diagnosed. Mrs. Ng is administered  300mg of aspirin and 600mg of clopidogrel, orally. She is referred for emergency percutaneous stenting,  after which she will be transferred to the coronary care unit (CCU). 
ASSESSMENT  
Mrs. Ng is alert and oriented to person, place, and time. Vital signs are T 37.5°C, HR 118, RR 24 with adequate depth, and BP 172/92. Auscultation reveals an S4 and fine crackles in the bases of both lungs. The ECG shows sinus tachycardia. Her skin is cool and slightly diaphoretic. Capillary refill is less than 3 seconds and peripheral pulses are strong and equal. Her nail beds are pink.  
The peripheral intravenous line has a saline lock. Mrs Ng states, ‘The pain is better since the nurse in the ED  gave me a needle. But it has been coming and going. I would rate it a 4 right now, but it was terrible before. The doctor told me that this procedure I’m having will quickly open up the artery that is blocked. I hope it works! Do many people have this done?’  
DIAGNOSIS  
• Hypoxaemia related to impaired myocardial function. 
• Risk of decreased cardiac output related to altered cardiac rate, rhythm, and contractility.

 • Acute pain related to ischaemic myocardial tissue.  
• Anxiety and fear related to change in health status.  
THERAPEUTIC INTERVENTIONS 
The following interventions are planned during the immediate phase of Mrs. Ng’s hospitalization.  
• Titrate intravenous glyceryl trinitrate infusion for chest pain; stop infusion if systolic BP is below 100  mmHg. Administer 2 to 4 mg of morphine intravenously for chest pain unrelieved by glyceryl trinitrate infusion.  
• Explain the purpose of percutaneous coronary intervention.  
• Explain the need for frequent monitoring of vital signs.  
• Repeat ECGs and Troponin level determination.

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