Acute Coronary Syndrome Case Study

Case Study 16 Acute Coronary Syndrome

Difficulty: Advanced

Setting: Emergency department, hospital, home care

Index Words: heart failure (HF), coronary artery disease (CAD), arm fracture, communication deficit, cultural diversity, geriatric, laboratory values, therapeutic nutrition, medications, electrolytes

Giddens Concepts: Care Coordination, Communication, Culture, Fluid and Electrolyte Balance, Perfusion

HESI Concepts: Assessment, Care Coordination, Communication, Cultural/Spiritual, Fluid & Electrolyte, Perfusion

 

 

 

 

 

You are just getting caught up with your work when you receive the following phone call: “Hi, this is Deb in the emergency department. We’re sending you M.M., a 63-year-old Hispanic woman with a past medi- cal history of coronary artery disease (CAD). Her daughter reports that her mom has become increasingly weak over the past couple of weeks and has been unable to do her housework. Apparently, she has had complaints of swelling in her ankles and feet by late afternoon ‘she couldn’t wear her shoes’ and has nocturnal diuresis× 4. Her daughter brought her in because she has had heaviness in her chest off and on over the past few days but denies any discomfort at this time. The daughter took her to see her family physician who immediately sent her here. Vital signs are 146/92, 96, 24, 99 ° F (37.2 ° C). She has an IV of D5W at 50 mL/hr in her right forearm. Her laboratory results are as follows: Na 134 mEq/L, K 3.5 mEq/L, Cl 103 mEq/L, HCO3 23 mEq/L, BUN 13 mg/dL, creatinine 1.3 mg/dL, glucose 153 mg/dL, WBC 8300/mm3, Hct 33.9%, Hgb 11.7 g/dL, platelets 162,000/mm3. PT/INR, PTT, and urinalysis are pending. She has had her chest x-ray and ECG, and her orders have been written.”

· Scenario

 

1. What additional information do you need from the emergency department (ED) nurse?

 

 

 

 

2. How are you going to prepare for this patient?

 

 

 

 

 

 

 

 

 

 

 

 

 

1 Cardiovascular Disorders

 

3. M.M. arrives by wheelchair. As she transfers to the bed, what observations will you make? Why?

 

 

 

4. Given the previous information, you can anticipate orders for M.M. Carefully review each order to determine whether it is appropriate or inappropriate as written. If the order is appropriate, mark it as A; if the order is inappropriate, mark it as I and change the order to make it appropriate. Provide any other orders that might be appropriate for M.M.

1. Routine VS

2. Serum magnesium (Mg) STAT

3. Up ad lib

4. 10 g sodium (Na), low-fat diet

5. Change IV to a saline lock

6. Cardiac enzymes on admission and q8h × 24 hr, then daily every morning

7. CBC, BMP, and fasting lipid profile in morning

8. Schedule for abdominal CT scan for am

9. Heparin 10,000 units subcut q8h

10. Docusate sodium (Colace) 100 mg/day PO

11. Ampicillin 250 mg IV piggyback q6h

12. Furosemide (Lasix) 200 mg IV push STAT

13. Nitroglycerin (NTG) 0.4 mg 1 SL q4h prn for chest pain

14. Schedule echocardiogram

 

 

 

 

1 Cardiovascular Disorders

 

 

5. Which interventions are appropriate for administering subcutaneous heparin? Select all that apply.

a. Rotate injection sites with each dose.

b. Monitor activated partial thromboplastin time (aPTT) levels daily.

c. Massage the area after the injection.

d. Give the injection at least 2 inches away from the umbilicus.

e. Do not aspirate the syringe before injecting the heparin.

 

 

 

 

 

CASE STUDY PROGRESS

Shortly after admission, M.M.’s call light comes on. When you respond to M.M.’s call light, you observe she is talking rapidly in Spanish and pointing to the bathroom. Her speech pattern indicates she is short of breath; she is having trouble completing a sentence without taking a labored breath. You help her use a bedpan and note that her skin feels clammy. While sitting on the bedpan, she vomits.

 

6. On a scale of 0 to 10 (0 being no problem, 10 being a code-level emergency), how would you rate this situation, and why?

 

 

 

7. Identify at least four actions you should take next, and state your rationale.

 

 

 

 

1 Cardiovascular Disorders

 

8. M.M.’s physician calls your unit to find out what is happening. Using SBAR, what information would you need to convey at this time?

