Case Study -

Myocardial infarction with history of stable angina and mitral valve stenosis Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit (CCU) from the emergency department for management of episodic chest pain. He has a history of stable angina and mitral valve stenosis. Mr Savea is of Samoan background and has lived in regional Queensland for the last 20 years with his wife and children. He was brought in by ambulance having had chest pain and shortness of breath. He reports having similar symptoms on and off for the past two months but did not visit his GP as he assumed the discomfort was due to indigestion. Mr Savea is an ex-smoker, tobacco free for the last six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a local hospital and is active in the Samoan support community.

On assessment Mr Savea's vital signs are: PR 90 bpm and irregular; RR 12 bpm; BP 150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a body mass index (BMI) of 35 kg/m2 indicating clinical obesity. Blood test results show elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG indicates that he has a ST segment elevated myocardial infarction. Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the emergency department. He reports being pain free on admission to CCU

The following questions must be answered for your chosen case study

The following questions relates to the patient within the first 24 hours since admission to the emergency department (ED):

1. Outline the causes, incidence and risk factors of the identified condition and how it can impact on the patient and family (400 words)

2. List five (5) common signs and symptoms of the identified condition; for each provide a link to the underlying pathophysiology (350 words) a. This can be done in the form of a table - each point needs to be appropriately referenced

3. Describe two (2) common classes of drugs used for patients with the identified condition including physiological effect of each class on the body (350 words)

a. This does not mean specific drugs but rather the class that these drugs belong to.

4. Identify and explain, in order of priority the nursing care strategies you, as the registered nurse, should use within the first 24 hours post admission for this patient (500 word)

Q1:

• Cause/risks of disease needs to be focused on what the pt has presented with
• The incidence of the disease needs to be as current as possible and based in Australia as this is your country of practice
• Impact on family MUST be linked back to the patient you have chosen. If there is no link it is not a case study
• Refrain from listing, as we are looking for you to provide a rationale for all your answers, e.g. Financial impact as evidenced by increased acuity leading to sick leave and no income etc

Q2:

• The signs and symptoms can be taken from those listed in the case study, or you will find more relevant ones when completing your research. When considering the signs and symptoms consider those that the patient presents with or describes. Lab test results are diagnostic findings
• As long as you are able to link it back to the patho of the current patient condition and explain why you have chosen it that is fine
• Pathophysiology needs to be in depth and at the cell level where possible

Q3:

• The drug classes chosen can be from the case study or what you think may be used to manage the patient's condition
• Need to include drug CLASSES, not specific drug names, or broad types
• Eg. Loop diuretics - CORRECT. Frusemide - INCORRECT. All diuretics have a different mechanism of action, so stating generic name is not acceptable
• You need to explain how each drug class works at the cell level where possible, and LINK it back to the patient in the case study. Why are these drugs indicated for the patient?

Q4:

• PRIORITISE your care - if it helps, number it
• Every nursing care priority must include a rationale as to why it needs to be done
• This includes nursing care, not medical management. For example, if you think that a patient may need thrombolytics but are not ordered this, phrase it in a way that links it back to nursing. What are your nursing considerations in this case then?
• The parameters are in the first 24 hours only which will help you narrow your care
• We prefer less considerations with more rationale, than you including a list, i.e. 8-10 would be sufficient as long as you can rationalise your care

Instructions:

The assignment is to be presented in a question/answer format NOT as an essay (i.e. no introduction or conclusion).

• Each answer has a word limit (1600 in total); each answer must be supported with citations.
• A reference list must be provided at the end of the assignment.
• Please refer to the marking guide available in the unit outline for further information.