Which initial assessment finding indicates that the patient is NOT experiencing acute respiratory distress?

A) Clear bilateral breath sounds

C) Chest discomfort rated as 3 out of 10

What is the primary purpose of monitoring vital signs every four hours for a patient with potential cardiac ischemia?

B) To detect early signs of deterioration

A) To ensure the patient is comfortable

B) To detect early signs of deterioration

C) To evaluate the effectiveness of medications

D) To prepare for upcoming diagnostic tests

What is the primary purpose of administering aspirin to a patient diagnosed with a non-ST-elevation myocardial infarction (NSTEMI)?

B) To prevent further clot formation

D) To increase oxygen saturation

The patient with a non-ST-elevation myocardial infarction (NSTEMI) has been started on a low-dose aspirin regimen. What is the primary purpose of administering aspirin in this scenario?

C) To prevent further clot formation

D) To increase oxygen saturation

What is the primary purpose of encouraging a heart-healthy diet in patients with a history of cardiac events?

B) To reduce the risk of future cardiac events

C) To manage blood glucose levels

D) To promote rapid weight loss

What is the primary purpose of encouraging lifestyle modifications, such as a heart-healthy diet and light physical activity, in patients with cardiac conditions?

D) To prevent future cardiac events

A) To eliminate the need for medications

B) To enhance the effectiveness of medications

C) To immediately reduce symptoms

D) To prevent future cardiac events

Which intervention is most appropriate for a patient experiencing postural hypotension due to beta-blocker therapy?

C) Encourage the patient to rise slowly from sitting or lying positions

A) Increase fluid intake to improve blood volume

B) Administer additional beta-blockers to manage symptoms

C) Encourage the patient to rise slowly from sitting or lying positions

D) Increase sodium intake to balance electrolytes

A patient who started beta-blocker therapy reports mild headache and dizziness upon standing. What is the most appropriate initial nursing intervention to address these symptoms?

B) Encourage the patient to rise slowly from sitting or lying positions

A) Administer a dose of acetaminophen for the headache

B) Encourage the patient to rise slowly from sitting or lying positions

C) Increase the patient's fluid intake to prevent dehydration

D) Notify the healthcare provider immediately about the symptoms

A patient has developed mild bruising on the forearms and has a platelet count at the lower end of normal. What is the most appropriate initial nursing intervention to ensure patient safety?

B) Apply protective padding to bed rails

A) Administer platelet transfusion

B) Apply protective padding to bed rails

C) Increase fluid intake to improve circulation

D) Encourage ambulation to prevent blood clots

What is the primary nursing action when a patient exhibits new bruising and has a low platelet count?

C) Communicate the findings to the healthcare provider

A) Monitor the patient's vital signs every 4 hours

B) Apply ice packs to the bruised areas

C) Communicate the findings to the healthcare provider

D) Encourage the patient to increase fluid intake

MI - Nursing Case Study

Pathophysiology

• Primary mechanism: Atherosclerosis - Fatty deposits (plaques) build up in the coronary arteries, narrowing them and reducing blood flow to the heart muscle, leading to ischemia (lack of oxygen).

• Secondary mechanism: Plaque rupture and thrombosis - The plaque can rupture, causing a blood clot to form, which can completely block the coronary artery, resulting in myocardial infarction (heart attack) as heart tissue begins to die from lack of oxygen.

• Key complication: Heart failure - Damaged heart muscle from the infarction can weaken the heart's ability to pump blood effectively, potentially leading to heart failure, which requires careful monitoring and management.

Patient Profile

Demographics:

54-year-old male, office manager

History:

• Hypertension, hyperlipidemia

• Lisinopril, atorvastatin, aspirin

• No known drug allergies

Current Presentation:

• Chief complaint: Mild chest discomfort

• Key symptoms: Chest discomfort radiating to left arm, mild shortness of breath, slight fatigue

• 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 conducting a thorough initial assessment, the nursing team noted that the patient appeared slightly anxious, but was alert and oriented to person, place, and time. The patient's skin was warm and dry, with no signs of cyanosis or diaphoresis. Heart sounds were regular with no murmurs detected, and breath sounds were clear bilaterally without any adventitious sounds such as crackles or wheezes. Peripheral pulses were palpable and equal bilaterally, with no significant edema observed in the extremities. The patient reported the chest discomfort as a 3 out of 10 on the pain scale, describing it as a dull ache that occasionally intensified with physical exertion.

Laboratory tests were subsequently ordered, including cardiac enzymes such as troponin, which would help confirm or rule out myocardial infarction. An electrocardiogram (ECG) was also performed, and initial results indicated slight ST-segment changes suggestive of early ischemic changes, but no definitive signs of an acute myocardial infarction. The patient was closely monitored for any changes in symptoms or vital signs, with a focus on maintaining stable hemodynamics and preventing progression to a full-blown heart attack.

The nursing team implemented a care plan that included continued monitoring of vital signs every four hours, administration of prescribed medications, and patient education on recognizing worsening symptoms. This approach aimed to stabilize the patient's condition and prevent complications while awaiting further diagnostic results. Education focused on the importance of medication adherence, lifestyle modifications such as diet and exercise, and recognizing signs of potential complications like increased chest pain or shortness of breath, which could indicate worsening ischemia or heart failure.

Section 2

New Diagnostic Results:

A few hours after the initial assessment, the laboratory results returned, providing more insight into the patient's condition. The cardiac enzyme levels, particularly troponin, were slightly elevated, which confirmed a minor myocardial injury consistent with an early-stage myocardial infarction. The patient's ECG was reviewed again by the healthcare team, and it showed subtle ST-segment elevation, reinforcing the diagnosis of a non-ST-elevation myocardial infarction (NSTEMI). These findings underscored the importance of vigilant monitoring and timely intervention to prevent further cardiac damage.