 

 

 

 

 

 

9. The hospital’s staff physician is coming to the floor immediately to evaluate the patient. In the meantime she orders furosemide (Lasix) 40 mg IV push STAT. You have only 20 mg in stock. Should you give the 20 mg now, and then give the additional 20 mg when it comes up from the pharmacy? Explain your answer.

 

 

 

 

10. M.M. continues to experience vomiting and diaphoresis that are unrelieved by medication and comfort measures. A STAT 12-lead ECG reveals ischemic changes, and she is transferred to the coronary care unit (CCU). As you give the report to the receiving registered nurse, what laboratory value is the most important to report, and why?

 

 

 

11. You are monitoring while a new nurse prepares to administer IV potassium to M.M. Which technique is correct? Explain why the other answers are incorrect.

a. Give the IV potassium by slow IV push.

b. Add potassium to a hanging IV bag as needed.

c. The rate of IV administration should not exceed 10 mEq/hr.

d. Administer the IV potassium by gravity drip.

 

 

 

 

1 Cardiovascular Disorders

 

CASE STUDY PROGRESS

While recovering in the CCU, M.M. tried to get up out of the bed, fell, and fractured her right humerus. Because of the surgical risks involved, M.M. was treated conservatively and put in a full arm cast. She is transferred back to your floor.

CASE STUDY PROGRESS

A case manager (CM) has been asked to evaluate M.M.’s home to see whether she can be discharged to her own home or will need to stay in a long-term care facility.

 

12. Identify at least eight things that the CM would assess.

 

 

 

13. M.M.’s nutritional intake over the past few weeks has been poor. She also has increased nutritional needs because of her fractured arm. What are some of the nutritional needs that should be met? What would you recommend to help her with this?

 

 

 

 

CASE STUDY PROGRESS

Because the case manager determined that M.M. lived in an apartment with poor access, M.M. elects to stay with her daughter and five grandchildren in their small home. A home care nurse comes three times a week to check on her. M.M. is easily fatigued, and the children are quite lively. School is out for the summer.

 

14. Suggest some ways for M.M.’s daughter to ensure that her mother is not overwhelmed and does not become exhausted in this situation.


Get Professional Assignment Help Cheaply

Buy Custom Essay

Are you busy and do not have time to handle your assignment? Are you scared that your paper will not make the grade? Do you have responsibilities that may hinder you from turning in your assignment on time? Are you tired and can barely handle your assignment? Are your grades inconsistent?

Whichever your reason is, it is valid! You can get professional academic help from our service at affordable rates. We have a team of professional academic writers who can handle all your assignments.

Why Choose Our Academic Writing Service?

  • Plagiarism free papers
  • Timely delivery
  • Any deadline
  • Skilled, Experienced Native English Writers
  • Subject-relevant academic writer
  • Adherence to paper instructions
  • Ability to tackle bulk assignments
  • Reasonable prices
  • 24/7 Customer Support
  • Get superb grades consistently
 

Online Academic Help With Different Subjects

Literature

Students barely have time to read. We got you! Have your literature essay or book review written without having the hassle of reading the book. You can get your literature paper custom-written for you by our literature specialists.

Finance

Do you struggle with finance? No need to torture yourself if finance is not your cup of tea. You can order your finance paper from our academic writing service and get 100% original work from competent finance experts.

Computer science

Computer science is a tough subject. Fortunately, our computer science experts are up to the match. No need to stress and have sleepless nights. Our academic writers will tackle all your computer science assignments and deliver them on time. Let us handle all your python, java, ruby, JavaScript, php , C+ assignments!

Psychology

While psychology may be an interesting subject, you may lack sufficient time to handle your assignments. Don’t despair; by using our academic writing service, you can be assured of perfect grades. Moreover, your grades will be consistent.

Engineering

Engineering is quite a demanding subject. Students face a lot of pressure and barely have enough time to do what they love to do. Our academic writing service got you covered! Our engineering specialists follow the paper instructions and ensure timely delivery of the paper.

Nursing

In the nursing course, you may have difficulties with literature reviews, annotated bibliographies, critical essays, and other assignments. Our nursing assignment writers will offer you professional nursing paper help at low prices.

Sociology

Truth be told, sociology papers can be quite exhausting. Our academic writing service relieves you of fatigue, pressure, and stress. You can relax and have peace of mind as our academic writers handle your sociology assignment.

Business

We take pride in having some of the best business writers in the industry. Our business writers have a lot of experience in the field. They are reliable, and you can be assured of a high-grade paper. They are able to handle business papers of any subject, length, deadline, and difficulty!

