70-year-oldfemale patient transported to the ED via EMS. Full code, past medical history:Angina,dyslipidemia, Diabetes type 2., NKA/NKDA. VS: Temp. 97, HR 150 and irregular/irregular, BP 80/60, O2 Sats. 80% on room air, now 90% on 6L HFNC.Husband with the patient.
You place 12 lead on the patient and note ST elevation and the patient complains of 8/10 left shoulder pain radiating down her arm. Immediately after you do a point of care blood glucose test (results 125) the patient goes into v. fib. and you call the code. CPR is commenced and the code lasts 15 minutes. The patient is defibrillated and regains a pulse. She is immediately transported to the cath. lab. You accompany the patient and observe insertion of cardiac stents.
Orders:
Full Code
02 HFNC titrate prn
EKG STAT
POCT BG STAT
Dopamine 50mcg/kg/min. IV
Epinephrine (1:1000) 1 mg IVP STAT, may repeat q 3-5 min x 2
Amiodarone 300 mg IVP STAT
Lisinopril 20mg PO daily
Metoprolol 100mg PO daily
Spironolactone 100mg PO daily
Lipitor 20mg PO daily
Metformin 500mg PO BID
Aspirin 81mg PO daily
Nitroglycerine spray 400mcg SL.May repeat q 5 minutes x 2
Docusate 200mg PO BID
Diazepam/Valium 2mg PO qid prn
Morphine 2mg IVP/IVPB q4h prn
Midazolam 2.5mg IV pre-procedure, repeat q 5-15 minutes prn during procedure
Fentanyl 25mcg IV pre-procedure, then 25mcg q 5 prn during procedure
WHAT TO DO
From the information provided in the case study for patient with MI, as a nurse handing over to the next nurse
- write out a pre-shift report using the SBAR tool
- Write out the discharge planning for this patient
- Write out the teachings for this patient.
Sample Solution
