Rovero, John Mark Lorenzana

BSN 3-YA-4
NCMA312
Week 2: MS1 COURSE TASK- CU 2

Scenario 1: Angina Pectoris

Lita a 65 year-old retired secretary, is admitted to the medical surgical area for management of chest pain
caused by angina pectoris. (10 points)

1. The patient asked the nurse “What is causing this pain?” What is the best response by the nurse?
- The best response from the nurse is that heart blood flow may be reduced by artery constriction.
The amount of blood and oxygen reaching the cardiac muscle is insufficient. Reduced blood flow
will eventually lead to angina pectoris.

2. The patient is diagnosed with chronic stable angina. The nurse can anticipate that her pain may
follow what type of pattern?
- When your heart is functioning hard enough to require more oxygen, such as during exercise,
chronic stable angina develops. Resting may help the ache go away. For at least two months, the
pattern of pain—how long it lasts, how frequently it happens, what causes it, and how it reacts to
rest or medication—remains steady.
3. Lita has nitroglycerin at her bed side to take PRN. The nurse knows that nitroglycerin acts in
what ways?
- When your heart is functioning hard enough to require more oxygen, such as during exercise,
chronic stable angina develops. Resting may help the ache go away. For at least two months, the
pattern of pain—how long it lasts, how frequently it happens, what causes it, and how it reacts to
rest or medication—remains steady.

4. Lita took a nitroglycerin tablet at 10:00 AM, after her morning care. It did not relieve her pain, so
5 minutes later, she repeated the dose. 10 minutes later, and still in pain, she calls the nurse. What
is the priority intervention of the nurse?
- The nurse should administer the 3rd nitroglycerine, oxygen @2L.

Scenario 2: Decreased Myocardial Tissue Perfusion

Mr. Santos, a 46 year-old teacher, is brought to the ER by ambulance with a suspected diagnosis of MI.
He appears ashen, is diaphoretic, and tachycardic, and has a severe chest pain. The nursing diagnosis is
Decreased Cardiac Output related to Decreased Myocardial Tissue Perfusion. (10 points)

1. The nurse is aware that there is a critical time period for this patient. When should the
nurse be most vigilant in monitoring this patient?
- When cardiogenic shock occurs, when cardiac output is insufficient to meet the
metabolic demands of the body, resulting in inadequate tissue perfusion, the nurse is
especially vigilant in monitoring this patient. It is a medical and nursing crisis. Acute
 myocardial infarction (MI), which results in the loss of more than 40% of the functional
myocardium, is the most common cause of cardiogenic shock.

2. The nurse is interpreting the result of the ECG. What findings does the nurse understand
are indicative of initial myocardial injury?
- ST elevation (indicating injury), Q waves (indicating necrosis), and T-wave inversion
are examples of infarction ECG changes (indicating ischemia and evolution of the
infarction). These changes, known as indicative changes of infarction, occur in leads that
face the damaged tissue.

3. What laboratory test are positive indicators of MI?

- Cardiac Troponin. Positive Troponin levels are considered virtually diagnostic of MI, as
they are without equal in combined specificity and sensitivity in this diagnosis.

4. The nurse should closely monitor the patient for a complication of an MI that leads to
sudden death during the first 48 hours. Which complication should the nurse monitor for?
- Arrhythmias may cause many of the reported sudden cardiac deaths in patients with
acute coronary syndromes.