Statistics

We boast of having some of the most experienced statistics experts in the industry. Our statistics experts have diverse skills, expertise, and knowledge to handle any kind of assignment. They have access to all kinds of software to get your assignment done.

Law

Writing a law essay may prove to be an insurmountable obstacle, especially when you need to know the peculiarities of the legislative framework. Take advantage of our top-notch law specialists and get superb grades and 100% satisfaction.

What discipline/subjects do you deal in?

We have highlighted some of the most popular subjects we handle above. Those are just a tip of the iceberg. We deal in all academic disciplines since our writers are as diverse. They have been drawn from across all disciplines, and orders are assigned to those writers believed to be the best in the field. In a nutshell, there is no task we cannot handle; all you need to do is place your order with us. As long as your instructions are clear, just trust we shall deliver irrespective of the discipline.

Are your writers competent enough to handle my paper?

Our essay writers are graduates with bachelor's, masters, Ph.D., and doctorate degrees in various subjects. The minimum requirement to be an essay writer with our essay writing service is to have a college degree. All our academic writers have a minimum of two years of academic writing. We have a stringent recruitment process to ensure that we get only the most competent essay writers in the industry. We also ensure that the writers are handsomely compensated for their value. The majority of our writers are native English speakers. As such, the fluency of language and grammar is impeccable.

What if I don’t like the paper?

There is a very low likelihood that you won’t like the paper.

Reasons being:

  • When assigning your order, we match the paper’s discipline with the writer’s field/specialization. Since all our writers are graduates, we match the paper’s subject with the field the writer studied. For instance, if it’s a nursing paper, only a nursing graduate and writer will handle it. Furthermore, all our writers have academic writing experience and top-notch research skills.
  • We have a quality assurance that reviews the paper before it gets to you. As such, we ensure that you get a paper that meets the required standard and will most definitely make the grade.

In the event that you don’t like your paper:

  • The writer will revise the paper up to your pleasing. You have unlimited revisions. You simply need to highlight what specifically you don’t like about the paper, and the writer will make the amendments. The paper will be revised until you are satisfied. Revisions are free of charge
  • We will have a different writer write the paper from scratch.
  • Last resort, if the above does not work, we will refund your money.

Will the professor find out I didn’t write the paper myself?

Not at all. All papers are written from scratch. There is no way your tutor or instructor will realize that you did not write the paper yourself. In fact, we recommend using our assignment help services for consistent results.

What if the paper is plagiarized?

We check all papers for plagiarism before we submit them. We use powerful plagiarism checking software such as SafeAssign, LopesWrite, and Turnitin. We also upload the plagiarism report so that you can review it. We understand that plagiarism is academic suicide. We would not take the risk of submitting plagiarized work and jeopardize your academic journey. Furthermore, we do not sell or use prewritten papers, and each paper is written from scratch.

When will I get my paper?

You determine when you get the paper by setting the deadline when placing the order. All papers are delivered within the deadline. We are well aware that we operate in a time-sensitive industry. As such, we have laid out strategies to ensure that the client receives the paper on time and they never miss the deadline. We understand that papers that are submitted late have some points deducted. We do not want you to miss any points due to late submission. We work on beating deadlines by huge margins in order to ensure that you have ample time to review the paper before you submit it.

Will anyone find out that I used your services?

We have a privacy and confidentiality policy that guides our work. We NEVER share any customer information with third parties. Noone will ever know that you used our assignment help services. It’s only between you and us. We are bound by our policies to protect the customer’s identity and information. All your information, such as your names, phone number, email, order information, and so on, are protected. We have robust security systems that ensure that your data is protected. Hacking our systems is close to impossible, and it has never happened.

How our Assignment  Help Service Works

1.      Place an order

You fill all the paper instructions in the order form. Make sure you include all the helpful materials so that our academic writers can deliver the perfect paper. It will also help to eliminate unnecessary revisions.

2.      Pay for the order

Proceed to pay for the paper so that it can be assigned to one of our expert academic writers. The paper subject is matched with the writer’s area of specialization.

3.      Track the progress

You communicate with the writer and know about the progress of the paper. The client can ask the writer for drafts of the paper. The client can upload extra material and include additional instructions from the lecturer. Receive a paper.

4.      Download the paper

The paper is sent to your email and uploaded to your personal account. You also get a plagiarism report attached to your paper.

smile and order essaysmile and order essay PLACE THIS ORDER OR A SIMILAR ORDER WITH US TODAY AND GET A PERFECT SCORE!!!

order custom essay paper