BSN 3-YA- 16

Course Task CU #2

Answer the following questions base on the cited situation. Answer will be submitted through CANVAS.

Consider the scenarios and answer the following questions:

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?

Angina pectoris usually happens when the patient has greater than or equal to 70% stenosis, meaning 70% of the artery is blocked
by plaque buildup. The small opening that blood flows through might be enough to supply the heart during rest, but if the body
demands more blood and oxygen, like during exercise or stressful situations, the heart has to work harder, and therefore needs
more blood and oxygen itself.

2. The patient is diagnosed with chronic stable angina. The nurse can anticipate that her pain may follow what type of pattern?

Chronic stable angina may can cause pressure or squeezing and it can radiate to the left arm, jaw, shoulders and back and
sometimes it accompanied by shortness and diaphoresis (sweating) symptoms last less than 20 minutes and subside after the
exertion or is stress is taken away, and therefore the heart muscle isn't demanding as much blood.

3. Lita has nitroglycerin at her bed side to take PRN. The nurse knows that nitroglycerin acts in what ways?

Nitroglycerin is a vasodilator that increases blood vessel diameter to allow more blood flow. Also, it helps to increases the oxygen to
the heart and it works by relaxing the blood vessels.
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

1. Baseline vitals, intake & output and assess the lung sound
2. Thorough health history including allergies, medication use, alcohol and substance use
3. Assess for potential contraindications and drug interactions
4. Thorough pain assessment, including PQRST components
5. Check dosages carefully

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 tachycardia, 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 critical time period for this patient. When should the nurse be most vigilant in monitoring
this patient?

Initially asses the vitals and effect of ischemia to the heart, brain and kidney. Also, this data help to know cause and effect of
chest discomfort and provide baseline therapy for treatment.

1. The nurse is interpreting the result of the ECG. What findings does the nurse understand are indicative of initial myocardial
injury?

ST segment elevation is among the most important symptoms of myocardial infarction. The ECG trace segment known as the ST
segment runs from the end of the S wave to the beginning of the T wave. The J point is the location where the ST segment and the
end of the Q wave converge. A ST segment elevation myocardial infarction is likely if the J point is more than 2 mm above the
baseline.

2. What laboratory test are positive indicators of MI?

 The suggested laboratory tests for the diagnosis of MI include Cardiac Troponin I or Troponin T, both of which are very
sensitive and specific tests.

3. 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?

Myocardial ischaemia is the cause of early dysrhythmias, which happen within the first 24 to 48 hours and have little to do
with the magnitude of the MI.