What is the primary reason for administering aspirin to a patient with chest discomfort and suspected myocardial ischemia?

B) To decrease platelet aggregation and prevent clot formation

A) To reduce chest pain by vasodilation

B) To decrease platelet aggregation and prevent clot formation

D) To provide analgesic effects

After administering nitroglycerin and aspirin to a patient with chest discomfort, which of the following findings indicates that the treatment is effective?

B) Pain level reduced to 2 out of 10

A) Oxygen saturation of 92% on room air

B) Pain level reduced to 2 out of 10

C) Blood pressure increased to 150/90 mmHg

D) Heart rate increased to 100 beats per minute

Following the administration of nitroglycerin, which of the following vital sign changes should the nurse anticipate?

C) Decrease in respiratory rate

D) Increase in oxygen saturation

Which of the following is the most appropriate initial nursing action when a patient with stable vital signs expresses concerns about lifestyle changes after a cardiac event?

B) Provide reassurance and educational resources about lifestyle modifications

A) Increase the patient's medication dosage

B) Provide reassurance and educational resources about lifestyle modifications

C) Schedule an immediate follow-up appointment with the cardiologist

D) Suggest the patient reduce physical activity to prevent further events

A 58-year-old male patient with a history of hypertension and hyperlipidemia is being monitored in a telemetry unit. His vital signs are stable, and he reports slight fatigue but no chest pain or shortness of breath. Which nursing intervention is most important to prioritize at this time?

C) Continuing continuous cardiac monitoring for early detection of changes

A) Administering supplemental oxygen to maintain oxygen saturation levels

B) Encouraging the patient to ambulate to improve circulation

C) Continuing continuous cardiac monitoring for early detection of changes

D) Providing the patient with a high-calorie diet to address fatigue

Which of the following is the most effective intervention to prevent complications in a patient with stable cardiac status following a cardiac event?

C) Recommend the patient participate in a cardiac rehabilitation program

A) Encourage the patient to rest in bed indefinitely

B) Advise the patient to maintain a diet high in saturated fats

C) Recommend the patient participate in a cardiac rehabilitation program

D) Suggest the patient avoid all physical activity to prevent fatigue

Which of the following vital signs indicates that the patient's condition is stable according to the nursing observations?

B) Heart rate of 102 beats per minute

C) Respiratory rate of 24 breaths per minute

D) Oxygen saturation of 88% on room air

A patient recovering from a heart attack reports mild dizziness when standing up. The nurse notes a modest drop in blood pressure upon standing. Which nursing intervention is most appropriate to address this symptom?

B) Advise the patient to avoid standing up quickly.

A) Encourage the patient to increase fluid intake.

B) Advise the patient to avoid standing up quickly.

C) Suggest the patient take deep breaths before standing.

D) Recommend the patient perform leg exercises before getting up.

A patient recovering from a heart attack reports mild dizziness when standing up. Which nursing intervention is most appropriate to address this symptom?

B) Advise the patient to sit up slowly and dangle their feet before standing

A) Encourage the patient to drink more caffeinated beverages

B) Advise the patient to sit up slowly and dangle their feet before standing

C) Instruct the patient to increase salt intake

D) Recommend complete bed rest until the dizziness subsides

heart attack - Nursing Case Study

Pathophysiology

• Primary mechanism: Blockage of coronary arteries – Plaque buildup in the coronary arteries narrows the vessels, reducing blood flow to the heart muscle. This is known as atherosclerosis.

• Secondary mechanism: Plaque rupture and clot formation – When the plaque ruptures, it triggers the formation of a blood clot that can completely block the artery, causing oxygen-rich blood to be cut off from part of the heart muscle.

• Key complication: Myocardial ischemia and infarction – The lack of oxygen causes heart muscle cells to become damaged and die, leading to myocardial infarction (heart attack), which can impair heart function and cause chest pain or discomfort.

