Question

Write an exemplar in 500 words or less explaining the care that you would provide for the patient in the following clinical scenario:

You are working on a busy medical unit and your preceptor has left the unit for a few minutes when you respond to the call light of your patient, Mr Jones. Mr Jones is 56 years old with a hx.of HTN, CAD and DM. Upon entering his room, he is holding his hand to his chest, complaining of chest pain and shortness of breath. His wife is hysterical and yelling for you to “do something”. He is pale and diaphoretic. He is currently on telemetry and oxygen at 2 liters.

Answer 1

Management of CAD

CAD (Coronary artery disease): coronary arteries are the arteries that supply blood to the heart. As heart is an organ in itself, it needs oxygen and nutrition which is supplied by coronary arteries. When there is an obstruction in these arteries there is less supply of oxygen and nutrition to the cells of the heart leading to alteration in the working of heart, sometimes the arteries are blocked to an extent that it may lead the heart cell become infracted.

Coronary artery diseases are combination of three disease they are arteriosclerosis, myocardial infraction, and angina pectoris. Arteriosclerosis means blockage of coronary arteries due to calcifications, fat depositions, emboli, thrombus etc… which may lead for mild, moderate or severe damage to the heart cells depending upon severity of the blockage of coronary arteries called as myocardial infraction. If there is a block or damage to the heart cells there is severe chest pain (pain in pectoris muscles the muscles of the chest) is called angina pectoris.

The patients suffering with CAD’s in the current scenario complains of chest pain which is a most common symptom. The treatment of angina pectoris is nitro-glycerine to cause vasodilation, as well as IV thrombolytic drugs to clear any impending block. It is also important to check the various parameters using telemetry at hospital. Telemetry in hospital means continuous monitoring of the patient regarding his/her condition about using monitors or devices for use. If there is ST segment of ECG monitor shows elevation then it shows the presence of MI for which the immediate treatment is MONA, (Morphine, Oxygen, Nitrates, and Antiplatelet antibodies). If there is no ST segment elevation then the blood tests are carried out to assess for cardiac parameters like ABG, troponin -t, troponin-m, myoglobin’s which elevate in MI and can help in identifying the disease.

For long term treatment the patient is advised several lifestyle modifications like quit smoking, alcohol intake limit, lose weight, eat healthy and practice exercise daily. The medications that are ordered are vasodilators, anti-hypertensives, anti-anginal, anti-coagulants for rest of the life. Regular health check-ups and blood pressure monitoring is essential as well.