Reference no: EM134039764 , Length: 10 min PPT

Acute Exacerbations of Chronic Conditions, Presentation: Acute Coronary Syndrome (ACS) with ST elevation myocardial infarction (STEMI)

Instructions:

Aim of the assessment- The purpose of this assessment is to enable you to:

Demonstrate knowledge of a comprehensive assessment for a patient with a STEMI, using the A to E (Airway, Breathing, Circulation, Disability, Exposure) and linking these to the underlying pathophysiology for each.

Identify and discuss relevant diagnostic results to inform clinical decision-making and implementing high-priority interventions to optimise patient outcomes.

Identify and discuss key evidence based high priority nursing interventions for managing a patient with a STEMI

Demonstrate effective management to optimise the care of a patient with a STEMI by administering prescribed therapies and medications

CASE STUDY - ORAL PRESENTATION-Mr Anthony Romano

Review the ISBAR, identify AND analyse important information

I -Introduction Mr Anthony Romano a 53-year-old male with no known allergies (NKA) was admitted with acute coronary syndrome (ACS) with ST elevation myocardial infarction (STEMI)

S- Situation Anthony presented to the Emergency Department at 1130 hrs. Upon arrival he presented with central crushing chest pain radiating to his jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4. 300mg Aspirin administered on route to hospital.

B- Background Hypertension, Hyperlipidaemia, Type 2 Diabetes Mellitus (DM)

Current Regular Medications taken:

Captopril 12.5mg bd
Simvastatin 40mg nocte
Metformin 850mg Daily

A- A to G Assessment

Airway- Patent, own

Breathing- Auscultation: bilateral air entry, breath sounds clear. RR-22 b/min, SPO2 92% on room air.

Circulation- Sinus Tachycardia 105 bpm. BP 148/92. Diaphoretic and peripherally cool. Central crushing chest pain radiating to the jaw.

COLDSPA:

Character: crushing chest pain
Onset: 10am
Location: Central, radiating to jaw
Duration: ongoing
Severity: pain score 8/10
Pattern: at rest, not relieved by SL Anginine Spray
Associated symptoms: diaphoresis

Capillary Refill Time 3 sec, peripherally cool, heart sounds dual no murmur.

Disability- GCS 15 -Alert and orientated, Equal strength in all four limbs. PEARL, distressed ++

Exposure- Afebrile, skin intact, IV cannula right cubital fossa

Abdo: bowel sounds present in all four quadrants with a soft, nontender abdomen

Fluid- NBM (Nil by mouth), IVF fluids in progress TKVO. Height: 163cm Weight: 95 kg

Glucose- 6.8mmol/L

Diagnostic Results for Troponin 1 (hs-cTnI), ABG's and ECG

Suspected Diagnosis: STEMI

Test: High-sensitivity Cardiac Troponin I (hs-cTnI)

Reference Range: <14 ng/L (normal)

Test Result Interpretation

Troponin I Level (ng/L) 42 Elevated

A DIAGNOSIS FOR Mr Romano is confirmed with ACUTE ANTERIOR ST Elevation Myocardial Infarction (STEMI)

R- Recommendations:

Continuous monitoring of vital signs- Transfer to High Dependency Unit

Supplemental oxygen if SpO2 < 93%

Continuous cardiac ECG monitoring

Keep in resuscitation bay (Triage category 2)

Blood tests:

Troponin now, then again in 2 hours

Medications:

Morphine 2.5mg IVI 2/24 (PRN maximum dose 10mg)

Nitro-glycerine 600mcg SL (PRN maximum 3 doses); if pain persists, consider IV Glyceryl Trinitrate infusion

Clopidogrel 300mg PO STAT

Heparin 5000IU IV STAT

As per STEMI reperfusion flowchart:

Transfer to Cardiac Cath Lab for urgent primary PCI when ready (<90mins).

If PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1230pm

Q1. Discuss the A to E (Airway, Breathing, Circulation, Disability, Exposure) assessment approach for Mr Anthony Romano who is experiencing an acute coronary syndrome (ACI) with ST elevation myocardial infarction (STEMI). In your discussion, highlight abnormal vital signs and test results and how these relate to the underlying pathophysiology of a STEMI.

Q2. Discuss the following four high priority nursing interventions for managing Mr Romano's STEMI and brief rationales for each:

Oxygen therapy
12 lead ECG within 10 minutes of arrival and then every 30 minutes
Pain relief
Reducing high distress levels

Q3. Select any 3 of the following medications and discuss each of the nursing considerations (i.e., Assessment, Administration and Side Effects) when administering the following therapies and medications to Mr Romano.

Morphine 2.5mg IV
Nitro-glycerine 600mcg SL
Aspirin 300mg
Heparin 5000iu IV

Oral Presentation Details:

You are to record and submit your oral presentation based on the case study for Mr Anthony Romano who has a STEMI.

For your oral presentation: -
Use a slide show such as PowerPoint to support your presentation.
Show your student ID card and introduce yourself before presenting
Use some diagrams in your presentation
Speak clearly
10 minutes duration (+/-10%)
Record your presentation in ZOOM by arranging a meeting and sharing your screen.

Upload the oral presentation to YouTube: Instructions on how to upload to YouTube are provided in the Ultra site, Assessment 2.

Submit a transcript (approx. 1000 words or sufficient for a 10-minute presentation) on a Word document which is the script that you follow when presenting. This needs to be submitted to the Turnitin submission portal. Template of the transcript is provided in the Ultra site, Assessment 2.

References need to be included as intext citations throughout the transcript and in full at the bottom of the transcript.

The YouTube link that you have uploaded the recording to needs to be copied to the top of the transcript.

The recorded presentation should take no more than 10 minutes. If you exceed the time limit by more than 10%, the marker will stop marking at 11 minutes.

A note on ACADEMIC references: References to support your discussion must be from peer-reviewed and/or published sources no more than 5-10 years old. This includes textbooks, journal articles, MIMS and evidence-based guidelines.