Case Study, Assessment and Management of Patients with
Cardiovascular Disorders
1. The nurse working in the cardiac procedures area receives a patient who
has undergone a cardiac catheterization via the right femoral artery for
evaluation of unstable angina. Prior to the procedure, the patient was NPO for
12 hours, and received a sedative. An IV catheter was placed for
administration of the contrast agents and for access in case of an emergency
situation.
a. What is the rationale for assessing distal pulses immediately after the
catheterization?
- Assessing distal pulses immediately after catheterization ensures
there is no arterial occlusion from the procedure and that
oxygenated blood is getting to the extremities without any issues.
b. What other assessments should the nurse perform to check for arterial
insufficiency?
- Assessing pulses (rate, rhythm, strength), color of skin, capillary
refill, pain assessments, any signs of parasthesia.
- DVT precautions/assessments
c. The patient asks why he needs to stay in bed with the leg extended for
2 to 6 hours. How should the nurse respond?
- Patient should stay in bed with leg extended for 2-6 hours to ensure
the surgical wound is properly healing and blood is freely flowing to
the affected extremity.
d. After the procedure, why is it important to assess the patient’s BUN,
creatinine, and fluid volume status?
- The procedure required contrast dye that is excreted via the
kidneys. It is important to monitor kidney function and fluid volume
status to make sure no renal dysfunction or harm is occurring.
2. Dylan Radin, 55 years of age, is a male patient who is admitted to the ED
via ambulance with acute onset of midsternal chest pain radiating down the
left arm and radiating up the left side of the neck. The patient complains of
shortness of breath and is cool, pale, and diaphoretic. The vital signs include:
blood pressure, 160/90 mm Hg; heart rate, 110 bpm; respiratory rate, 26
breaths/min; and temperature 99°F. The 12-lead ECG reveals an anterior wall
ST-elevation myocardial infarction (STEMI).
a. What first actions should the nurse take after the patient has arrived in
the emergency department?
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, - Assess ABCs and position client upright
- Administer O2 via nasal cannula or nonrebreather mask
- Obtain baseline VS
- Initiate continuous cardiac monitoring
b. The emergency physician has contacted a cardiologist and the patient
is scheduled for a percutaneous coronary intervention (PCI) in less than
60 minutes from the door-to-balloon time. Explain the reasoning for
this action based on evidence-based guidelines and considering the
clinical manifestations and the pathophysiology of the STEMI.
- This client would require an emergent PCI because this is
considered to be the first line of tx for patients with a confirmed MI.
- Goal of this tx is to open the blocked artery within 90 minutes of
arrival to the hospital.
- Greatly reduces need for emergent CABG surgery.
3. The home health care nurse is visiting Mr. Simpson, a 62-year-old man with
a significant history of angina pectoris. During the visit, the nurse assesses
Mr. Simpson’s current status, including his vital signs, activity level, and
dietary intake. Mr. Simpson’s medications include sublingual nitroglycerin as
needed for chest pain, metoprolol, Cardizem, and ticlopidine.
a. What are the rationales for the prescribed medications?
- Nitroglycerin is used to prevent and treat anginal pain and
exacerbations.
- Metoprolol is a cardioselective beta blocker used to treat severe
angina pectoris and prevent MIs.
- Cardizem is a CCB used to also treat his angina.
- Ticlopidine is used as an antiplatelet to reduce risk of stroke and
blood clots.
b. Mr. Simpson continues to smoke despite his disease process. How does
smoking increase Mr. Simpson’s chances of angina episodes?
- Smoking cigarettes cause vasoconstriction and create plaque build
up in arteries. The lack of oxygen from vasoconstriction and
decreased arterial lumen size can cause worsening angina
episodes.
c. The nurse reviews the correct procedure for taking nitroglycerin for
chest pain, and includes what information?
- Take 1 tab if you are experiencing chest pain, wait 5 mins to see if it
goes away.
- If it does not go away after taking 1 tablet, take another tablet after
the 5 minutes and call 911.
- Can only take a max of 3 tablets, 1 every 5 minutes.
