Question

Discussion Post#2 Due April 8 11:59pm

Case #2: Use the following story to complete the questions below:

Ruth is an 85-year-old woman who lives with her husband, who is 87. Two nights before her admission to your cardiac unit, she awoke with heavy substernal pressure accompanied by epigastric distress. The pain was reduced somewhat when she rolled onto her side but did not completely subside for about 6 hours. The next night, she experienced the same chest pressure. The following morning, Ruth’s husband took her to the physician, and she was subsequently hospitalized to rule out myocardial infarction (MI). Lab specimens were drawn in the emergency department. She was given 325 mg chewable, non–enteric-coated aspirin, and an IV line was started. She was placed on oxygen (O2) at 2 L via nasal cannula.

You obtain the following information from your history and physical examination: Ruth has no history of smoking or alcohol use, and she has been in good general health, with the exception of osteoarthritis of her hands and knees and some osteoarthritis of the spine. Her only medications are simvastatin (Zocor), ibuprofen as needed for bone and joint pain, and “herbs.” Her admission vital signs (VS) are blood pressure 132/84, pulse 88, respirations 18 breaths/min, and oral temperature 99 ° F (37.2 ° C). Her weight is 114 pounds (51.7 kg) and height is 5 ft, 4 in. (163 cm). Moderate edema of both ankles is present; capillary refill is brisk, and peripheral pulses are 1+. You hear a soft systolic murmur. She denies any discomfort at present. You place her on telemetry, which shows the rhythm in the following figure.

Cardiac Rhythm Strip

Unit 5C Discussion Post Pic.jpg

Laboratory Results

Cardiac troponin T is less than 0.01 ng/mL (0.01 mcg/L) (at admission) and same result 4 hours after admission

Serial CPK tests are 30 units/L at admission, 32 units/L 4 hours after admission

d-Dimer test result less than 250 ng/mL (250 mcg/L)

Vital Signs

BP 140/92, P 110; R 20

1. What cardiac rhythm is Ruth in?

2. What is the purpose of administering an aspirin tablet?

3. What are 4 specific focused assessments that should be done on Ruth and why?

4. Identify which of the following conditions you believe Ruth has from the list below. Give a brief explanation of each as to why you believe she has this or does not have this.

a. Pulmonary Emboli:

b. Angina:

c. Myocardial Infarction:

Answer 1

*The first question cannot be answered because there is no picture attached that shows cardiac rhythm *

ADMINISTRATION OF ASPIRIN TABLETS

Usually aspirin has been the primary treatment for cardiovascular diseases. Many cardiovascular disease result as a result of blockage of the blood flow due to obstruction usually by plaque formation( plaque is formed due to fat and cholesterol build up with platelets.) or by clots. Aspirin helps to dissolve the clots as it is having anti platelet actions. It helps in free flowing of the blood through the narrowed blood vessels and hence helps in relieving the pain.

FOUR SPECEFIC ASSESSMENTS

• Assessment of LIPID PROFILE. This will provide blood cholesterol levels and will help in diagnosis.
• Perform an ECG (electrocardiograph) whic will provide a clear picture of the heart fucnction.
• ECHOCARDIOGRAM, here motion of the walls of the heart is monitored. Decreased motion means decreased blood flow.
• CORONARY COMPUTED TOMOGRAPHY ANGIOGRAPHY: It will help to establish the extent of narrowing.
• X-RAY to rule out causes of non cardiac causes of chest pain.

RUTH HAS ANGINA. She presents with symptoms of chest pain and epigastric pain that occurs at the night time. It is a case of unstable angina, where there is pain the person takes rest or exerts excessive pressure on the heart.
There is no MYOCARDIAL INFARCTION because there is no evidence supporting it that is there is no elevation in the troponin levels and CPK is also normal.
There is no clinical evidence of pulmonary embolism, as in pulmonary embolism there is shortness of breath and also here the patient has managed to survive the pain for almost 2 days which is not the case for pulmonary embolism.