CHECK FOR UNDERSTANDING (60 minutes) You will answer and rationalize this by yourself.

This will be
recorded as your quiz. One (1) point will be given to correct answer and another one (1) point for the
correct ratio. Superimpositions or erasures in you answer/ratio is not allowed. You are given 60 minutes
for this activity:

Case Profile: Mrs. Sims, aged 43, is admitted to the intensive care unit with a diagnosis of atypical chest
pain. She has a history of midsternal chest cramping. The pain is radiating to her left and right shoulders
and down her left arm. Her pain increases with activity and decreases with rest. She smokes one and a
half packs of cigarettes per day and is 50 pounds overweight. The cardiac monitor shows normal sinus
rhythm without dysrhythmias. She has an NTG sublingual order PRN for chest pain. One hour after
admission, Mrs. Sims reports midsternal pain radiating to the left neck and jaw. The cardiac monitor
shows sinus tachycardia with occasional premature ventricular contractions (PVC’s) her blood pressure
is 100/70, respirations are 20 and unlabored and skin is warm and dry.

1. What actions should you take?

Answer: place on bedrest, administer o2 at 2 l nasal cannula, assess bp and pulse, administer
nitroglycerin sublingual as ordered, obtain ECG, and notify physician

2. What is happening to Mrs. Sims?

Answer: she may be having an anginal attack versus acute MI

3. How is angina different from an MI?

Answer: nitroglycerin usually stops chest pain associated with angina. rest may also alleviate chest pain.
neither nitroglycerin or rest will relieve the pain of an acute MI

4. What are the four indicators of an MI?

Answer: pt hx, ecg changes with st segment elevation, elevated troponin 1, and ck-mb elevation

5. What medical interventions can be used for an MI?

Answer: nitroglycerin drip, morphine, or anticoagulant therapy (heparin), and thrombolytic agents to
dissolve the clot. a cardiac cath can determine which coronary arty is blocked. pci or a coronary artery
bypass graft may be done to reroute blood

6. What education is indicated for Mrs. Sims?

Answer: The nurse should teach the patient to take his medication exactly as directed and to stop
smoking and lose weight in the best possible ways. I will encourage her to have bed rest with the back
rest elevated to help decrease chest discomfort and dyspnea, I will also encourage her of changing
positions frequently to help keep fluid from pooling in the bases of the lungs. Most especially I will
educate the patient to eat right:

 Eat a variety of fruits, vegetables and grain products, especially whole grains.
 Consume fat-free and low-fat dairy products, fish, beans, skinless poultry and lean meats.
 Limit foods high in saturated fat, trans fat and cholesterol.
 Eat less than 6 grams of salt a day.
 Have no more than one alcoholic drink (no more than 1/2 ounce of pure alcohol) per day if
you're a woman and no more than two drinks if you're a man.

 Education. This is one of the priorities that the nurse must teach the
patient about heart-healthy living.