K. Peterson Age: 35 Weight: 171 kg Height: 175 cm
Case Objectives
• Designs an individualized plan of care for the nursing management of a postoperative laparoscopic
adjustable gastric banding patient who experiences chest pain (CREATING)
• Prioritizes the implementation and approach to the nursing care of the postoperative laparoscopic
adjustable gastric banding patient who experiences chest pain (APPLYING)
• Evaluates the patient’s response to interventions and modifies the nursing care as appropriate
(EVALUATING)
• *Analyze social and cultural dimensions simulated patient encounters to build understanding and
capacity for the provision of culturally congruent nursing care.
Synopsis
35-year-old individual who is post-operative day 1 after undergoing an elective laparoscopic adjustable gastric
banding procedure due to unhealthy weight. The scenario takes place on the second day of admission.
Patient History
Past Medical History:
• No significant medical history other than unhealthy weight
Allergies:
• No known allergies
Medications:
• None
Code Status:
• Full code
Social/Family History:
• Client has been married for eight years and has a 4-year-old boy and 2-year-old girl. Denies any smoking or
illicit drug use. Reports drinks a beer no more than 3 a week
Patient Problem: Unhealthy weight, elective laparoscopic adjustable gastric banding
Risk Factors (if applicable): Family inheritance and influences, unhealthy diet, inactivity, social and economic issues, age.
1
, Questions:
1. Discuss the etiology and pathophysiology of chest pain.
● Etiology
● Heart-related causes: heart attack, angina, myocardial ischemia, thoracic aortic dissection, myocarditis,
pericarditis
● Digestive causes: heartburn, esophageal rupture, gallbladder or pancreatitis
● Lung-related causes: pulmonary embolism, pleurisy, collapsed lung, pulmonary hypertension
● Muscle and bone causes: costochondritis, injured ribs
● Pathophysiology
● The heart, lungs, esophagus, and great vessels provide afferent visceral input through the same thoracic
autonomic ganglia. A painful stimulus in these organs is typically perceived as originating in the chest, but
because afferent nerve fibers overlap in the dorsal ganglia, thoracic pain may be felt (as referred pain)
anywhere between the umbilicus and the ear, including the upper extremities.
2. Discuss the clients risk for development of chest pain.
● Obesity, carbon dioxide gas trapped against the diaphragm, embolus, thrombus
3. Identify the components necessary to include in the nursing assessment of the patient with an unhealthy
weight.
● Assess the patient’s risk for obesity-related complications: calculating BMI, measuring waist circumference,
and screening for the presence of cardiovascular disease (CVD) risk factors (eg high cholesterol and LDL, low
HDL) and co-morbidities. Check patients’ blood pressure to assess for HTN and blood glucose to assess for
T2DM and pre-diabetes. Assess if cigarette smoking, family history of premature CHD, and age >55 years.
● Diet, motivation, physical activity, social support.
4. How will the nursing management strategy need to be adapted to care for the patient with an unhealthy
weight?
● Many obese patients suffer from obstructive sleep apnoea and obesity hypoventilation syndrome, it is
important to focus on measures to improve lung function. Make sure appropriate positioning, prevent
atelectasis by using lung expansion techniques. Be aware of cardiovascular risks. Use prophylaxis of deep vein
thrombosis. Tight glucose control.
5. When a patient complains of chest pain, what is the appropriate response of the nurse?
● Assessment. ABC, vital signs, PQRST (P – Position/Provoking Factors, Q – Quality, dull, sharp, squeezing,
pressure, burning, aching, pounding, cramping, stabbing or crushing, R – Radiation, S – Severity/Symptoms, T
– Time), give O2, Inform senior staff immediately, perform ECG, give aspirin/nitrates/analgesia, ensure easy
access to a defibrillator
6. Identify the nursing management of a patient experiencing chest pain.
● Assess the patient’s vital signs and characteristics of heart beat. Assess heart sounds via auscultation.
● Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor,
cyanosis, and cool, clammy skin.
● Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed.
● Administer prescribed medications.
● Place the patient in complete bed rest during chest pain attacks.
7. Discuss the medical management of chest pain, including how the various therapies relieve chest pain.
● Artery relaxers. Nitroglycerin relaxes heart arteries, so blood can flow more easily through the narrowed
spaces. Some blood pressure medicines also relax and widen blood vessels.
● Antiplatelet aggregators. Aspirin reduces the risk of thrombus formation in blood vessels.
● Thrombolytic drugs. These work to dissolve the clot that is blocking blood from reaching your heart muscle.
● Blood thinners for clot in an artery feeding your heart or lungs. These drugs inhibit blood clotting to prevent
the formation of more clots.
● Acid-suppressing medications for chest pain is caused by stomach acid splashing into esophagus. These
medications reduce the amount of acid in the stomach.
● Antidepressants for panic attacks. Helps control your symptoms. Psychological therapy, such as cognitive
behavioral therapy, also might be recommended.
8. Do chest pain and angina mean the same thing? Discuss your answer.
● No.
9. What social, cultural, or health equity considerations are apparent to you? Think about individual, family,
and community factors.
