ANGINA CASE STUDY
R.K. 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, R.K.’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 (O
) at 2 L via nasal cannula.
You obtain the following information from your history and physical examination: R.K. 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.
3. Explain the purpose of the aspirin tablet. Why is “non–enteric-coated” aspirin specified? What
4. What additional history and physical information should you obtain related to her admitting
diagnosis? Name at least 4 for each.