Patient Profile

Demographics:

56-year-old male, office manager

History:

• Key past medical history: Hypertension, high cholesterol

• Current medications: Lisinopril 10 mg daily, Atorvastatin 20 mg daily

• Allergies: None

Current Presentation:

• Chief complaint: Mild chest discomfort

• Key symptoms: Slight pressure in the chest, occasional shortness of breath

• Vital signs: Blood pressure 130/85 mmHg, Heart rate 78 bpm, Respiratory rate 18 breaths per minute, Temperature 98.6°F, Oxygen saturation 98% on room air

Section 1

Initial Assessment Findings:

Upon initial assessment, the patient remains stable but exhibits some concerning signs that warrant close monitoring and further evaluation. The patient describes the chest discomfort as a mild but persistent pressure, localized to the center of the chest, which he rates as a 3 out of 10 on the pain scale. This discomfort occasionally radiates to his left shoulder, but he denies any nausea, vomiting, or diaphoresis. His skin is warm and dry, and he appears to be in no acute distress. Breath sounds are clear bilaterally, and there are no signs of jugular venous distention or peripheral edema.

A focused cardiac assessment reveals regular heart sounds without murmurs, rubs, or gallops. The patient’s radial pulses are palpable and equal bilaterally. An electrocardiogram (ECG) is performed promptly, showing slight ST-segment depression in the anterior leads, suggestive of myocardial ischemia. The laboratory tests reveal elevated cardiac biomarkers, with a troponin I level at 0.06 ng/mL, which is consistent with a minor myocardial injury. The nursing team initiates standard protocols for chest pain, including administering aspirin 325 mg and nitroglycerin 0.4 mg sublingually, with careful monitoring of the patient’s response to these interventions.

The nursing team discusses with the patient the importance of closely monitoring his condition and the need for possible admission for further observation and management. Education about lifestyle modifications and adherence to medication is reinforced, emphasizing the role of controlling blood pressure and cholesterol levels to prevent further cardiac events. The team plans for continuous cardiac monitoring and frequent reassessment of the patient’s symptoms and vital signs to ensure early detection of any changes in his condition.

Section 2

Response to Interventions:

Following the administration of aspirin and nitroglycerin, the patient reports a mild reduction in chest discomfort, now rating it as a 2 out of 10 on the pain scale. The nursing team notes a slight decrease in blood pressure to 118/76 mmHg, while heart rate remains stable at 78 beats per minute. The patient continues to be alert and oriented, maintaining clear and coherent communication with the healthcare team. Oxygen saturation is measured at 98% on room air, indicating adequate oxygenation. The patient is encouraged to rest quietly while being continuously monitored on telemetry for any changes in cardiac rhythm.

Throughout the next few hours, the patient remains stable with no new symptoms or signs of distress. Repeat ECGs show no significant changes in ST-segment depression, suggesting that the ischemic episode is being controlled effectively with the current interventions. A second set of cardiac biomarkers is drawn to assess for any further myocardial injury. The troponin I level shows a slight increase to 0.08 ng/mL, but remains consistent with the initial findings of a minor myocardial injury. Blood chemistry and complete blood count remain within normal limits, providing reassurance that there are no immediate complications such as electrolyte imbalances or anemia.

The nursing team continues to educate the patient about the importance of medication adherence and lifestyle changes, including dietary modifications and regular physical activity, tailored to his current health status. Plans are made for the patient's admission to a telemetry unit for continued observation and management. The team emphasizes the need for ongoing monitoring and reassessment to ensure the patient’s condition remains stable, and they discuss the potential for future diagnostic testing, such as a stress test or coronary angiography, to further evaluate the underlying cause of the myocardial ischemia.

Section 3

As the patient transitions to the telemetry unit for continued observation, the nursing team conducts a thorough initial assessment. The patient is a 58-year-old male with a history of hypertension and hyperlipidemia. Upon assessment, his vital signs remain stable with a blood pressure of 116/74 mmHg, heart rate of 76 beats per minute, respiratory rate of 16 breaths per minute, and an oxygen saturation of 98% on room air. The patient reports feeling slightly fatigued but denies any new or worsening chest pain, shortness of breath, or other symptoms. He is resting comfortably in bed, and his skin is warm and dry. Cardiac auscultation reveals a regular rhythm without any murmurs, rubs, or gallops, and lung sounds are clear bilaterally.

