Saint Mary’s University

SCHOOL OF HEALTH and NATURALSCIENCES

Nursing Department
Bayombong, Nueva Vizcaya

Mrs. Darsana was sitting at a family cookout at approximately 2:00 p.m. when she
experienced what she later describes to the nurse as “nausea with some
heartburn.” Assuming the discomfort was because of something she ate, she
dismissed the discomfort and took Tums. After about two hours, she explains,
“My heartburn was not much better and it was now more of a dull pain that
seemed to spread to my shoulders. I also noticed that I was a little short of
breath.” Mrs. Darsana told her son what she was feeling. Concerned, her son
called emergency medical services.At the hospital, emergency medical personnel
established an intravenous access. Mrs. Darsana was given four children’s
chewable aspirins and three sublingual nitroglycerin tablets without relief of her
chest pain. She was placed on oxygen 2 liters via nasal cannula. Upon arrival in
the emergency department, Mrs. Darsana is very restless. She states, “It feels like
an elephant is sitting on my chest.” Her vital signs are blood pressure 160/84,
pulse 118, respiratory rate 28, and temperature 99.38F (37.48C). Her oxygen
saturation is 98% on 2 liters of oxygen. A 12-lead electrocardiogram (ECG, EKG)
shows sinus tachycardia with a heart rate of 120 beats per minute. An occasional
premature ventricular contraction (PVC), T wave inversion, and ST segment
elevation are noted. A chest X-ray is within normal limits with no signs of
pulmonary edema. Mrs. Darsana’s laboratory results include potassium (K1) 4.0
mEq/L, magnesium (Mg) 1.9 mg/dL, total creatine kinase (CK) 157 μ/L, CK-MB 7.6
ng/mL, relative index 4.8%, and troponin I 2.8 ng/mL. Her stool tests negative for
occult blood.

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURALSCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

Doctors Orders:

 Please admit under my service

 NPO for 6 hours then may start LSLF diet after
 On Complete bed rest without bathroom privileges
 Moderate to high fowler’s position
 Oxygen therapy at 2-3 lpm via nasal canula
 IVF: PNSS IL at KVO
 Pls repeat EKG after 6 hours
 Diagnostics: Cardiac Markers CKMD, Trop I, For FBS in AM, BUN, Crea, Sodium,
Potassium, ionized Calcium.
 For echo cardiogram once stable
 Medications: Nicardipine Drip: Dilute 10mg of Nicardipine in 100cc PNSS to run for 10-
15cc/hour Titrate and Maintain BP at 140/90 mmhg
 Isoket Drip: dilute 5mg of ISOKET in 50cc sterile water to run for 10cc per hour use
another venous access pls.
 isosorbide mononitrate(Montra) 30mg PO OD after Breakfast
 Atenolol(Tenormin) 50mg PO after dinner
 Celecoxib (Celebrex) 300 mg PO BID
 Morphine SO4 5mg IV PRN for severe chest pain
 Monitor VS q 1
 I&O q shift
 Thank you for this referral

Dr. Arnold B. House, MD

 Kardex
 Medication Card

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269
 Saint Mary’s University
SCHOOL OF HEALTH and NATURALSCIENCES
Nursing Department
Bayombong, Nueva Vizcaya

List of Patients

Room 1

Bed 1 Viavian Darsana 50 yers old, Accute Myocardial Infarction, PNSS1L x KVO, NPO,

Bed 2 Rolina Ducusin 60 years old HPN II D5NSS IL x 16 hours LSLF

Bed 3 Gigi Arlong 49 years old DM II PNSS IL x 12 hours on diabetic diet

 Make an Endorsement form and make 2 medication cards suitable for their cases.

1st Floor, Constant Jurgens (UB) Building

Saint Mary’s University, Ponce St., Bayombong, Nueva Vizcaya, 370 Philippines
Telephone: (078) 321-2221 ext. 122; Telefax: (078) 321-2117; Mobile No.: 0936-286-7269