Myocardial Infarction, The Respiratory Rate (RR) & Hypernatremia - Joe Hutchington & AMI Case Study - Nursing Assignment Help

Assignment Task -                 
 

Myocardial Infarction

Joe Hutchington, 53 yr. old male. Presented to the Emergency Department with central crushing chest pain, pain score 8/10, pale and sweating. Joe has a history of osteoporosis and is also an insulin-dependent type 2 diabetic. He admits to being a pack a day smoker and drinks 3 red wine glasses a night to help him relax. He maintains 30 minutes, exercises daily.

His vital signs on the first presentation are:

Blood Pressure - 167/72

Respiratory Rate - 17

O2 - 97%

Heart Rate - 137 and arrhythmic

Blood Glucose Level - 6.2

Urine output - >30 ml PH

Capillary refill time - <2 seconds 

Commentary - Scenario, and observations:

• Good scenario. It is likely from the information that an AMI is likely, but not clearly given away, and requires the reader to collect cues to come to this conclusion.

• Not all vital signs convincingly match the scenario, and this will need to be addressed in the MCQ items or rationale to avoid losing marks. In particular, the respiratory rate (RR) is not what I would expect from someone with 8/10 crushing chest pain. The catecholamine response should increase the RR. Additionally, if there was a build-up of lactic acid, we would expect to see an emerging metabolic acidosis with respiratory compensation – driven by an increase in RR. A more convincing picture would probably have included a longer capillary refill time.

• It is not clear if the urine output is low or high based on the .5ml/kg/hour principle.  Giving a number or simply writing ‘unknown’ would be better.

• Include units after each observation

• An indication of alertness would be appropriate.

Questions:

Symptoms 

Q1) What is the most likely reason, Joe's BP elevation? 

1. The amount of sodium and other electrolytes are too high causing hypernatremia which in the result is causing a rise in BP. 

2. Exercise may be a causing factor, as Joe, maintains an active lifestyle. 

3. Due to peripheral arteriole vasoconstriction, resulting from an adrenergic response to pain anxiety and ventricular dysfunction. 

4. All the above

Rational 

Q1)

1. Hypernatremia involves dehydration, which can have many causes, including not drinking enough fluids, diarrhea, kidney dysfunction, and diuretics (James L. Lewis, III,2018) and is a good distractor for this question as it involves high salt in the blood, fatty and salty foods are common in people with MI although hypernatremia normally be followed by a drop-in BP. As our patient has a normal amount of urine output hourly with a raise in BP and is showing no high cause for worry of Hypernatremia this is not the correct answer. 
2. Joe maintains 30 minutes of exercise daily and although this can increase the BP for a short period of time should cause a long-term increase in BP and should slowly relieve itself (Blood Pressure Association, 2008). This is also a wrong answer as the BP is increased a while after the excursion.
3. peripheral arteriole vasoconstriction resulting from an adrenergic chronic response to pain anxiety and ventricular dysfunction (C. Ayada et al, 2015). The narrowing of the coronary artery or heart disease where the dominant cause of heart failure and is normally the cause for acute or prior myocardial infarction. The vasoconstriction and ventricular dysfunction of the coronary artery is there for the likely cause for a rise in BP (Paul W Armstrong, 2000).

Commentary – Items and explanation:

The question will ideally require the test-taker to refer to the scenario to answer the question. Eg ‘Which cue is most likely correlates with Joe’s elevated BP?’

• RR

• CRT

• Diaphoresis

• Age

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