Question

Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)-sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes type 2 diabetes mellitus, heart failure, hypertension, and

osteoarthritis. Home medications include furosemide (Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), metformin (Glucophage), and ibuprofen (Motrin).

Clinical Assessment

Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free. His only complaint is shortness of breath and swelling in his ankles, feet, and hands. Physical assessment reveals bilateral breath sounds with basilar crackles; dressing at catheter site; right femoral clean, dry, and intact; peripheral pulses 2+ bilaterally; and 2+ edema noted in lower extremities. Mr. X has a body mass index (BMI) of 35 kg/m² and weighs 100 kg. IV fluids have been discontinued, and saline lock is in place in preparation for transfer to the telemetry unit.

Diagnostic Procedures

Admission diagnostic studies: Electrocardiogram (ECG) with ST segment elevation in V₁-V₄; elevated cardiac enzymes; electrolytes and glucose within normal limits; blood urea nitrogen (BUN), 26 mg/dL; serum creatinine, 1.8 mg/dL; cholesterol, 250 mg/dL; and serum B-type natriuretic peptide (BNP), 300 pg/mL. Current vital signs are as follows: blood pressure of 138/80 mm Hg, heart rate of 108 beats/min (sinus tachycardia), respiratory rate of 28 breaths/min, temperature of 99° F, and O₂saturation of 92% on oxygen at 2 L per nasal cannula. Urine output for the past 6 hours is 100 mL. The health care provider is notified of Mr. X’s urine output, and repeat diagnostic studies are ordered that reveal the following: BUN, 56 mg/dL; serum creatinine, 5.6 mg/dL; and potassium, 5.8 mEq/L.

Medical Diagnosis

• Acute anteroseptal myocardial infarction
• STEMI (ST elevation myocardial infarction)
• Contrast-induced nephropathy (CIN)

QUESTIONS

1. What major outcomes do you expect to achieve for this patient?
2. What problems or risks must be managed to achieve these outcomes?
3. What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?
4. . What interventions should be initiated to promote optimal functioning, safety, and well-being of the patient?
5. What possible learning needs would you anticipate for this patient?

6. What cultural and age-related factors may have a bearing on the patient’s plan of care?

Answer 1

1.Outcomes Expected

• Patient functional Status shouldbe maintained/Improved
• Patient safely Should maintain by reducing fatalities.
• Satisfaction Of thePatient should achieve.

2. Shortness of breath and the bilateral breath sound may be  due to pulmonary edema.

• Swelling in ankles, feet and hands may be due to renal dysfunction.
• 100ml urine also indicating the same problem.Edema noted in the lower extremities.
• Creatinine level was high.(greater than 1.5)

To achieve the outcomes the above mentioned risks should eliminate.

3.Regular diagnosis of Vitals should carried out to monitor.

Drug therapy should start immediately to pulmonary edema and renal dysfunction.

4.The patient safety and well being can be promoted by these nursing interventions

• Use monitoring technology
• make sure patient understand their treatment
• verify all medicalProcedures
• follow proper handwashing procedures
• Promote a team atmosphere
• 5.Learning needs for the patient.

5.It should be assessed using Cardiac patient learning need inventory (CPLNI)

• Introduction to CCU should give
• Anatomy and Physiology of the heart
• Psychological factors
• Lifestyle factors and medication
• medication information
• Dietary information
• Physical activity
• Symptom
• management other information related to support system.

The health information in these areas have greater importance.

6.Age of the patient is 64.The patient above 69 years should gave special care.

Regardless of a patient age, nurses must respond to the patients need for

• safety
• Privacy
• Confidentiality
• Comfort
• Pain management
• Choices and control
• Involvement of family/ significant others.

Depending upon the age of the patient, the nurse may use differed approaches,assessment tools, or equipment to addressothe needs.Themse needs are also patients rights and must be respected.

Infants, pediatric and elderly patients are particularlyVulnerable to safety risks.