In preparation for potential diagnostic testing, the nursing team reviews the patient’s lab results. The follow-up troponin I remains stable at 0.08 ng/mL, confirming the absence of significant myocardial necrosis. The complete blood count and comprehensive metabolic panel are repeated, showing no significant changes from baseline, with electrolytes, renal function, and hemoglobin levels all within normal limits. These findings suggest that the patient remains stable and free from acute complications such as arrhythmias or heart failure. The nursing team discusses the importance of continuous cardiac monitoring and reassures the patient about the current management plan.

The patient expresses concerns about the implications of his condition and the lifestyle changes recommended by the healthcare team. The nurse takes the opportunity to engage in patient education, emphasizing the role of medications in preventing further cardiac events and the significance of a heart-healthy diet and regular exercise. The nurse provides resources and support to help the patient understand and implement these changes, including referrals to a dietitian and cardiac rehabilitation program. This ongoing education aims to empower the patient to take an active role in his recovery and long-term health management, setting the stage for successful discharge planning and follow-up care.

Section 4

As the patient continues to be monitored on the telemetry unit, the nursing team observes his response to the interventions and the stability of his condition. Over the course of the next few hours, the patient's vital signs remain consistent, with a blood pressure of 118/76 mmHg, heart rate of 78 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation holding steady at 98% on room air. He reports feeling slightly more energetic and expresses gratitude for the information and support provided. The patient is encouraged to ambulate around the unit as tolerated, and he is able to do so with minimal assistance, walking slowly but steadily without any signs of distress or fatigue. The nurse notes that the patient’s skin remains warm and dry, and his color looks good, indicating adequate perfusion and oxygenation.

The nursing team closely monitors the telemetry readings, which consistently display a normal sinus rhythm, further confirming the absence of any acute cardiac arrhythmias. A repeat echocardiogram is performed, showing preserved left ventricular function with an ejection fraction of 55%, which is within normal limits. These findings provide additional reassurance about the patient's cardiac status, supporting the decision to continue with the current management plan. The nurse discusses these results with the patient, explaining that the heart is pumping effectively and that no significant damage appears to have occurred from the cardiac event.

With the patient's condition stable, the focus shifts towards discharge planning and reinforcing lifestyle modifications. The nurse reiterates the importance of adhering to prescribed medications, including antihypertensives and statins, to control blood pressure and cholesterol levels. Education on recognizing warning signs of potential complications, such as new or worsening chest pain, is also provided. The patient is scheduled for a follow-up appointment with his cardiologist and is encouraged to actively participate in the cardiac rehabilitation program. By empowering the patient with knowledge and resources, the nursing team sets the foundation for a smooth transition to self-management and long-term cardiovascular health.

Section 5

As the patient continues his recovery, the nursing team notes a slight change in his status during their morning rounds. While his vital signs remain stable, with a blood pressure of 116/74 mmHg, heart rate of 76 beats per minute, respiratory rate of 16 breaths per minute, and oxygen saturation at 98% on room air, the patient mentions experiencing mild, intermittent episodes of dizziness when getting out of bed. The nurse performs an orthostatic blood pressure assessment, finding a modest drop in blood pressure upon standing, suggesting a potential issue with orthostatic hypotension. Given these findings, the team decides to adjust the patient's medication schedule slightly and encourages him to rise slowly from a sitting or lying position to minimize these symptoms.

To ensure a comprehensive understanding of this new development, the nurse reviews the patient's recent laboratory results, which include a complete blood count (CBC) and electrolyte panel. The CBC reveals a hemoglobin level of 14 g/dL, which is within normal limits, ruling out anemia as a cause for the dizziness. The electrolyte panel shows sodium at 138 mmol/L and potassium at 4.1 mmol/L, both of which are normal, indicating that electrolyte imbalances are unlikely to be contributing factors. These findings reinforce that the dizziness is most likely related to the cardiovascular adjustments following the heart attack and the initiation of new medications.

Reassured by the laboratory results, the nursing team continues to educate the patient on strategies to manage these symptoms, emphasizing the importance of gradual position changes and maintaining adequate hydration. The patient is also advised to report any significant changes in his symptoms, such as persistent dizziness or any new chest discomfort. By addressing this minor complication proactively, the nursing team aims to enhance the patient's confidence in managing his recovery, ensuring a smoother transition towards discharge and ongoing self-care.