Author Question: You are just getting caught up with your work when you receive the following phone call: Hi, this is ... (Read 49 times)

Frost2351 · **on:** Jun 25, 2018

You are just getting caught up with your work when you receive the following phone call: Hi, this is Deb in the emergency department.

We're sending you M.M., a 63-year-old Hispanic woman with a past medical history of coronary artery disease (CAD). Her daughter reports that her mom has become increasingly
weak over the past couple of weeks and has been unable to do her housework. Apparently, she has had
complaints of swelling in her ankles and feet by late afternoon 'she couldn't wear her shoes' and has
nocturnal diuresis 4. Her daughter brought her in because she has had heaviness in her chest off and
on over the past few days but denies any discomfort at this time. The daughter took her to see her family
physician who immediately sent her here. Vital signs are 146/92, 96, 24, 99 F (37.2 C). She has an IV of
D5W at 50 mL/hr in her right forearm. Her laboratory results are as follows: Na 134 mEq/L, K 3.5 mEq/L, Cl
103 mEq/L, HCO3 23 mEq/L, BUN 13 mg/dL, creatinine 1.3 mg/dL, glucose 153 mg/dL, WBC 8300/mm3, Hct
33.9, Hgb 11.7 g/dL, platelets 162,000/mm3. PT/INR, PTT, and urinalysis are pending. She has had her
chest x-ray and ECG, and her orders have been written.

What additional information do you need from the emergency department (ED) nurse?

How are you going to prepare for this patient?

Question 2

You titrate the NTG drip up, assess his compliance with the oxygen cannula, and assess his vital signs. In addition, you administer a dose of morphine, but his pain is not relieved. Based on your assessment findings, you decide to call the physician.

Using SBAR (Situation, Background, Assessment, Recommendation), what information
would you provide to the physician when you call?

W.R.'s chest pain subsides after the dose of morphine and he settles down for the night. You
monitor him closely and watch for side effects of the NTG infusion. Side effects of NTG
include which of these? Select all that apply.
a. Constipation
b. Headache
c. Tachycardia
d. Postural hypotension
e. Decreased respirations

firehawk60 · **Reply #1 on:** Jun 25, 2018

Answer to Question 1

What is the patient's admitting diagnosis?
Does she speak English? Some facilities state that family members can be used as an interpreter
only if the patient gives permission and only if it is documented that an interpreter was offered
and refused.
Have any cardiac enzymes been drawn?
What did her chest x-ray (CXR) examination show? Any changes from the last time? Spo2?
What medications does she take? Any medication allergies? Was she given any medication in
the ED?
Does she have diabetes? Keep in mind that people with diabetes sometimes experience atypical
chest discomfort, such as heaviness in the chest, instead of the classic substernal chest pain.
Does she have a history of anemia or any bleeding recently?
What are other pertinent assessment findings, such as orientation and voiding?

If the patient does not speak English and the daughter is not coming to the unit with her, find out
what the hospital's procedures are for finding an interpreter. Many facilities have an interpreter
service (such as a telephone language service) and/or a resource list of employees who speak
Spanish.
Turn the bed down and place an IV pole in her room. Obtain an infusion pump.
Make certain a thermometer, blood pressure cuff, and admission pack are in the room.
Have a scale in the room to get a baseline weight.
Make certain there is a hat in the toilet to measure urinary output.

Answer to Question 2

Following SBAR, you would first identify yourself, then explain that W.R. is complaining about aching
in his left shoulder and arm that has been unrelieved by increasing the NTG drip. For background,
state that W.R. was admitted at 1900 for R/O MI (patient complaint was unrelieved indigestion).
He cannot be transported to the larger medical center until the morning because of the weather
conditions. Give current VS and pertinent details of his physical examination, including ECG and
laboratory results, and any other assessment items that have changed. The assessment of the
situation is that W.R. is experiencing angina and possibly an MI. You would anticipate diagnostic
testing, medication with IV morphine and nitrates, and close monitoring until he is able to be
transported to the medical center.

Answers: b, c, d
Constipation and decreased respirations do not occur with NTG administration but may result
from the opioid morphine sulfate.