Republic of the Philippines

Tarlac State University

College of Science
Department of Nursing
Lucinda Campus, Brgy. Ungot, Tarlac City Philippines 2300
Accredited Level 3 Status by the Accrediting Agency of Chartered Colleges and Universities in
the Philippines (AACUP), Inc.

NCM 118 EMERGENCY NURSING CLINICAL

Case Scenario Number 1: STE ACS

Patient Profile
Name: Patient Ben N.
Age: 62 years old
Address: San Miguel, Tarlac City
Chief complaint: Chest pain, nausea and vomiting
Date of Admission: 8/23/21
Admitting diagnosis: Acute Coronary Syndrome

Doctor’s Order:
8/23/21 8:00 AM
-Admit patient to CCU
-Low salt low fat diet
-insert heplock
-o2 inhalation at 2-3 LPM per nasal cannula
-medications:
1. Aspirin 300 mg tab now then 80 mg 1 tab OD at noon
2. Clopidogrel 75mg 1 tab now then 75 mg 1 tab OD at noon
3. Enoxaparin 0.6 cc SQ now then q12 hours
4. Rosuvastatin 40 mg 1 tab OD at HS
5. Lactulose 30 cc OD at HS
6. Morphine Sulfate 0.4mg IVP PRN for chest pain
-Facilitate labs: Urinalysis, CBC, Chest Xray, Troponin I (Quantitative), ECG,
FBS, BUN, Creatinine, Lipid profile
-For 2D Echo with Doppler studies once stable
-For RBS now, then monitor BID
-Monitor ECG OD in AM and relay
-Monitor and record vital signs every 1 hour
-Complete bed rest without bathroom privileges
-Limit visitors
-watch out for hypotension and arrhythmias
-refer accordingly

Dr. Moiren
Doctor’s Order:
8/24/21 10:00 AM
-Low salt low fat diet
-maintain heplock
-maintain o2 inhalation at 2-3 LPM per nasal cannula
-medications:
1. Aspirin 80 mg 1 tab OD at noon
2. Clopidogrel then 75 mg 1 tab OD at noon
3. Enoxaparin 0.6 cc SQ q12 hours
4. Rosuvastatin 40 mg 1 tab OD at HS
5. Lactulose 30 cc OD at HS
6. Morphine Sulfate 0.4mg IVP PRN for chest pain
-start Metoprolol 50 mg tab, ½ tab BID
-start Captopril 25 mg tab, ¼ tab BID
-For 2D Echo with Doppler studies once stable
-continue RBS monitoring BID
-Monitor ECG OD in AM and relay
-Monitor and record vital signs every 1 hour
-Complete bed rest without bathroom privileges
-Limit visitors
-watch out for hypotension and arrhythmias
-refer accordingly

Dr. Moiren

DIAGNOSTICS:

TROPONIN I (8/23/21): 0.90ng/mL

URINALYSIS:
Color – Yellow
Clarity/turbidity – Clear
pH – 6.5
Specific gravity – 1.015
Glucose – Negative
Bilirubin- Negative
Ketones – None.
Nitrites – Negative.
Leukocyte esterase – Negative
Bacteria- Rare
Crystals- None
Protein- Negative
WBC- 1-3/ hpf
 RBC- 3-5/ hpf

LIPID PROFILE (8/24/21):

FBS: 6.3 mmol/ L (3.5- 5.6 mmol/ L)
BUN: 8.2 mmol/L (2.1- 8.5 mmol/L)
Creatinine: 300 mmol/L (65- 120 mmol/L)
RBS: 140 mg/dL
Cholesterol: 260 mg/dL (<200 mg/dL)
LDL: 220 mg/dl (60-130 mg/dL)
HDL: 37 mg/dL (60 mg/dL)
Triglyceride: 230 mg/dL
Uric Acid: 5 mg/dL (4.6- 7.0 mg/dL)

CHEST XRAY (8/23/21):

IMPRESSION:
Lung fields are clear
Atheromatous aorta
Cardiomegaly

ECG (8/23/21) 7:05 AM