Question

Mrs. Jones is a 63-year-old patient who has come to the ED after waking this morning at 8:00 AM experiencing symptoms after eating. She has a 5-year history of hyperlipidemia, hypertension, type 2 diabetes, and osteoarthritis. She states that she had a total hysterectomy 10 years ago and that her gallbladder was removed 2 years ago. At this time, the patient states that she has fatigue, shoulder pain, indigestion, a moderate ache in the chest that is worse on inspiration, nausea, and a headache.

1. Which portion(s) of Mrs. Jones’s health history should the nurse identify that require priority assessment?

2. Based upon the symptoms that Mrs. Jones expressed and the nurse’s identification of priority assessment, what actions should the nurse take?

3. What would be the indication for Aspirin in this case?

Answer 1

CHEST PAIN .

1. Moderate chest pain that is worse on inspiration , shoulder pain , fatigue these problems of  the patient should be identified as the priority assessment by the nurse .

Causes of chest pain can vary from minor problems , such as indigestion or stress , to serious medical emergencies , such as a heart attack or pulmonary embolism . A heart attack occurs when an artery that supplies oxygen to the heart muscle become blocked . A heartattack may cause chest pain that lasts a few minutes or longer , or it can also be silent and produce no signs or symptoms . The earliest warning sign of blocked heart arteries may be ongoing episodes of chest pain that start when you are physically active and are relieved by rest . However , during a heart attack those symptoms appear even without any physical activity . Someone having a heart attack may experience none , any or all of the following ;

• Uncomfortable pressure , fullness or squeezing pain in the center of the chest lasting more than a few minutes .
• Pain spreading to the shoulders , back , neck , jaw or arms .
• Lightheadedness , fainting , cold sweating , nausea or shortness of breath .

2 . MANAGEMENT FOR CHEST PAIN .

MEDICAL MANAGEMENT

  The objectives of the medical management of angina are to increase the oxygen demand of the myocardium and to increase the oxygen supply .

Oxygen therapy ; Oxygen therapy is usually initiated at the onset of chest pain in an attempt to increase the amount of oxygen delivered to the myocardium and reduce pain .

Pharmacologic therapy ;

• Nitroglycerin ; gives long term and short term reduction of myocardial oxygen consumption through selective vasodilation within 3 minutes .
• Beta-blockers ; reduces myocardial oxygen consumption by blocking beta - adrenergic stimulation of the heart .
• Calcium channel blockers ; have negative inotropic effects .
• Antiplatelets ; medications prevent platelet aggrevation ( Aspirin ) , and anticoagulants prevent thrombus formation .

NURSING MANAGEMENT

Nursing assessment ;

In assessing the patient with angina , the nurse may ask regarding the following ;

•   Location of pain
• Charecteristics of pain
• Health history
• Pain scale
• Onset of pain
• Cause of pain
• Other symptoms that occur with pain

Nursing diagnoses ;

• Ineffective cardiac tissue perfusion secondary to CAD as evidenced by chest pain or other prodromal symptoms .
• Deficient knowledge about the underlying disease and methods for avoiding complications .
• Noncompliance , ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes .

Nursing interventions ;

• Treating angina ; The nurse should instruct the patient to stop all activities and sit or rest in bed in a semi- fowlers position when they experience angina , and administer nitroglycerin sublingually .
• Preventing pain ; The nurse reviews the assessment findings , identifies the level of activity that causes the patient's pain , and plan the patient's activities accordingly .Administer medications as per doctors order .
• Decreasing oxygen demand ; Balancing activity and rest is an important aspect of the educational plan for the patient and the family .
• Reducing anxiety ; Exploring implications that the diagnosis has for the patient and providing information about the illness , it's treatment , and methods of preventing its progression are important nursing interventions .
• Documentation guidelines ; documentation includes ,

= Nature , extent , and duartion of problem .

= Effect on independence and lifestyle .

= Characteristics of pain , precipitators , and what relieves pain .

= Pulse and BP .

• Managing poor diet ; Eat a healthy diet with limited amounts of saturated fat , trans fat , salt and sugar . Include a variety of fruits and vegetables , whole grains , lean meats , and low - fat dairy products in the diet
• Maintain a healthy weight .
• Advice the patient to stop smoking if so .

3 . ASPIRIN IN CHEST PAIN

• It helps prevent blood clots ( antiplatelet effect ) ; some chemicals in the blood trigger events that cause blood clots . When aspirin stops those chemicals , it helps slow the formation of the clots .They can clog the arteries that bring blood to the heart muscle and the brain , which increases the risk of heart attack and stroke .
• It eases inflammation ; Plaque may be more likely to cause a heart attack or stroke if it's inflamed . Aspirin blocks an enzyme called cyclooxygenase . That makes the body less likely to produce chemicals that can help cause inflammation .
• It can reduce the risk of death ; Taking aspirin regularly can lower the risk of death from all causes , particularly among the elderly , people with heart diseases , people who are physicaly unfit .

Indication of aspirin in this case includes ;

1. Angina pectoris

2 . Angina pectoris prophylaxis

3 . Cardiovascular risk reduction

4 . Pain

5.Osteoarthritis .

Research says between 80 milligrams and 160 milligrams of aspirin can take per day . This is less than half of the standard 325 - milligram aspirin most people are prescribed . Many studies show the lower dose works just as well as the higher dose . It also drops the risk of internal bleeding .

PATIENT TEACHING ;

• Advice the patient to don't take it on an empty stomach . Take aspirin with a full glass of water with meals or after meals to prevent stomach upset .
• Don't break , crush , or chew extended - release tablets or capsules - swallow them whole . Chewable aspirin tablets may be chewed , crushed , or dissolved in a liquid .
• Aspirin should never be taken in place of another medications or treatments recommended by your doctor .
• Never take it with alcohol . That increases the chance of stomach bleeding .