● Safe areas to walk or exercise. Being taught healthy ways of cooking. Access to healthier foods. The people
you spend time with may influence your weight — you're more likely to develop obesity if you have friends
2
Case Objectives
• Designs an individualized plan of care for the nursing management of a postoperative laparoscopic
adjustable gastric banding patient who experiences chest pain (CREATING)
• Prioritizes the implementation and approach to the nursing care of the postoperative laparoscopic
adjustable gastric banding patient who experiences chest pain (APPLYING)
• Evaluates the patient’s response to interventions and modifies the nursing care as appropriate
(EVALUATING)
• *Analyze social and cultural dimensions simulated patient encounters to build understanding and
capacity for the provision of culturally congruent nursing care.
Synopsis
35-year-old individual who is post-operative day 1 after undergoing an elective laparoscopic adjustable gastric
banding procedure due to unhealthy weight. The scenario takes place on the second day of admission.
Patient History
Past Medical History:
• No significant medical history other than unhealthy weight
Allergies:
• No known allergies
Medications:
• None
Code Status:
• Full code
Social/Family History:
• Client has been married for eight years and has a 4-year-old boy and 2-year-old girl. Denies any smoking or
illicit drug use. Reports drinks a beer no more than 3 a week
Patient Problem: Unhealthy weight, elective laparoscopic adjustable gastric banding
Risk Factors (if applicable): Family inheritance and influences, unhealthy diet, inactivity, social and economic issues, age.
1
, Questions:
1. Discuss the etiology and pathophysiology of chest pain.
● Etiology
● Heart-related causes: heart attack, angina, myocardial ischemia, thoracic aortic dissection, myocarditis,
pericarditis
● Digestive causes: heartburn, esophageal rupture, gallbladder or pancreatitis
● Lung-related causes: pulmonary embolism, pleurisy, collapsed lung, pulmonary hypertension
● Muscle and bone causes: costochondritis, injured ribs
● Pathophysiology
● The heart, lungs, esophagus, and great vessels provide afferent visceral input through the same thoracic
autonomic ganglia. A painful stimulus in these organs is typically perceived as originating in the chest, but
because afferent nerve fibers overlap in the dorsal ganglia, thoracic pain may be felt (as referred pain)
anywhere between the umbilicus and the ear, including the upper extremities.
2. Discuss the clients risk for development of chest pain.
● Obesity, carbon dioxide gas trapped against the diaphragm, embolus, thrombus
3. Identify the components necessary to include in the nursing assessment of the patient with an unhealthy
weight.
● Assess the patient’s risk for obesity-related complications: calculating BMI, measuring waist circumference,
and screening for the presence of cardiovascular disease (CVD) risk factors (eg high cholesterol and LDL, low
HDL) and co-morbidities. Check patients’ blood pressure to assess for HTN and blood glucose to assess for
T2DM and pre-diabetes. Assess if cigarette smoking, family history of premature CHD, and age >55 years.
● Diet, motivation, physical activity, social support.
4. How will the nursing management strategy need to be adapted to care for the patient with an unhealthy
weight?
● Many obese patients suffer from obstructive sleep apnoea and obesity hypoventilation syndrome, it is
important to focus on measures to improve lung function. Make sure appropriate positioning, prevent
atelectasis by using lung expansion techniques. Be aware of cardiovascular risks. Use prophylaxis of deep vein
thrombosis. Tight glucose control.
5. When a patient complains of chest pain, what is the appropriate response of the nurse?
● Assessment. ABC, vital signs, PQRST (P – Position/Provoking Factors, Q – Quality, dull, sharp, squeezing,
pressure, burning, aching, pounding, cramping, stabbing or crushing, R – Radiation, S – Severity/Symptoms, T
– Time), give O2, Inform senior staff immediately, perform ECG, give aspirin/nitrates/analgesia, ensure easy
access to a defibrillator
6. Identify the nursing management of a patient experiencing chest pain.
● Assess the patient’s vital signs and characteristics of heart beat. Assess heart sounds via auscultation.
● Observe for signs of decreasing peripheral tissue perfusion such as slow capillary refill, facial pallor,
cyanosis, and cool, clammy skin.
● Elevate the head of the bed if the patient is short of breath. Administer supplemental oxygen, as prescribed.
● Administer prescribed medications.
● Place the patient in complete bed rest during chest pain attacks.
7. Discuss the medical management of chest pain, including how the various therapies relieve chest pain.
● Artery relaxers. Nitroglycerin relaxes heart arteries, so blood can flow more easily through the narrowed
spaces. Some blood pressure medicines also relax and widen blood vessels.
● Antiplatelet aggregators. Aspirin reduces the risk of thrombus formation in blood vessels.
● Thrombolytic drugs. These work to dissolve the clot that is blocking blood from reaching your heart muscle.
● Blood thinners for clot in an artery feeding your heart or lungs. These drugs inhibit blood clotting to prevent
the formation of more clots.
● Acid-suppressing medications for chest pain is caused by stomach acid splashing into esophagus. These
medications reduce the amount of acid in the stomach.
● Antidepressants for panic attacks. Helps control your symptoms. Psychological therapy, such as cognitive
behavioral therapy, also might be recommended.
8. Do chest pain and angina mean the same thing? Discuss your answer.
● No.
9. What social, cultural, or health equity considerations are apparent to you? Think about individual, family,
and community factors.
● Safe areas to walk or exercise. Being taught healthy ways of cooking. Access to healthier foods. The people
you spend time with may influence your weight — you're more likely to develop obesity if you have friends
2
