During the episode of chest pain, R.K.'s vital signs were as ...

[nautica902]

During the episode of chest pain, R.K.'s vital signs were as follows: pulse 110 beats/min; blood pressure 140/92 mm Hg, respirations 20 breaths/min.
 
  The rhythm strip shows sinus tachycardia, and she was very
  anxious. Her chest discomfort subsided in 3 minutes after one nitroglycerin dose, and she is resting quietly
  with O2 per nasal cannula at 2 L/min. R.K.'s physician is making rounds.
 
  Using SBAR (Situation, Background, Assessment, Recommendation), how would you
  communicate this episode to R.K.'s physician?

Question 2

After some rest, R.K.'s chest pain has subsided, and she tells you she feels much better now. You review her laboratory results.
 
  Laboratory Results
  12-lead ECG: Light left-axis deviation, normal sinus rhythm with no ventricular ectopy
  Serial CPK tests are 30 units/L at admission, 32 units/L 4 hours after admission
  Cardiac troponin T is less than 0.01 ng/mL (at admission) and same result 4 hours after admission
  Cardiac troponin T is less than 0.03 ng/mL (at admission) and same result 4 hours after admission
  D-dimer test result less than 250 ng/mL
 
  On the basis of the information presented so far, do you believe she had an MI? What is your
  rationale?
 
  Do you think she may have a pulmonary embolus?
 
  While you care for R.K., you carefully observe her. Identify two possible complications of
  coronary artery disease (CAD) and the signs and symptoms associated with each.
 
  R.K. rings her call bell. When you arrive, she has her hand placed over her heart and tells
  you she is having that heavy feeling again. She is not diaphoretic or nauseated, but states
  she is short of breath. What else do you assess, and what can you do to make her more
  comfortable?

[pocatato]

Answer to Question 1

You would first need to identify yourself and the patient. Then describe the situation, focusing on the
vital signs and the episode of chest pain. Relate that a STAT ECG was obtained and provide a copy.
State that you placed R.K. on oxygen and gave her 1 sublingual nitroglycerin tablet. Conclude your
remarks by stating that the chest pain subsided after the single dose of nitroglycerin and that you
noted that she may need an order for something to reduce her anxiety.

Answer to Question 2

No. Her cardiac symptoms are probably a result of angina secondary to coronary artery disease
(CAD) rather than an MI, based on the following:
 Cardiac enzymes are within the normal range (for a female patient, 30 to 235 units/L). In the
presence of myocardial damage, CK-MB levels would rise 3 to 6 hours after infarction occurs and
would peak at 12 to 24 hours (if no further infarction occurs), then return to normal 12 to 48 hours
after infarction. CK-MB levels are not usually elevated with angina. Cardiac troponins typically
become elevated within 2 to 3 hours after an MI.
 The ECG did not show ST, T wave, or Q wave changes.
 Decreased activity and change of position somewhat relieved pain.

The D-dimer test results rule out the occurrence of a pulmonary embolus.

 Cardiac ischemia
 Cardiac dysrhythmias, particularly premature ventricular contractions: dysrhythmias seen on
telemetry, syncope, lightheadedness, shortness of breath, palpitations felt by patient
 HF: crackles; dyspnea; confusion; dry, hacking, nonproductive cough; peripheral edema; JVD

 Assess her VS, including pulse oximetry, and cardiac rhythm on telemetry.
 Order a STAT ECG.
 Give her supplemental oxygen as ordered (2 to 4 L/min. by nasal cannula) if she is not wearing it.
 Give her sublingual NTG 0.4 mg as ordered (1 q5min prn chest pain  3 doses) to decrease the
venous return to the heart and dilate the coronary arteries to increase the O2 supply to the heart.
 Obtain an order for 30 mL aluminum hydroxide/magnesium hydroxide (such as Maalox) to rule out
GERD.
 Have her rest quietly in bed to decrease O2 demand.
 Elevate the head of the bed to facilitate respiratory expansion.
 Encourage verbalization of concerns to decrease anxiety and O2 demand.