Client Profile: Lane Bronson is a 55 year old male with a history of angina, hypertension, Type 2 diabetes, COPD, and sleep apnea. He comes to the physican’s office complaining of worsening shortness of breath. His skin tone is grey, and his angina is worsening. Previously stable, he now does not get relief from rest or nitroglycerin. The physician called 911 and had Mr. Bronson directly admitted to the hospital.
1. What are the treatment priorities of the registered nurse upon admission? What orders would the RN expect to be included on the standing orders?
The treatment priorities of the registered nurse upon admission to the emergency department are as follows; within ...view middle of the document...
Thrombolytic therapy should be implemented within 30 minutes from the patient’s arrival to the emergency department, and if they are a candidate for cardiac catheterization it should be done within 90 minutes from the patient being admitted to the hospital. Delay on either therapy option increases the risk of mortality (Kosowsky, Yiadom, Hermann, & Jagoda, 2009, p. 10).
2. Explain how oxygen via nasal cannula benefits a patient in chest pain.
Oxygen supplementation is a standard treatment for all patients who present with chest pains, regardless of oxygen saturation levels. Low dose oxygen delivered via nasal cannula 2-4 L/min will help to increase oxygen supply to the myocardium, and sustain oxygen saturation levels at 96-100 (Grigsby, 2011, p. 20). It will also help with Mr. Bronson with his shortness of breath.
Initial Laboratory results include: potassium (K+) 4.0 mEq/L; magnesium (Mg) 1.9 mg/dL; total creatine kinase (CK) 157 /L, CK-MB 7.6 ng/ml, relative index 4.8%, and Troponin 1.28 ng/ml. His stool tests were negative for occult blood.
3. Discuss these laboratory tests. Which are significant for the determination of MI?
Potassium is an essential electrolyte for proper function of cells, tissues, and organs. Potassium is responsible in the aid of smooth muscle contraction. An abnormal increase (hyperkalemia) or decrease (hypokalemia) in potassium can increase the risk of cardiac arrhythmias. Normal potassium lab values are 3.5-5.1 mEq/L (Lefever Kee, 2013, p. 314). Magnesium is a positive ion electrolyte in the cells and intracellular fluid. Magnesium influences the use of potassium, calcium, and protein. Magnesium is needed for neuromuscular activity. Normal Magnesium lab values are 1.5-2.5 mEq/L (Lefever Kee, 2013, p. 279). Total creatine kinase (CK) measures an enzyme in the blood found in muscles and heart tissue; levels rise when there is damage to the heart muscle. Normal CK values are 30-170 units/L. Creatine kinase MB is useful in making the differential diagnosis of myocardial infarction. Troponins are chemical makers for cardiac diseases particularly for the diagnosis of myocardial infarction. Normal Troponin levels are 0.1-0.5 ng/mL (Lefever Kee, 2013, p. 375). Occult blood tests are helpful in determining gastrointestinal bleeding (Lefever Kee, 2013, p. 291).
Myocardial injury is accompanied by the release of cardiac Troponin into the cardiac tissue and into circulation. CK and CK-MB are cardiac biomarkers; they are released into the blood when there is cardiac tissue damage. They are extremely important when diagnosing myocardial infarction. The relative index is helpful in establishing where the damage to the cardiac tissue is (Linden, 2013, p. 8).
Continuing Case Study: After reviewing the EGK and labs, the ER physician calls the cardiac cath lab and the patient is taken for a cardiac catheterization. The cardiac cath lab nurse assigned to care for Robert Bronson will provide...