The nursing team, in collaboration with the attending physician, adjusted the care plan to address these new diagnostic results. The patient was started on a low-dose aspirin regimen to help prevent further clot formation and improve blood flow to the heart. Additionally, a beta-blocker was prescribed to decrease the heart's workload and oxygen demand, contributing to the stabilization of the patient's condition. The nursing staff continued to monitor the patient's vital signs, noting that blood pressure remained stable at 130/80 mmHg, heart rate was at 78 beats per minute, and oxygen saturation was consistently at 98% on room air.

The patient was reassured about the findings and the plan of care, with emphasis placed on the importance of reporting any changes in symptoms, such as increased chest pain or shortness of breath, which could signal a need for immediate medical attention. With the patient understanding the significance of these findings and the rationale behind the treatment strategy, the nursing team felt confident in their approach to managing this early-stage myocardial infarction. This step in the patient's journey set the stage for ongoing evaluation and potential adjustments to the therapeutic regimen based on the patient's response to treatment.

Section 3

Response to Interventions

Over the next 24 hours, the nursing team diligently monitored the patient's response to the prescribed interventions. The patient adhered well to the medication regimen, exhibiting no adverse reactions to the low-dose aspirin or beta-blocker. Vital signs remained stable, with the blood pressure holding at 128/76 mmHg and heart rate consistently around 75 beats per minute. Oxygen saturation stayed at 98% on room air, reinforcing the effectiveness of the current treatment approach. The patient reported a reduction in chest discomfort, describing the sensation as more of a mild pressure than pain, and there were no episodes of shortness of breath, which was encouraging for the healthcare team.

In addition to pharmacological interventions, the nursing staff emphasized the importance of lifestyle modifications to support cardiac health. They educated the patient on dietary changes, recommending a heart-healthy diet low in sodium and saturated fats. The patient was also encouraged to engage in light physical activity as tolerated, such as short walks, to enhance cardiovascular function without overexertion. The patient expressed a willingness to make these changes, understanding their role in recovery and prevention of future cardiac events.

As the patient continued to show signs of stabilization, the healthcare team planned for the next steps in the care plan, considering the potential transition from hospital to home care. They prepared to coordinate with the patient's family and support system to ensure a smooth discharge process. This included setting up a follow-up appointment with a cardiologist for ongoing evaluation and management. The patient was reminded to remain vigilant for any changes in symptoms and to maintain regular communication with healthcare providers, signaling a proactive approach to managing their health moving forward.

Section 4

The following day, during the morning assessment, the nursing team noted a slight change in the patient's status that required careful evaluation. Although the patient continued to be stable overall, they reported experiencing a mild headache and slight dizziness upon standing. The vital signs remained within acceptable ranges; however, the blood pressure was noted to have decreased slightly to 118/70 mmHg, and the heart rate was consistent at 72 beats per minute. Oxygen saturation continued to be optimal at 98% on room air. The patient's electrocardiogram (ECG) showed no new changes, remaining consistent with previous findings of early-stage myocardial infarction without significant ischemic alterations.

To further investigate these new symptoms, the healthcare team ordered a basic metabolic panel and a complete blood count. The results showed a slight decrease in hemoglobin levels, now at 12 g/dL, compared to the previous 13.5 g/dL. Electrolyte levels, including sodium and potassium, were within normal limits, ruling out imbalances as the cause of dizziness. The team hypothesized that the symptoms might be related to the initiation of the beta-blocker therapy, potentially causing a slight postural hypotension.

In response, the nursing team decided to adjust the patient’s activities, recommending that they rise slowly from sitting or lying positions to mitigate the dizziness. They also provided additional education on recognizing signs of hypotension. The patient was encouraged to maintain adequate hydration and to report any persistent or worsening symptoms. With these interventions in place, the team felt confident in managing the patient's care while preparing for eventual discharge, ensuring that both the patient and their family were well-informed about managing potential side effects at home. This proactive approach aimed to promote patient safety and facilitate a successful transition from hospital care.

Section 5

As the day progressed, the nursing team continued to monitor the patient closely, particularly focusing on the response to the interventions aimed at managing the symptoms of dizziness and mild headache. By the afternoon, the patient reported feeling more comfortable and experienced less dizziness when standing, indicating a positive response to the gradual position changes and hydration strategies. The vital signs remained stable, with blood pressure slightly improving to 122/74 mmHg, and the heart rate steady at 74 beats per minute. Oxygen saturation remained optimal at 98% on room air. The patient was able to ambulate short distances in the room with minimal assistance, displaying improved tolerance to activity.

However, the nursing team noted a new development during the routine skin assessment. The patient exhibited mild bruising on the forearms, which was not present during the previous assessments. Concerned about potential bleeding tendencies, the team reviewed the latest lab results. While the slight decrease in hemoglobin had been noted earlier, the platelet count was found to be at the lower end of normal, at 150,000/mm³, which could contribute to the bruising. The nursing team communicated these findings to the healthcare provider for further evaluation.

A careful review of the patient's medication regimen was conducted to assess any potential interactions or side effects that could contribute to the bruising and lower hemoglobin levels. The healthcare provider considered adjusting the medication dosage and ordering further tests to monitor the patient’s coagulation profile. Meanwhile, the nursing team reinforced safety precautions to prevent injury, including using protective padding on the bed rails and ensuring a clutter-free environment in the patient’s room. These measures aimed to mitigate any risk of falls or additional bruising, ensuring the patient's safety while the team continued to evaluate and adjust the care plan as needed.