Week 3 Rule out MI_Answers.docx - Difficulty Intermediate...

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Difficulty: Intermediate Setting: Hospital emergency department Index Words: rule out myocardial infarction (R/O MI), substance abuse, coronary artery disease (CAD), crisis management, risk factors, Giddens Concepts: Addiction, Clinical Judgment, Coping, Pain, Perfusion HESI Concepts: Addiction, Assessment, Clinical Decision Making—Clinical Judgment, Pain, Perfusion, Stress & Coping Name _________________________________ Class/Group _______________ Date _______________ Scenario The time is 1900. You are working in a small, rural hospital. It has been snowing heavily all day, and the medical helicopters at the large regional medical center, 4 hours away by car (in good weather), have been grounded by the weather until morning. The roads are barely passable. W.R., a 48-year old plumber with a 36-pack-year smoking history , is admitted to your floor with a diagnosis of rule out myocardial infarction (R/O MI). He has significant male-pattern obesity (“beer belly ,” large waist circumference) and a barrel chest and reports a dietary history of high-fat food . His wife brought him to the emergency department after he complained of unrelieved “indigestion.” His admission vital signs (VS) were BP 202/124, pulse 106, respirations 18, and oral temperature 98.2°F (36.8 ° C). W.R. was put on oxygen (O 2 ) by nasal cannula (NC) titrated to maintain Spo 2 over 92% and started on an IV nitroglycerin (NTG) infusion . He was given aspirin 325 mg to chew and swallow and was admitted to Dr. A.’s service. There are plans to transfer him by helicopter to the regional medical center for a cardiac catheterization in the morning when the weather clears. Meanwhile, you have to deal with limited lab and pharmacy resources. The minute W.R. comes through the door of your unit, he announces he’s “just fine” in a loud and angry voice and demands a cigarette. He also says he has no time to fool around with hospitals. 1. What is the first priority in his care? -
2. Are these VS typical for a man of his age? If not, which one(s) concern(s) you? Explain why or why not.
3. Identify 5 priority problems associated with the care of a patient such as W.R.
Cigarette smoking : He is going to want to smoke. Smoking negatively affects the heart because of the increased stress on the lungs and the vasoconstriction that restricts oxygenation . You need to

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