Week 2 – Discussion 1
9090 unread replies.113113 replies.
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.
Group 2 Scenario:
C.L. is a 58-year-old female post op day 1 following coronary artery bypass graft
(CABG). C.L. has a history of coronary heart disease and angina; she recently had a
coronary angiogram, which indicated that she had several blocked coronary arteries. A
traditional CABG was scheduled due to the finding of the angiogram.
,C.L. is transferred to the ICU after surgery with mediastinal chest tubes. Hemodynamic
monitoring lines are in place for the first day. After 4 hours the patient was extubated
from the mechanical vent. The oncoming night shift nurse performs an assessment after
receiving report; she notes the following vital signs: HR 108 and irregular, RR 18/min,
BP 118/78, O2 sat 98% on 2L oxygen NC. The nurse assesses C.L.s rhythm and notes
she is having periods of atrial fibrillation.
1. What are the manifestations of tamponade C.L. should be monitored for post op?
2. Post op CABG patients are at risk for sternal wound infection. What teaching
would you provide to C.L. to prevent infection of her incision?
3. Besides wound infection and tamponade noted above, discuss the other
complications should nurses monitor for with a post-op CABG patient?
4. Why is early ambulation important for C.L.?
5. The provider orders warfarin for the a-fib. What teaching points are appropriate
for patients prescribed warfarin for a-fib?
6. Math practice question: The provider has prescribed nitroprusside 225mcg/min
IV. The IV bag contains 100mg in 250mL of D5W. The patient weighs 190 pounds.
What rate (mL/hr) should the IV pump be set to infuse this med? Show your
calculation and round to nearest whole number.
Use Iggy as a scholarly reference and cite in APA format with page number(s) where
information was accessed.
Discussion Requirements:
This discussion forum requires that the student create an initial post before being able
to see other student posts. Once you make your first post, your classmates’ posts will
appear and you can respond as directed below. Students must first post a topic before
they are allowed to view or reply to other student’s posted topics.
Your initial response should be posted no later than midnight on Day 3. In your
responses, I want to see informed input. In other words, do not simply recite the text
and do not simply give your opinion. Your input should be in your own words,
demonstrating your understanding and comprehension of the topic. Responses need to
be substantive, thorough, offer new insight or reasoning, or critical and analytical
thoughts. One or two sentences are not a substantive response. You are required to use
correct spelling and grammar. Then, I want to see you respond to your classmates on
at least 2 other days throughout the week. The purpose here is to generate discussion,
to further explore the topics, ask questions, add insight, agree or disagree, etc. Of
course, all discussion should be positive and professional. Professional nurses
demonstrate professional conduct at all times. It is acceptable to disagree with your
peers but your interactions must remain professional.
Bottom Line: Be sure to at least meet the minimum posting requirements...you cannot
just log in, post one day and be done. You will be required to remain active throughout
the week in order to receive full credit for participation. Please be sure to post
responses to other classmates' posts on at least 2 other days after your initial post.
You are not required to reply to everyone during the discussion just ensure that you
,respond to a least 2 of your peers per discussion question. I am looking for quality posts
that further the discussion. Think of this as a discussion we may have in the classroom
setting!
If you have questions about this participation requirement, post them to the course
questions forum.
Search entries or author Filter replies by unread Unread Collapse replies Expand
replies
Subscribed
Collapse SubdiscussionCinthia Fuentes
Cinthia Fuentes
Jul 15, 2019Local: Jul 15 at 3:56pm<br>Course: Jul 15 at 4:56pm
Manage Discussion Entry
*T.M. is 50-year-old male patient who came into 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?
-Assess Pain/location, severity.
-Nitroglycerin
-Assess vitals
, -Give oxygen if needed
-Collect ordered labs
2.Explain the difference in a STEMI and NSTEMI including how these two
conditions would be treated.
-STEMI- is a very serious type of heart attack during which one of the heart's major
arteries one of the arteries that supplies oxygen and nutrient-rich blood to the heart
muscle is blocked.
- TX-The priority in treating a STEMI heart attack is to open the artery quickly, saving
as much heart muscle as possible. Treatment options include percutaneous
coronary intervention (PCI), a term that encompasses both angioplasty and stenting;
clot-busting medication; and coronary artery bypass graft surgery (CABG).
-NSTEMI- Non-ST-elevation myocardial infarction, which is the most common type
of heart attack, by causing less damage to a person's heart.
-TX- Treatment for an NSTEMI depends on how blocked the coronary artery is, as
well as the severity of the heart attack itself.
3.What labs would you expect to be ordered for this patient? Explain with a
rationale.
-Troponin, CK-MB , BNP, Myoglobin, CMP, CBC.
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?
- PCI would work with chronic chest pain from coronary artery disease and those in
the midst of suffering a heart attack. It is also the preferred method to open an
artery and stop a person’s heart attack quickly to prevent further damage to the
heart muscle. Assess V/S for any abnormalities, Heart arrythmias. Assess insertion
site for s/sx of infection and bleeding.
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?
-TPA medicines are approved for the emergency treatment of stroke and heart
attack. Thrombolytic therapy is the use of drugs to break up or dissolve blood clots,
which are the main cause of both heart attacks and stroke. Monitor for bleeding after
this medication is given.
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.
