Presenting Case: Mr. Miller
Mr. Miller is a 49-year-old man with morbid obesity who presents to the emergency room (ER) complaining of severe chest pain radiating down his left arm. He also complains of jaw pain. He is sweating, grasping his chest, and complaining of nausea. He states, "I feel like someone is sitting on my chest." He says the pain started suddenly about 3 hours ago while he was mowing the lawn. Rest did not relieve the pain. His wife pressed him to come to the ER.
Mr. Miller is brought into the exam room where the nursing assistant begins taking his vital signs. Mr. Miller's blood pressure is 180/100, pulse is 128, respirations are 22, and temperature is 98.6°F. While the nurse is starting an IV and instituting advanced cardiac life support (ACLS) guidelines, she takes a health history. Mr. Miller has a past history of coronary artery disease and type 2 diabetes mellitus. He smokes one pack of cigarettes daily, enjoys eating fried foods, and does not follow any type of diet. He admits that he does not like to exercise and would rather sit on the sofa and watch television. He states, "I try to steer clear of the doctor's office. I only came to the hospital because my wife wouldn't stop nagging me about it."
Assessment Indicators
Based on the facts of this case and your studies in this unit, offer at least three assessment findings that indicate Mr. Miller may be having a myocardial infarction. Provide your answer and supporting reference/s in the box below. Use as much space as you need - the box will expand as you type.
Risk Factors
Based on the facts in this case and your studies in this unit, list and explain at least five risk factors that increase Mr. Miller's chances of having a myocardial infarction. Provide your answer and supporting reference/s in the box below. Use as much space as you need - the box will expand.
Further Investigation
Mr. Miller presented to the ER with several signs and symptoms indicating potential myocardial infarction. Discuss standard diagnostics measures the healthcare team might take to determine whether the patient experienced an actual myocardial infarction. Include at least two appropriate diagnostic tests and their rationale. Diagnostic tests may include blood work, electrodiagnostics, and radiologic imaging. Provide your answer and supporting reference/s in the box below. Use as much space as you need - the box will expand.
Education and the Future
The healthcare team determined that Mr. Miller did suffer a myocardial infarction. He was successfully treated with IV thrombolytics and a cardiac catheterization. Two major blockages in his coronary arteries were located and treated via percutaneous coronary artery angioplasty. He had no complications and is being discharged with follow-up services in place.
During preparation for discharge, Mr. Miller states:
"I can't wait to get out of here. I am grateful for everything that was done for me. But this is overwhelming. I know I had a heart attack. But I really don't even understand what that means."
How should the nurse explain a myocardial infarction to Mr. Miller? Provide your answer and supporting reference/s in the box below. Use as much space as you need - the box will expand as you type.
Mr. Miller needs to be educated on immediate lifestyle and behavior changes to prevent another myocardial infarction. In the space below, list and explain at least four behavioral and lifestyle changes that the nurse needs to discuss with Mr. Miller to decrease his chances of a future myocardial infarction.