Case Study - Management of Patients With Coronary
Vascular Disorders
1. 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?
The first actions the nurse should take after the patient has arrived in the
emergency department is place the patient on continuous cardiac
monitoring and telemetry in addition to administering supplemental
oxygen. Immediately following, the patient should be given a dose of
aspirin. The nurse should then start two IV lines for administering any
emergency medication that would be needed. The patient’s vital signs
should also be checked again, as well as a glucose check, along with a
pain scale assessment. The patient will have laboratory studies obtained
and sent for immediate processing – these will include a complete blood
count (CBC), prothrombin time (PT), partial thromboplastin time (PTT),
internalized normalized ratio (INR), troponin I and T levels, creatine
kinase-MB (CK-MB), and a type and cross match should the patient need
a transfusion. Following that, the patient should be provided with
nitroglycerin for the chest pain – this should be started sublingually at 0.4
mg doses every 5 minutes for up to 3 doses. If the pain does not decrease
and there is no relief after the third dose, an IV infusion of nitroglycerin
will be ordered and will be titrated until the patient would describe the
pain level to be at 0. Nitroglycerin is a vasodilator and will decrease blood
pressure, so it is important to monitor vitals while it is being administered.
In addition to the nitroglycerin, the patient can be prescribed doses of IV
This study source was downloaded by 100000839383624 from CourseHero.com on 02-02-2022 09:28:46 GMT -06:00
https://www.coursehero.com/file/81863050/MSI-Cardiac-Case-Studydocx/
, morphine and with that it will be important to, again, monitor blood
pressure, respirations, and other vital signs; the morphine will help in
reducing both the pain and anxiety of the patient. Furthermore, a dose of a
beta-blocker can be administered to the patient if there are dysrhythmias
present or the patient is tachycardic and they are to continually be
monitored. Finally, the patient should be made NPO (no food or drink),
should there be a need for an emergency surgery. The ultimate goal with
these interventions is to minimize the myocardial damage and prevent
complications in addition to preserving the myocardial functions.
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.
b. Explain the reasoning for this action based on evidence-based guidelines and
considering the clinical manifestations and the pathophysiology of the STEMI.
A percutaneous coronary intervention (PCI) is a procedure in which a
catheter is used to place a stent to open narrow blood vessels in the heart,
and it is the preferred treatment for a STEMI. A PCI will treat the
underlying cause of the STEMI which begins with a rupture of the build-
up plaque (atherosclerosis), leading to a thrombus forming and an
occlusion of the coronary artery. The PCI is ordered immediately in order
to open an occluded coronary artery in order for reperfusion to occur in
the area that has been oxygen-deprived. During the period of oxygen
deprivation, a number of myocardial cells can die and that is the reason for
the importance and emphasis on the “less than 60 minutes door-to-balloon
time”. By opening the artery quickly, as much of the myocardium (heart
muscles) can be saved.
c. Following the cardiac catheterization, what are the priority nursing interventions?
Following the cardiac catherization, it is important to continue to monitor
vital signs, complete a pain scale assessment, continuous cardiac
monitoring, particularly paying attention for ectopic beats. It is also
This study source was downloaded by 100000839383624 from CourseHero.com on 02-02-2022 09:28:46 GMT -06:00
https://www.coursehero.com/file/81863050/MSI-Cardiac-Case-Studydocx/
Vascular Disorders
1. 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?
The first actions the nurse should take after the patient has arrived in the
emergency department is place the patient on continuous cardiac
monitoring and telemetry in addition to administering supplemental
oxygen. Immediately following, the patient should be given a dose of
aspirin. The nurse should then start two IV lines for administering any
emergency medication that would be needed. The patient’s vital signs
should also be checked again, as well as a glucose check, along with a
pain scale assessment. The patient will have laboratory studies obtained
and sent for immediate processing – these will include a complete blood
count (CBC), prothrombin time (PT), partial thromboplastin time (PTT),
internalized normalized ratio (INR), troponin I and T levels, creatine
kinase-MB (CK-MB), and a type and cross match should the patient need
a transfusion. Following that, the patient should be provided with
nitroglycerin for the chest pain – this should be started sublingually at 0.4
mg doses every 5 minutes for up to 3 doses. If the pain does not decrease
and there is no relief after the third dose, an IV infusion of nitroglycerin
will be ordered and will be titrated until the patient would describe the
pain level to be at 0. Nitroglycerin is a vasodilator and will decrease blood
pressure, so it is important to monitor vitals while it is being administered.
In addition to the nitroglycerin, the patient can be prescribed doses of IV
This study source was downloaded by 100000839383624 from CourseHero.com on 02-02-2022 09:28:46 GMT -06:00
https://www.coursehero.com/file/81863050/MSI-Cardiac-Case-Studydocx/
, morphine and with that it will be important to, again, monitor blood
pressure, respirations, and other vital signs; the morphine will help in
reducing both the pain and anxiety of the patient. Furthermore, a dose of a
beta-blocker can be administered to the patient if there are dysrhythmias
present or the patient is tachycardic and they are to continually be
monitored. Finally, the patient should be made NPO (no food or drink),
should there be a need for an emergency surgery. The ultimate goal with
these interventions is to minimize the myocardial damage and prevent
complications in addition to preserving the myocardial functions.
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.
b. Explain the reasoning for this action based on evidence-based guidelines and
considering the clinical manifestations and the pathophysiology of the STEMI.
A percutaneous coronary intervention (PCI) is a procedure in which a
catheter is used to place a stent to open narrow blood vessels in the heart,
and it is the preferred treatment for a STEMI. A PCI will treat the
underlying cause of the STEMI which begins with a rupture of the build-
up plaque (atherosclerosis), leading to a thrombus forming and an
occlusion of the coronary artery. The PCI is ordered immediately in order
to open an occluded coronary artery in order for reperfusion to occur in
the area that has been oxygen-deprived. During the period of oxygen
deprivation, a number of myocardial cells can die and that is the reason for
the importance and emphasis on the “less than 60 minutes door-to-balloon
time”. By opening the artery quickly, as much of the myocardium (heart
muscles) can be saved.
c. Following the cardiac catheterization, what are the priority nursing interventions?
Following the cardiac catherization, it is important to continue to monitor
vital signs, complete a pain scale assessment, continuous cardiac
monitoring, particularly paying attention for ectopic beats. It is also
This study source was downloaded by 100000839383624 from CourseHero.com on 02-02-2022 09:28:46 GMT -06:00
https://www.coursehero.com/file/81863050/MSI-Cardiac-Case-Studydocx/
