NR 305 Week 4 Discussion Topic, Assessment of Cardiac Status

NR 305 Week 4 Discussion Topic, Assessment of Cardiac StatusEsther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient's room for report. Approximately 1 hour later, you return to Ms. Jackson's room with her morning pills and find her slumped over the bedside stand in tears. The patient states, "I don't know what is wrong, I don't feel right. My back hurts and I'm just so tired. What is wrong with me?" The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach. Just then the nursing assistant comes into the patient's room to record Ms. Jackson's vital signs, you take this opportunity to quickly research the patient's medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn't get the patient's pulse because "it is all over the place." Please address the following questions related to the scenario. Hello Professor and class, 1. What do you suspect is the cause of the patient's symptoms? Based on the symptoms of Esther Jackson I would suspect myocardial infraction. She has elevated blood pressure, nausea, unrelieved back pain, extreme fatigue, her heart rate is all over the place and one-day post-op. According to the American College of Cardiology, Black women have a higher chance of AMI over other ethnic groups. As a nurse, I must differentiate the symptoms of fatigue and increased discomfort in her back after surgery or possible AMI, but it would be wise to assume that it is an AMI due to the unexplained fatigue and discomfort in her back (Jarvis, 2016). 2. Describe the course of action that you will take to confirm this suspicion and prevent further decline. My first course of action would be to activate the rapid response. The priority of my action is controlling the pain and stabilize her heart rhythm to reduce her hearts workload. I would notify the doctor as well as the charge nurse. As soon as I suspect AMI I would start oxygen, Peripheral IV line, and get the patient on pain medication. Next, I would order a 12 lead EKG, STAT labs (CBC, CMP, PT, PTT, Cardiac enzymes test (troponin levels, CK-MB), Myoglobin levels, and a Chest X-ray at bed side. I would ask for the Doctors choice of vasodilation therapy and possible administration of tpA if needed. 3. What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so. I would also get and order for 12 lead EKG and draw cardiac markers, myoglobin, troponin, CK-MB. ST segment elevation may not notify initial EKG for post-operative patient. After a few hours’ I would order another EKG because the results may change. The first cardiac enzymes may be negative for AMI so in order to be sure I would have the blood work repeated. The reason behind this is the enzymes have different rising and peak times. For example, myoglobin is released within 2hours after an MI and peaks in 3 to 15 hours. The first cardiac markers may not be cardiac specific so the test should be repeated. Troponin is cardiac specific, the enzymes will rise 3–6 hours after AMI, and peak at 12-16 hours, and may stay elevated for several days (Schub& Holle2018). Esther Jackson will need continues monitoring and ongoing assessments and needs to be on bedrest. STEMI and NSTEMI are differently approached, so proper diagnosis are required and appropriate measures initiated, and protocols followed. 4. While you are caring for this patient, how will you ensure that the needs of your other patients are being met? I would notify the charge nurse about acute situation of Esther and ask her/him to temporarily reassign my other patients until Esther is stable or has been transferred to a unit of higher level of care. I will give the report to the charge nurse about my other patients so the other nurses can resume their care. Once Esther is stable or transferred, I will resume as the primary nurse of my other patients. References Gao-Pu Liu, Fu-Shan Xue, Chao Sun, & Rui-Ping Li. (2016). Assessing Risk Factors of Postoperative Myocardial Infarction. American Surgeon, 82(4), E99–E100. Retrieved from Jarvis, C. (2016). Physical examination & health assessment (7th ed.). Philadelphia, PA: Saunders. Liu, G.-P., Xue, F.-S., Sun, C., & Li, R.-P. (2016). Assessing Risk Factors of Postoperative Myocardial Infarction. The American Surgeon, 82(4), E99–E100. Retrieved from McDonald, M. (2015). In Understanding Medical Surgical Nursing, 5th ed (pp. 462–498). Philadelphia, Pennsylvania: F.A. Davis Company. Retrieved from Schub, T. B., & Holle, M. R. B. O. (2018). Acute Myocardial Infarction: Cardiac Biomarkers. CINAHL Nursing Guide. Retrieved from When Heart Attacks Happen. (2002). Understanding Heart Attacks (2002), 9. Retrieved from