This study source was downloaded by 100000817935606 from CourseHero.com on 01-27-2022 05:58:28 GMT -06:00
https://www.coursehero.com/file/103872920/Cardiocascular-Case-Studiesdocx/
Cardiovascular Disorders
1. The nurse working in the cardiac procedures area receives a patient who
has undergone a cardiac catheterization via the right femoral artery for
evaluation of unstable angina. Prior to the procedure, the patient was NPO for
12 hours, and received a sedative. An IV catheter was placed for
administration of the contrast agents and for access in case of an emergency
situation.
a. What is the rationale for assessing distal pulses immediately after the
catheterization?
- Assessing distal pulses immediately after catheterization ensures
there is no arterial occlusion from the procedure and that
oxygenated blood is getting to the extremities without any issues.
b. What other assessments should the nurse perform to check for arterial
insufficiency?
- Assessing pulses (rate, rhythm, strength), color of skin, capillary
refill, pain assessments, any signs of parasthesia.
- DVT precautions/assessments
c. The patient asks why he needs to stay in bed with the leg extended for
2 to 6 hours. How should the nurse respond?
- Patient should stay in bed with leg extended for 2-6 hours to ensure
the surgical wound is properly healing and blood is freely flowing to
the affected extremity.
d. After the procedure, why is it important to assess the patient’s BUN,
creatinine, and fluid volume status?
- The procedure required contrast dye that is excreted via the
kidneys. It is important to monitor kidney function and fluid volume
status to make sure no renal dysfunction or harm is occurring.
2. Dylan Radin, 55 years of age, is a male patient who is admitted to the ED
via ambulance with acute onset of midsternal chest pain radiating down the
left arm and radiating up the left side of the neck. The patient complains of
shortness of breath and is cool, pale, and diaphoretic. The vital signs include:
blood pressure, 160/90 mm Hg; heart rate, 110 bpm; respiratory rate, 26
breaths/min; and temperature 99°F. The 12-lead ECG reveals an anterior wall
ST-elevation myocardial infarction (STEMI).
a. What first actions should the nurse take after the patient has arrived in
the emergency department?
This study source was downloaded by 100000817935606 from CourseHero.com on 01-27-2022 05:58:28 GMT -06:00
https://www.coursehero.com/file/103872920/Cardiocascular-Case-Studiesdocx/
, - Assess ABCs and position client upright
- Administer O2 via nasal cannula or nonrebreather mask
- Obtain baseline VS
- Initiate continuous cardiac monitoring
b. The emergency physician has contacted a cardiologist and the patient
is scheduled for a percutaneous coronary intervention (PCI) in less than
60 minutes from the door-to-balloon time. Explain the reasoning for
this action based on evidence-based guidelines and considering the
clinical manifestations and the pathophysiology of the STEMI.
- This client would require an emergent PCI because this is
considered to be the first line of tx for patients with a confirmed MI.
- Goal of this tx is to open the blocked artery within 90 minutes of
arrival to the hospital.
- Greatly reduces need for emergent CABG surgery.
3. The home health care nurse is visiting Mr. Simpson, a 62-year-old man with
a significant history of angina pectoris. During the visit, the nurse assesses
Mr. Simpson’s current status, including his vital signs, activity level, and
dietary intake. Mr. Simpson’s medications include sublingual nitroglycerin as
needed for chest pain, metoprolol, Cardizem, and ticlopidine.
a. What are the rationales for the prescribed medications?
- Nitroglycerin is used to prevent and treat anginal pain and
exacerbations.
- Metoprolol is a cardioselective beta blocker used to treat severe
angina pectoris and prevent MIs.
- Cardizem is a CCB used to also treat his angina.
- Ticlopidine is used as an antiplatelet to reduce risk of stroke and
blood clots.
b. Mr. Simpson continues to smoke despite his disease process. How does
smoking increase Mr. Simpson’s chances of angina episodes?
- Smoking cigarettes cause vasoconstriction and create plaque build
up in arteries. The lack of oxygen from vasoconstriction and
decreased arterial lumen size can cause worsening angina
episodes.
c. The nurse reviews the correct procedure for taking nitroglycerin for
chest pain, and includes what information?
- Take 1 tab if you are experiencing chest pain, wait 5 mins to see if it
goes away.
- If it does not go away after taking 1 tablet, take another tablet after
the 5 minutes and call 911.
- Can only take a max of 3 tablets, 1 every 5 minutes.
This study source was downloaded by 100000817935606 from CourseHero.com on 01-27-2022 05:58:28 GMT -06:00
https://www.coursehero.com/file/103872920/Cardiocascular-Case-Studiesdocx/
