30.9: Chapter 24
Unfolding Case Study
1. The 7/10 chest pain is the finding of most concern because this is a new symptom and may indicate an acute problem. It is also important to recognize that the patient is experiencing an abnormally fast heart rate with PVCs, which can indicate an underlying cardiac issue. The elevated respiratory rate is also a concern because this may indicate issues with the lungs. The high blood pressure is a concern but not the priority at this time.
2. Based on the recognized cues, it is likely that the patient is experiencing a cardiac issue. Specifically, the patient may be experiencing a myocardial infarction or a continued severe exacerbation of heart failure.
3. The nurse should anticipate performing diagnostic tests to rule out cardiac disorders. These include a 12-lead ECG and blood tests. Eventually the provider may also order a stress test or cardiac catheterization.
4. An elevated troponin level is indicative of myocardial damage or ischemia, often related to a myocardial infarction, or heart attack. The nurse should first alert the treating provider about the elevated troponin if they are unaware. Next, the nurse should monitor the patient closely and prepare to take the patient to the cardiac catheterization laboratory for further investigation and possible intervention.
5. The nurse should explain that the patient will be given medication to help her sleep while dye is injected into their vessels. The dye helps to visualize the vessels that lead to the heart to determine if there are any blockages present. If blockages are present, the provider can perform an intervention such as placing a stent to keep the vessel open. This will help restore blood flow to the heart and keep the heart muscle from being damaged.
6. First and foremost, the patient should not be experiencing chest pain after the procedure. Additionally, the cardiac monitor should show a normal rhythm. Troponin levels should be trending downward and the patient should report less dyspnea.