Angina Case study.docx - ANGINA CASE STUDY Scenario R.K is...

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ANGINA CASE STUDY Scenario 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 2 ) 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.
ANGINA CASE STUDY Page #192 ATI History Family History of Cardiac Disorders? Stress? Any Allergies? Race? Physical Has this happened in the past 2 days? What medications or herbs are being taken? What does your diet consist of? Do you smoke? 5. List 7 laboratory or diagnostic tests you would expect to be performed; suggest what each might contribute. Page# 192 ATI

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