/Advance Med Surg Week 2 Discussion Week 2 – Discussion 1

See Announcement posted day 7 of week 1 for groups assigned. Group 1 Scenario: T.M. is 50-year-old male patient who came in to the emergency department with complaints of chest pain developing while shoveling snow this am. He is accompanied by his wife, who reports he became ill while outside working to remove snow on their driveway. T.M. states his pain level is an 8 on a scale of 0 – 10 and reports he feels heavy pressure in the center of his chest. Upon assessment, he denies pain radiating to extremities or any other location. He is breathing rapidly and is diaphoretic. He states after the pain started he stopped shoveling, went into the house to rest, felt nauseated and vomited once. The chest pain continued so he had his wife drive him to the ER. He is anxious and says, “I think I am having a heart attack”. T.M. has a history of hyperlipidemia and takes atorvastatin. He also has a history of HTN and is on nifedipine. There is no history of angina and he has never experienced chest pain before. He smoked cigarettes for 23 years but stopped smoking at age 40. T.M. has an ECG, which shows an anterior wall ST elevation myocardial infarction (STEMI). 1. List emergency best practices when caring for patients presenting with chest pain. What are the priorities? 2. Explain the difference in a STEMI and NSTEMI including how these two conditions would be treated. 3. What labs would you expect to be ordered for this patient? Explain with a rationale. 4. Describe how PCI would be used to manage the patient. What is the goal of PCI and what is the nurse’s role when caring for a patient post PCI? 5. What criteria is used to determine if a patient is appropriate to receive tPA and if the patient receives this medication what would you monitor for post administration? 6. Math practice question: A client is prescribed dobutamine 2.5mcg/kg/min IV. You have on hand 500mg in 250cc NS. The patient’s weight is 172 pounds. What would you set the mL/hr on an infusion pump? Show your calculation and round to the nearest tenth mL.