Rodney Davis (client), Maggie Davis (client’s wife), Christine Tripp (emergency nurse), Carl

Jensen (registered nurse), Karen Cooper (charge nurse), Dr. William Patterson (emergency
department provider).

On Monday at 1655, Mr. Davis was shoveling snow and experiences tightness in his chest so
the wife gives him a dose of nitroglycerin.

I chose the answer to give 325 mg of aspirin.

On Monday at 1725: EMS transfers Mr. Davis to ED. The wife gave him 3 doses of nitro when it
started and 325mg of aspirin at 1715. Pt tells the nurse that its hard to breathe and that his
chest is squeezed and states dizziness, sick to the stomach. Wife shares that he has a hx of
blocked arteries. 8/10 pain before meds in the ER. 12 lead ECG will be performed and the
provider will take a look at the results.

I chose the first-degree heart block

What I learned: We have not been exposed to enough strips to analyze that that was an
ST-segment elevation. The ones we see in books look much more flat rather than two spikes.
However, I still should have connected a concurrent MI with its ST elevation!

Monday 1730: Dr. tells pt that he has STEMI. He will perform heart cath to open artery by
insertion through wrist or groin area, inject dye, PTCA balloon and stent. Mild sedative ordered.
Nurse hands off paper information to client and preps him for cath lab.

I chose the Chest X-ray, Troponin level, Morphine, and the Potassium and creatinine
levels.

Monday 1755: ICU transfer report: Client has PTCA in LAD artery, central venous catheter,
arterial line, indwelling urinary cath, peripheral IV, stable VS, O2 @ 2L by nasal cannula,
vascular closure device used at the R femoral puncture site, no bleeding/hematoma.
Hx: HTN, CAD w angina, asthma.
Allergies to: penicillin, peanuts, sulfa.
Pt also states that chest and arms are itchy and that his tongue swelled before from eating
shrimp.

I stated that Nurse Carl should relate that shellfish allergies can also lead to contrast dye
allergies. Nurse Carl should keep an epi-pen handy and administer standing orders for
Benadryl.
What I learned: If there are no standing orders then, of course, inform Doctor as well but
also request prescription!
In the ICU, Nurse Carl returns and Mr. Davis states that he has a cough, cold, stuffy nose, SOB.
Nurse Carl teaches Mr. Davis to keep legs straight and apply pressure to R groin site when
coughing. Nurse gives 25 mg diphenhydramine.

I chose wheezing (anaphylactic).

He increases O2 @ 15L nonrebreather mask because he hears intermittent stridor, O2 sat 87%,
ashen skin, dusky nail bed. Nurse monitors for difficulty swallowing, notified rapid response
team, and provider.

I chose Epinephrine IV

Nurse changes nonrebreather to a NC because his O2 sat is 100%. Educates pt about his
shellfish contrast dye allergy. Performs post cath assessment.

I chose Diminished right dorsal pedal pulse from the client’s baseline

Pt states that he feels something wet.

I chose apply pressure for at least 10 minutes

Nurse outlines hematoma and stopped the bleeding. Flushes IV and checks on lab results.

I chose Potassium

Nurse gives oral Potassium with crackers since pt at 3.2. Leaves some paper info about
cardiac cath.

Chose Obesity

Nurse shares how to make changes to modifiable risk factors. Pt needs way more exercise and
need to cut out fast food and steak and wine. Pt has already quit cigarettes but those are hard.
Nurse recommends to eat low sat fat foods and high fiber. 4-6 servings of fruits and veggies
everyday. Replace red meat with fish or chicken a couple of times a week. Eat low sodium food
and take meds regularly.

2 days later since procedure: Nurse Carl tells Karen the charge that he suspects cardiogenic
shock (dmg to LV myocardium)

I chose Agitation and restlessness and Arterial blood pressure of 88/54 mm Hg.
What I learned: that we never learned the normal values of Mean Arterial Pressures and
how they relate to heart damage. It is vital to have a MAP of at least 60 mmHg to provide
enough blood to the coronary arteries, kidneys, and brain. The normal MAP range is between
70 and 100 mmHg

Pt has cool clammy skin, restlessness, agitation, O2 raised @ 3L NC, aortic pressure is at 54,
SBP < 90 in the last 15 mins, Charge nurse states that LV damage can cause acute left-side
HF, UO is at 48mL/hr (inadequate perfusion), 0.9 NaCl IV @ 250mL/hr. Nurse Carl will
administer dobutamine drip and monitor the telemetry for PVC/dysrhythmias. Provider is on his
way.

I chose 16.5 mL/hr

Nurse Carl confirms with Charge Nurse Karen the calculations. Sys still under 90

I chose Norepinephrine.

Improves flow to kidneys and brain, Mr. Davis needs to feel better

I chose Administer the medication through a central venous catheter.

Start at 0.5 mcg per minute, then titrate to maintain Sys over 100. Document bp every 2-3 min
initially then every 5 min once it’s stable.

I chose bronchial spasm.

What I learned:

Pt feels better and nurse will monitor through the night

I chose Reduce sodium to 1500 mg a day

Nurse Carl educates on looking at the labels on processed foods

Chose yogurt but apparently cereal has less sodium which is not always true.

Cumin, Garlic, chili power can replace salt. Nurse explains Clopidogrel and to look for unusual
bruising also to inform providers of the med before procedures. Aspirin will be taken
concurrently for the stent and Lisinopril is for his HTN.

Report persistent dry cough

60 MINUTES OR LESS IS THE INTERVENTION TIME FRAME!!!!! (MUST ARRIVE WITHIN

ED 30 min since onset of chest pain) Then hit the Cardiac Cath Lab also within 30 min
ALSO MOST IMPORTANTLY call 911 after first dose of NITRO doesn’t help!!!!!!! This module
reinforced a very important key crucial fact!