Mrs. Darsana Acute Myocardial Infarction Case Study
Order ID 53563633773 Type Essay Writer Level Masters Style APA Sources/References 4 Perfect Number of Pages To Order 5-10 Pages Description/Paper Instructions
Mrs. Darsana
GENDER Female
AGE 67
SOCIOECONOMIC SPIRITUAL/RELIGIOUS
SETTING Hospital
ETHNICITY Black American
CULTURAL CONSIDERATIONS Risk of hypertension and heart disease
PREEXISTING CONDITION Hypertension (HTN)
PHARMACOLOGIC
Acetylsalicylic acid (aspirin); enoxaparin (Lovenox); GPIIb/IIIa agents; heparin sodium; morphine sulfate; nitroglycerin; tissue plasminogen activator (tPA)
LEGAL
ETHICAL
ALTERNATIVE THERAPY
COEXISTING CONDITION PRIORITIZATION
COMMUNICATION
DISABILITY
■ Minimizing cardiac damage
DELEGATION
Overview: This case requires the nurse to recognize the signs and symptoms of an acute myocardial infarction (MI). The nurse must anticipate appropriate interventions to minimize cardiac damage and preserve myocardial function. Serum laboratory tests and electrocardiogram findings used to diagnose a myocardial infarction are discussed. Criteria to assess when considering reperfusion using a thrombolytic agent are reviewed. The nurse is asked to prioritize the client’s nursing diagnoses.
Client Profile
Mrs. Darsana was sitting at a family cookout at approximately 2:00 p.m. when she experienced what she later describes to the nurse as “nausea with some heartburn.” Assuming the discomfort was because of something she ate, she dismissed the discomfort and took Tums. After about two hours, she explains, “My heartburn was not much better and it was now more of a dull pain that seemed to spread to my shoulders. I also noticed that I was a little short of breath.” Mrs. Darsana told her son what she was feeling. Concerned, her son called emergency medical services.
Case Study
En route to the hospital, emergency medical personnel established an intravenous access. Mrs. Darsana was given four children’s chewable aspirins and three sublin-gual nitroglycerin tablets without relief of her chest pain. She was placed on oxygen 2 liters via nasal cannula. Upon arrival in the emergency department, Mrs. Darsana is very restless. She states, “It feels like an elephant is sitting on my chest.” Her vital signs are blood pressure 160/84, pulse 118, respiratory rate 28, and temperature 99.38F (37.48C). Her oxygen saturation is 98% on 2 liters of oxygen. A 12-lead elec-trocardiogram (ECG, EKG) shows sinus tachycardia with a heart rate of 120 beats per minute. An occasional premature ventricular contraction (PVC), T wave inversion, and ST segment elevation are noted. A chest X-ray is within normal limits with no signs of pulmonary edema. Mrs. Darsana’s laboratory results include potassium (K1) 4.0 mEq/L, magnesium (Mg) 1.9 mg/dL, total creatine kinase (CK) 157 μ/L, CK-MB 7.6 ng/mL, relative index 4.8%, and troponin I 2.8 ng/mL. Her stool tests negative for occult blood.
Questions
- What are the components of the initial nursing assessment of Mrs. Darsana when she arrives in the emergency department?
- Darsana has a history of unstable angina. Explain what this is.
- Briefly discuss what causes an MI. Include in the discussion the other terms used for this diagnosis
- The nurse listens to Mrs. Darsana’s heart sounds to see if S3, S4, or a murmur can be heard. What would the nurse suspect if these heart sounds were heard?
- What factors are considered when diagnosing an acute myocardial infarction (AMI)?
- Besides her unstable angina, what factors increased Mrs. Darsana’s risk for an MI?
Laboratory results follow:
April 1 at 1645:
Total CK 5 216 units/L CK-MB 5 5.6 ng/mL
April 2 at 0045:
Total CK 5 242 units/L CK-MB 5 8.1 ng/mL
- Identify which of Mrs. Darsana’s presenting symptoms are consistent with the profile of a client who is having an MI.
- The nurse overhears Mrs. Darsana’s son asking his mother sternly, “Mom. Why didn’t you tell me that you were having chest pain sooner? You should have never ignored this. You could have died right there at my house.” How might the nurse explain Mrs. Darsana’s actions to the son?
- Provide a rationale for why Mrs. Darsana was given sublingual nitroglycerin and aspirin en route to the hospital.
- Briefly discuss the laboratory tests that are sig-nificant in the determination of an acute myocardial infarction (AMI).
relative index 5 2.2% Troponin I 5 2.8 ng/mL
relative index 5 3.3% Troponin I 5 5.2 ng/mL
CASE STUDY 6 ■ MRS. DARSANA
Questions (continued)
April 2 at 0615:
Total CK 5 298 units/L CK-MB 5 9.2 ng/mL relative index 5 3.0% Troponin I 5 4.1 ng/mL
April 3 at 0615:
Total CK 5 203 units/L CK-MB 5 6.1 ng/mL relative index 5 3.0% Troponin I 5 1.7 ng/mL
- Are Mrs. Darsana’s laboratory results consistent with those expected for a client having an acute myocardial infarction?
- Describe four pharmacologic interventions you anticipate will be initiated/considered during an acute MI.
- Identify five criteria that could exclude an indi-vidual as a candidate for thrombolytic therapy with a tissue plasminogen activator (tPA).
- An echocardiogram reveals that Mrs. Darsana has an ejection fraction of 50%. How could the nurse explain the meaning of this result to Mrs. Darsana?
- Identify three appropriate nursing diagnoses for the client experiencing an AMI.
