Final Answer:
1. Priority Nursing Assessment Questions:
a. "Can you describe the character and intensity of your chest pain in more detail?"
b. "Have you experienced any shortness of breath or difficulty breathing along with the chest pain?"
c. "Can you recall any specific triggers or activities that occurred just before the onset of your chest pain?"
d. "Have you ever had a similar episode of chest pain that was diagnosed as stable angina?"
2. Priority Nursing Interventions:
a. Administer sublingual nitroglycerin as prescribed and reassess pain after 5 minutes.
b. Initiate continuous cardiac monitoring and observe for any changes in rhythm or additional ECG abnormalities.
c. Establish IV access for possible medication administration and obtain blood samples for troponin T or I, and CK-MB.
d. Facilitate a rapid response team activation to expedite transfer to the cardiac catheterization lab for possible percutaneous coronary intervention (PCI).
3. Troponin Result Prediction:
Given T.C.'s clinical presentation with chest pain, diaphoresis, and ST-segment elevation on ECG, the troponin result is expected to be elevated. Troponin is a cardiac marker released into the bloodstream during myocardial injury, and an elevated level correlates with cardiac muscle damage.
4. Diagnosis Differentiation:
T.C. is likely experiencing an acute myocardial infarction (MI) based on the persistent chest pain, diaphoresis, and ST-segment elevation. The absence of relief with nitroglycerin, coupled with elevated troponin and CK-MB levels, supports the diagnosis of an MI rather than stable or unstable angina. The family history of premature myocardial infarction also increases the suspicion for an acute coronary event. Rapid intervention, including PCI, is crucial to minimize cardiac damage and improve outcomes.
Step-by-step explanation:
1. The assessment questions aim to gather detailed information about the chest pain's characteristics, associated symptoms, potential triggers, and any history of stable angina, helping to differentiate between various cardiac conditions.
2. Nursing interventions prioritize pain management with nitroglycerin, continuous monitoring for dynamic changes, establishing IV access for medication and blood sampling, and prompt activation of the cardiac catheterization lab for potential PCI.
3. Troponin is a sensitive marker for myocardial injury. Elevated levels indicate cardiac damage, supporting the diagnosis of acute myocardial infarction.
4. The clinical picture, lack of relief with nitroglycerin, elevated cardiac markers, and family history strongly suggest an acute MI over stable or unstable angina. Rapid intervention is crucial for improved outcomes in acute coronary events.
Complete Question:
T. C. is a 48-year-old Cavcasian man presenting in the emergency department with reports of chest pain for the past 20 minutes. He is diaphoretic, pale, and reporting mid-sternal pain 7 no. Pain is descriced as hemry pressure, not radiating to his neck of arm, He denies nausea. He has taken 3 nitro sprays without effect. VS on admission: T 37.3-P 110 (regula)- RR 26 BP 160/100,02 sat 918 on RA. ECG: ST segment elevation. Troponin t or Ti result pending CK-MB: result pending Past Medical History: - Hyperterision - Hypercholesterolemia - Coronary Artery Disease - Stable Angina - 20 pack year smoker Family History: - Father-Hypertension, diabetes, Mi aged 51-deceased - Mother Hypertension and Hypercholesterolemia - Brother Ma aged 50, diabetes type 2 Social History: Divorced, two chidren (ages 10 s Bi), works as a traveing salesperson. Current Home Medications: - EC ASA 325mg PO daily - Nitroglycerin spray 0.4mg SL q 5 min x3 doses prn - Metoproiol 50mg PO BID - Lovastatin 20mg PO dally Choose four prionity nursing assessment questions to ask this patient. −14 2. Identify in order of peiority 3 nursing interventions tor this pasient. 13 3. Briefly explain what you would expect the troponin result to be and the rationale for this prediction. /3 4. Based on T.C.'s presenting iliness explain whether you think he is expeniencing stable angina, unstable angina or an ML. Support your answer with clear lins to assessment findings and findings of diaghostic tests identified above to differentiate between the three possibilities.