A 59-year-old black female is admitted at midnight with adiagnosis of chest pain. She complains of a fullness across themiddle of her chest.
Vital signs are: Blood Pressure-200/110; Pulse-128 beats perminute; Respirations- 26 per minute; Temperature-99.8; Saturationof Oxygen-86% on room air; pain level 9/10.
During your initial assessment she is rubbing her mid-chest,grimacing and is diaphoretic. The pain has been occurringintermittently throughout the evening and night. Her color is paleexcept around her lips which are bluish. Cardiac auscultationreveals a rapid regular rhythm and a murmur, no pulse deficit. Shehas never had this pain before. Lungs sounds are crackles in bothbases with clear upper lobes. She is afraid she is going todie.
Per standing orders, a nurse administers Nitroglycerine 0.4mgsublingually; applies cardiac electrodes for continuous cardiacmonitoring; obtains an electrocardiogram; places a peripheralintravenous catheter with saline lock; positions patient in lowFowlers.
On second assessment vital signs are Blood Pressure-180/95;Pulse-108 beats per minute; Respirations- 22 per minute;Temperature-99.0; Saturation of Oxygen-90% on 2 liters per minute;Pain level 8/10. She says her chest pain hasn’t changed. Heart andlung sounds are unchanged. Color is pale without previous bluechanges.
What makes this patient a “high risk” for cardiac events? Whatconcerns you as a nurse regarding this patient’s vital signs, thefirst set?
What labs would you expect to be drawing? The provider ordersAspiring 325 mg x1 dose. What is the rationale behind this?
Why is the patient diaphoretic? What is the pathophysiologybehind the diaphoresis and heart attack?
How would you describe the patient’s abnormal skin coloringaround her lips?
Do you think 2L is enough oxygen for this patient?
The nurse originally administered one dose of nitroglycerin?What does nitroglycerin do and why did she give it?
Would you administer a second dose of nitroglycerin based on thesecond set of vitals?
What are some differential diagnoses for this patient?