- Rank the following five nursing diagnoses for Mrs. Darsana in priority order.
- Decreased Cardiac Output related to (r/t) ineffective cardiac tissue perfusion secondary to ventricular damage, ischemia, dysrhythmia.
- Deficient Knowledge (condition, treatment, prognosis) r/t lack of exposure, unfamiliarity with information resources.
- Risk for Injury r/t adverse effect of pharmaco-logic therapy.
- Acute Pain r/t myocardial tissue damage from inadequate blood supply.
- Fear r/t threat to well-being
RUBRIC
QUALITY OF RESPONSE NO RESPONSE POOR / UNSATISFACTORY SATISFACTORY GOOD EXCELLENT Content (worth a maximum of 50% of the total points) Zero points: Student failed to submit the final paper. 20 points out of 50: The essay illustrates poor understanding of the relevant material by failing to address or incorrectly addressing the relevant content; failing to identify or inaccurately explaining/defining key concepts/ideas; ignoring or incorrectly explaining key points/claims and the reasoning behind them; and/or incorrectly or inappropriately using terminology; and elements of the response are lacking. 30 points out of 50: The essay illustrates a rudimentary understanding of the relevant material by mentioning but not full explaining the relevant content; identifying some of the key concepts/ideas though failing to fully or accurately explain many of them; using terminology, though sometimes inaccurately or inappropriately; and/or incorporating some key claims/points but failing to explain the reasoning behind them or doing so inaccurately. Elements of the required response may also be lacking. 40 points out of 50: The essay illustrates solid understanding of the relevant material by correctly addressing most of the relevant content; identifying and explaining most of the key concepts/ideas; using correct terminology; explaining the reasoning behind most of the key points/claims; and/or where necessary or useful, substantiating some points with accurate examples. The answer is complete. 50 points: The essay illustrates exemplary understanding of the relevant material by thoroughly and correctly addressing the relevant content; identifying and explaining all of the key concepts/ideas; using correct terminology explaining the reasoning behind key points/claims and substantiating, as necessary/useful, points with several accurate and illuminating examples. No aspects of the required answer are missing. Use of Sources (worth a maximum of 20% of the total points). Zero points: Student failed to include citations and/or references. Or the student failed to submit a final paper. 5 out 20 points: Sources are seldom cited to support statements and/or format of citations are not recognizable as APA 6th Edition format. There are major errors in the formation of the references and citations. And/or there is a major reliance on highly questionable. The Student fails to provide an adequate synthesis of research collected for the paper. 10 out 20 points: References to scholarly sources are occasionally given; many statements seem unsubstantiated. Frequent errors in APA 6th Edition format, leaving the reader confused about the source of the information. There are significant errors of the formation in the references and citations. And/or there is a significant use of highly questionable sources. 15 out 20 points: Credible Scholarly sources are used effectively support claims and are, for the most part, clear and fairly represented. APA 6th Edition is used with only a few minor errors. There are minor errors in reference and/or citations. And/or there is some use of questionable sources. 20 points: Credible scholarly sources are used to give compelling evidence to support claims and are clearly and fairly represented. APA 6th Edition format is used accurately and consistently. The student uses above the maximum required references in the development of the assignment. Grammar (worth maximum of 20% of total points) Zero points: Student failed to submit the final paper. 5 points out of 20: The paper does not communicate ideas/points clearly due to inappropriate use of terminology and vague language; thoughts and sentences are disjointed or incomprehensible; organization lacking; and/or numerous grammatical, spelling/punctuation errors 10 points out 20: The paper is often unclear and difficult to follow due to some inappropriate terminology and/or vague language; ideas may be fragmented, wandering and/or repetitive; poor organization; and/or some grammatical, spelling, punctuation errors 15 points out of 20: The paper is mostly clear as a result of appropriate use of terminology and minimal vagueness; no tangents and no repetition; fairly good organization; almost perfect grammar, spelling, punctuation, and word usage. 20 points: The paper is clear, concise, and a pleasure to read as a result of appropriate and precise use of terminology; total coherence of thoughts and presentation and logical organization; and the essay is error free. Structure of the Paper (worth 10% of total points) Zero points: Student failed to submit the final paper. 3 points out of 10: Student needs to develop better formatting skills. The paper omits significant structural elements required for and APA 6th edition paper. Formatting of the paper has major flaws. The paper does not conform to APA 6th edition requirements whatsoever. 5 points out of 10: Appearance of final paper demonstrates the student’s limited ability to format the paper. There are significant errors in formatting and/or the total omission of major components of an APA 6th edition paper. The can include the omission of the cover page, abstract, and page numbers. Additionally the page has major formatting issues with spacing or paragraph formation. Font size might not conform to size requirements. The student also significantly writes too large or too short of and paper 7 points out of 10: Research paper presents an above-average use of formatting skills. The paper has slight errors within the paper. This can include small errors or omissions with the cover page, abstract, page number, and headers. There could be also slight formatting issues with the document spacing or the font Additionally the paper might slightly exceed or undershoot the specific number of required written pages for the assignment. 10 points: Student provides a high-caliber, formatted paper. This includes an APA 6th edition cover page, abstract, page number, headers and is double spaced in 12’ Times Roman Font. Additionally the paper conforms to the specific number of required written pages and neither goes over or under the specified length of the paper. GET THIS PROJECT NOW BY CLICKING ON THIS LINK TO PLACE THE ORDER
CLICK ON THE LINK HERE: https://www.perfectacademic.com/orders/ordernow
Do You Have Any Other Essay/Assignment/Class Project/Homework Related to this? Click Here Now [CLICK ME] and Have It Done by Our PhD Qualified Writers!!