Question

Esther Jackson is a 56-year-old black female who is 1-day post-op following a left radical mastectomy. During morning rounds, the off-going nurse shares with you during bedside report that the patient has been experiencing increased discomfort in her back throughout the night and has required frequent help with repositioning. She states that the patient was medicated for pain approximately 2 hours ago but is voicing little relief and states that you might want to mention that to the doctor when he rounds later this morning. With the patient appearing to be in no visible distress, you proceed on to the next patient's room for report. Approximately 1 hour later, you return to Ms. Jackson's room with her morning pills and find her slumped over the bedside stand in tears. The patient states, "I don't know what is wrong, I don't feel right. My back hurts and I'm just so tired. What is wrong with me?" The patient refuses to take her medications at this time stating that she is starting to feel sick to her stomach. Just then the nursing assistant comes into the patient's room to record Ms. Jackson's vital signs, you take this opportunity to quickly research the patient's medication record to determine if she has a medication ordered for nausea. Upon return, the nursing assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she couldn't get the patient's pulse because "it is all over the place."

PLEASE address the following questions related to the scenario.

PLEASE DO NOT COPY AND PASTE!

1. What do you suspect is the cause of the patient's symptoms?

2. Describe the course of action that you will take to confirm this suspicion and prevent further decline.

3. What further assessments, lab values, and tests will likely be ordered for this patient and how often? If testing is to be completed more than once, please explain the rationale for doing so.

4. While you are caring for this patient, how will you ensure that the needs of your other patients are being met?

Answer 1

1. Ms. Jackson symptoms resemble the event of the heart attack. As the severe back pain which is not relieved by medication and changing of her mental status shows the symptoms of the coronary issue. This is due to the postoperative complications. Her heart rate "it is all over the place" suspects that she is suffering from atrial fibrillation. Moreover, the fatigue is the prodromal symptoms of MI.

2. Ms. Jackson is an African American women, she is high risk for Heart Attack.

• Call the doctor and inform about the patient condition.
• Recheck the vital signs.
• Check for the past medical history.
• Assess the surgical site for edema which leads to embolism.
• Assess for the cyanosis or pallor which indicate low cardiac output.
• Check lung and heart sounds.
• Connect the monitor to know the baseline ECG.
• Call for an emergency team to evaluate the patient for the cardiac issues.

3.

• A 12 lead EKG to be taken to detect the abnormal rhythm.
• Blood samples such as Troponin levels and cardiac enzymes should be sent to the lab.
• Chest X-ray and Echocardiogram should be taken.
• Inform the cath lab priorly in case of cardiac catheterization is necessary.
• Repeat the lab values every 8 hours to know the peak values.

4.

• Inform the nursing supervisor about the event.
• The charge nurse will take care of the unit and makes other nursing assistants to take care of the patients.
• Make sure that no patients are left unattended.
• If necessary take help from another unit nurse as they understood the situation.
• This situation can be handled by a team approach.