Patients With Coronary Vascular Disorders

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Case Study, Chapter 27, Management of Patients With Coronary Vascular Disorders



1. Dylan Radin, 55 years of age, is a male patient who is admitted to the ED via ambulance with acute onset of midsternal chest pain radiating down the left arm and radiating up the left side of the neck. The patient complains of shortness of breath and is cool, pale, and diaphoretic. The vital signs include: blood pressure, 160/90 mm Hg; heart rate, 110 bpm; respiratory rate, 26 breaths/min; and temperature 99°F. The 12-lead ECG reveals an anterior wall ST-elevation myocardial infarction (STEMI). (Learning Objective 4)



a. What first actions should the nurse take after the patient has arrived in the emergency department?


b. The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention (PCI) in less than 60 minutes from the door-to-balloon time. Explain the reasoning for this action based on evidence-based guidelines and considering the clinical manifestations and the pathophysiology of the STEMI.



2. The home health care nurse is visiting Mr. Simpson, a 62-year-old man with a significant history of angina pectoris. During the visit, the nurse assesses Mr. Simpson’s current status, including his vital signs, activity level, and dietary intake. Mr. Simpson’s medications include sublingual nitroglycerin as needed for chest pain, metoprolol, Cardizem, and ticlopidine. (Learning Objective 2)



a. What are the rationales for the prescribed medications?


b. Mr. Simpson continues to smoke despite his disease process. How does smoking increase Mr. Simpson’s chances of angina episodes?


c. The nurse reviews the correct procedure for taking nitroglycerin for chest pain, and includes what information?


d. The nurse uses the PQRST acronym to assess for symptoms of angina. What is the nurse assessing?

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