Reference no: EM133855212
Assignment:
You, the LVN, are half way through a 12 hour shift on the cardiac unit of your hospital and have a new admission. Patient is a 60 year old male, retired businessman. He is married with 3 grown children. He tells you on his health history that he began feeling changes in his heart rhythm about 10 days ago. He has HTN and a 5 year history or angina pectoris. During the past week he has had frequent episodes of mid-chest discomfort. The chest pain has awakened him from sleep but does respond to nitroglycerin which he has taken SL about 8-10 times over the past week. During the week he has also experienced increased fatigue. He states, "I feel crappy all the time". A cardiac catheterization done several years ago revealed a 65% stenosis of the right coronary artery and a 50% stenosis of the left anterior descending coronary artery.
He tells you that both his mother and father had CAD. He is taking amlodipine, metoprolol, atorvastatin (Lipitor), and a baby asa daily. VS: B/P 164/98, P 102, RR 18, Temp 98.5F. NKDA.
Upon admission patient was in atrial fib per telemetry monitoring, but over the past hours has converted to atrial flutter with a 4:1 block. He was given diltiazem and converted to tachycardia/bradycardia syndrome with long sinus pauses that caused lightheadedness and hypotension B/P 78/42.
Orders:
1. VS
2. Focused assessment / Physical assessment
3. Diltiazem 120mg po qd
4. Lipitor 20mg po bid
5. O2 at 2-6 L nc to keep sat above 95%
6. Xanax 0.25mg po q 4hrs prn anxiety
7. Coumadin 2mg po qd on M-Tues - Fri and 5mg on Wed - Thurs - Sat no dose on Sun
8. Place and NG tube to LIS
9. NPO
10. Morphine 2mg IVP q 2hrs prn pain
11. Strict I&O
12. Prep for possible pacemaker placement
13. Telemetry
14. IV D5NS at 125/hr
Questions:
1. What other questions are you going to ask the patient based on the history given? What are some common sites for radiation of ischemic cardiac pain?
2. What are the risk factors for CAD? What would you need to know about your patient's lifestyle to assess his risk factors? What are his risk factors?
3. What risks do the two after admission cardiac rhythms pose for this patient?
4. List 3 serious complications that can occur with pacemaker placement? List 5 things you will monitor on your patient related to the complications you have listed.