Cardiac Case Study: Nursing Assessment, Medications, and Patient Education

Nursing Assessment in a Retirement Living Facility

Part 1: Cardiac Case Study

Read through the case study below and work through the following questions. Include references for each question and include a reference list at the end of your assignment. You can include references for Part 1 and Part 2 on the same reference list.

 

You are the RPN working at a retirement living facility. You are called to a client’s room to find them lying on the floor, clutching their chest stating, “Help! Help!” The client appears frightened and is breathing rapidly. You help get the client into a seated position and request assistance from your colleague. Upon assessment, the client indicates that they are experiencing substernal chest pain that radiates to their left jaw and down their left arm.

You assess your patient and document the following findings:

• Temperature: 36.9 C
• Heart Rate: 188 beats per minute, regular
• Respirations: 26 breaths per minute
• Blood Pressure: 140/92 mmHg
• O2 Saturation: 92% on RA
• Alert and orientated x3
• Pain: 8 out of 10 on pain scale 

Answer the following questions based on the information provided above.

1. Applying your knowledge of the cardiovascular system, which of the above data requires follow up from the nurse? Provide rationale for your answer. (6 marks)

 

2. What other clinically pertinent data would you obtain from your patient to provide competent and clinically relevant nursing care? (4 marks)

 

3. Identify the primary cause of angina and describe how it leads to decreased cardiac functioning. (3 marks)

 

4. What drug would you expect to be administered by the nurse to decrease the client’s angina? Provide rationale for your response. (3 marks)

 

You expect your client is having an acute myocardial infarction. You administer 02 @4L via nasal prongs and administer chewable acetylsalicylic acid (Aspirin) 325 mg as per doctor’s orders. Your client is sent to the hospital for further emergency care and cardiac monitoring.

 

5. Why is acetylsalicylic acid (Aspirin) indicated for your client’s clinical condition? (2 Marks)

 

6. What drug would you expect to be administered to your client for severe angina unrelieved by nitroglycerin? (1 mark)

Patient Update

Health History: Client is an 82-year-old-male named Nigel Marlough who is new to living in the retirement facility in which you work. He is a widow and has three adult children who live nearby and are involved with providing care. Client has a history of hypertension, hyperlipidemia, benign prostatic hyperplasia, and depression. Pt had a total hip replacement 5 years ago and was having trouble ambulating independently in his two-story home before moving to the retirement facility. The client has a difficult time sleeping at night and reports a decrease in their appetite.

 

Your client returns to the retirement living facility after being in the hospital for four days. It was confirmed via ECG and cardiac enzyme monitoring they suffered from an acute MI and have since stabilized.

 

Your client reports that they are feeling scared this will happen again. They are unsure if any of their medications have changed since being admitted to hospital.

 

7. Identify the medications your client is currently taking (see MAR). Explain to the client why each of the medications is indicated for their clinical condition and what an expected therapeutic response is from each medication.  (12 marks)

 

8. Based on your client’s medical history, recent MI and knowledge regarding cardiovascular drugs, are there any other medications the nurse would expect to be ordered for your client? Provide the drug category and rationale. (2 marks)

 

9. Based on the medications your client has been ordered (see MAR) what is an important assessment that should be included in your clients plan of care? Provide rationale for your answer. (2 marks) 

Patient Update

Your client is settled back into their room and requests to rest. The nurse is updating the client’s prescription for PRN sublingual nitroglycerin spray for chest pain and Nitro-Dur (nitroglycerin) transdermal patch.

 

10. What pertinent health teaching measures would you provide with your client regarding use of this drug? (Discuss both forms of the medication ordered) (5 marks)

11. You refer your client to the dietician for assessment of their meal plan. What type of diet will the nurse expect to be ordered for this client? Provide your rationale for your answer. (3 marks)

 

12. Your client reports, “I hate taking all of these pills every morning. How long am I going to have to do this for?” What would be an appropriate response from the nurse? (2 marks)

13. Based on the client’s clinical condition and medication regime, what symptoms would you tell your client to immediately report to their health care provider? (3 marks)