-0.0025mg/78kg/60min
9090 unread replies.113113 replies.
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.
Group 2 Scenario:
C.L. is a 58-year-old female post op day 1 following coronary artery bypass graft
(CABG). C.L. has a history of coronary heart disease and angina; she recently had a
coronary angiogram, which indicated that she had several blocked coronary arteries. A
traditional CABG was scheduled due to the finding of the angiogram.
,C.L. is transferred to the ICU after surgery with mediastinal chest tubes. Hemodynamic
monitoring lines are in place for the first day. After 4 hours the patient was extubated
from the mechanical vent. The oncoming night shift nurse performs an assessment after
receiving report; she notes the following vital signs: HR 108 and irregular, RR 18/min,
BP 118/78, O2 sat 98% on 2L oxygen NC. The nurse assesses C.L.s rhythm and notes
she is having periods of atrial fibrillation.
1. What are the manifestations of tamponade C.L. should be monitored for post op?
2. Post op CABG patients are at risk for sternal wound infection. What teaching
would you provide to C.L. to prevent infection of her incision?
3. Besides wound infection and tamponade noted above, discuss the other
complications should nurses monitor for with a post-op CABG patient?
4. Why is early ambulation important for C.L.?
5. The provider orders warfarin for the a-fib. What teaching points are appropriate
for patients prescribed warfarin for a-fib?
6. Math practice question: The provider has prescribed nitroprusside 225mcg/min
IV. The IV bag contains 100mg in 250mL of D5W. The patient weighs 190 pounds.
What rate (mL/hr) should the IV pump be set to infuse this med? Show your
calculation and round to nearest whole number.
Use Iggy as a scholarly reference and cite in APA format with page number(s) where
information was accessed.
Discussion Requirements:
This discussion forum requires that the student create an initial post before being able
to see other student posts. Once you make your first post, your classmates’ posts will
appear and you can respond as directed below. Students must first post a topic before
they are allowed to view or reply to other student’s posted topics.
Your initial response should be posted no later than midnight on Day 3. In your
responses, I want to see informed input. In other words, do not simply recite the text
and do not simply give your opinion. Your input should be in your own words,
demonstrating your understanding and comprehension of the topic. Responses need to
be substantive, thorough, offer new insight or reasoning, or critical and analytical
thoughts. One or two sentences are not a substantive response. You are required to use
correct spelling and grammar. Then, I want to see you respond to your classmates on
at least 2 other days throughout the week. The purpose here is to generate discussion,
to further explore the topics, ask questions, add insight, agree or disagree, etc. Of
course, all discussion should be positive and professional. Professional nurses
demonstrate professional conduct at all times. It is acceptable to disagree with your
peers but your interactions must remain professional.
Bottom Line: Be sure to at least meet the minimum posting requirements...you cannot
just log in, post one day and be done. You will be required to remain active throughout
the week in order to receive full credit for participation. Please be sure to post
responses to other classmates' posts on at least 2 other days after your initial post.
You are not required to reply to everyone during the discussion just ensure that you
,respond to a least 2 of your peers per discussion question. I am looking for quality posts
that further the discussion. Think of this as a discussion we may have in the classroom
setting!
If you have questions about this participation requirement, post them to the course
questions forum.
Search entries or author Filter replies by unread Unread Collapse replies Expand
replies
Subscribed
Collapse SubdiscussionCinthia Fuentes
Cinthia Fuentes
Jul 15, 2019Local: Jul 15 at 3:56pm<br>Course: Jul 15 at 4:56pm
Manage Discussion Entry
*T.M. is 50-year-old male patient who came into 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?
-Assess Pain/location, severity.
-Nitroglycerin
-Assess vitals
, -Give oxygen if needed
-Collect ordered labs
2.Explain the difference in a STEMI and NSTEMI including how these two
conditions would be treated.
-STEMI- is a very serious type of heart attack during which one of the heart's major
arteries one of the arteries that supplies oxygen and nutrient-rich blood to the heart
muscle is blocked.
- TX-The priority in treating a STEMI heart attack is to open the artery quickly, saving
as much heart muscle as possible. Treatment options include percutaneous
coronary intervention (PCI), a term that encompasses both angioplasty and stenting;
clot-busting medication; and coronary artery bypass graft surgery (CABG).
-NSTEMI- Non-ST-elevation myocardial infarction, which is the most common type
of heart attack, by causing less damage to a person's heart.
-TX- Treatment for an NSTEMI depends on how blocked the coronary artery is, as
well as the severity of the heart attack itself.
3.What labs would you expect to be ordered for this patient? Explain with a
rationale.
-Troponin, CK-MB , BNP, Myoglobin, CMP, CBC.
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?
- PCI would work with chronic chest pain from coronary artery disease and those in
the midst of suffering a heart attack. It is also the preferred method to open an
artery and stop a person’s heart attack quickly to prevent further damage to the
heart muscle. Assess V/S for any abnormalities, Heart arrythmias. Assess insertion
site for s/sx of infection and bleeding.
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?
-TPA medicines are approved for the emergency treatment of stroke and heart
attack. Thrombolytic therapy is the use of drugs to break up or dissolve blood clots,
which are the main cause of both heart attacks and stroke. Monitor for bleeding after
this medication is given.
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.
-0.0025mg/78kg/60min
