12 Jul MYOCARDIAL INFARCTION WITH HISTORY OF STABLE ANGINA AND MITRAL VALVE STENOSIS
Instructions:
Choose one (1) of the case studies and answer the associated questions. The assignment is to be
presented in a question/answer format and not as an essay (i.e. no Introduction or conclusion).
Each answer has a word limit (1500 to 1700 in total); each answer must be supported with
appropriate references & must be supported with citations. . A Reference List must be provided at
the end of the assignment. Please refer to the Marking Rubric guide
Purpose:
To assessment task is designed to assess the knowledge and skills related to nursing care of
individuals experiencing acute medical health alterations, and the best practice in
Managing this exacerbation.
Specific focus will be on students researching the pathophysiology of the relevant disease, the
pharmacology of medications used to manage the disease, and the evidence based nursing care
required to look after these patients, while supporting this information with appropriate references.
** The following questions must be answered for your chosen case study **
The following questions relates to the patient within the first 24 hours since admission to the
emergency department (ED):
1. Outline the causes, incidence and risk factors of the identified condition and how it
can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each
provide a link to the underlying pathophysiology (350 words)
a) This can be done in the form of a table – each point needs to be
appropriately referenced
3. Describe two (2) common classes of drugs used for patients with the identified
condition including physiological effect of each class on the body (350 words)
a) This does not mean specific drugs but rather the class that these drugs
belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the
registered nurse, should use within the first 24 hours post admission for this patient
(500 words).
Case Study 1: Myocardial infarction with history of stable angina and mitral valve
stenosis
Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit
(CCU) from the emergency department for management of episodic chest pain. He has a
history of stable angina and mitral valve stenosis. Mr Savea is of Samoan background and
has lived in regional Queensland for the last 20 years with his wife and children.
He was brought in by ambulance having had chest pain and shortness of breath. He reports
having similar symptoms on and off for the past two months but did not visit his GP as he
assumed the discomfort was due to indigestion. Mr Savea is an ex-smoker, tobacco free for
the last six months and a social drinker (approx. 10 units/week). He works full-time as an
orderly at a local hospital and is active in the Samoan support community.
On assessment Mr Savea’s vital signs are:
• Pulse Rate ( PR) 90 bpm and irregular
• Respiration Rate (RR) 12 bpm;
• Blood Pressure (BP) 150/100mmHg;
• Temperature (Temp) 36.9°C;
• Oxygen saturation (SpO2) 98% on oxygen 8L/min via Hudson mask.
• He has a body mass index (BMI) of 35 kg/m2 indicating clinical obesity.
• Blood test results show elevated cardiac enzymes and troponin levels and cholesterol
level of 8.9mmol/L.
• His ECG indicates that he has a ST segment elevated myocardial infarction.
Mr Savea was administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for
pain in the emergency department. He reports being pain free on admission to coronary care
unit (CCU).
Case Study 2: Cushing’s Syndrome
Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing
gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was
referred to the local hospital for further investigation. Maureen was diagnosed with
rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple
exacerbations of RA which have required the use of high dose corticosteroids.
She is currently taking 50mg of prednisolone daily, and has been taking this dose since her
last exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with
metformin. She is currently studying nursing at university and works part-time at the local
pizza restaurant.
On assessment, Maureen’s vital signs are:
• Pulse Rate ( PR) 88 bpm and irregular
• Respiration Rate (RR) 18 bpm;
• Blood Pressure (BP) 154/106 mmHg;
• Temperature (Temp) 36.9°C;
• Oxygen saturation (SpO2) 99% on room air.
• She has a body mass index (BMI) of 38 kg/m2 and the fat is mainly distributed
around her abdominal area, as well as a hump between her shoulders.
• Blood test results show elevated cardiac enzymes and troponin levels and cholesterol
level of 8.9mmol/L.
• Maureen’s husband notes that her face has become more round over the past few
weeks. Her fasting Blood Glucose Level (BGL) is 14.0mmol/L.
• Blood test results show low cortisol and ACTH levels, and high levels of low density
lipoprotein cholesterol.
She is awaiting a bone mineral density test this afternoon, and is currently collecting urine for
a 24-hour cortisol level measurement.
Case Study 3: Decompensated Liver Cirrhosis
Mr Ronald Stone is a 47-year-old man who was brought in by ambulance to emergency
department with haematemesis. According to his partner he vomited a total of 300 mL of
fresh blood this morning. He reported that he has been spitting blood stained sputum for the
last few weeks with no associated cough or shortness of breath. For the past 3 days he has
complained of increasing abdominal pain but with no diarrhoea or black stools.
Mr Stone tested positive for Hepatitis C virus (HCV) genotype 1A in June 2010. He has
cirrhosis and a history of heavy alcohol use, although he no longer drinks. He ceased
intravenous drug use 10 years ago, and stills smokes tobacco and marijuana on a daily basis.
He used to work with City Rail but has been made redundant 13 months ago and has been
unemployed since. He lives with his partner and 2 young children from a previous marriage.
On assessment Mr Stone’s vital signs are:
• PR 112 bpm;
• RR 24 bpm;
• BP 105/64mmHg;
• Temp 37.4 °C;
• SpO2 94% on room air.
• He has a body mass index (BMI) of 31.5kg/m2 .
• He is lethargic but orientated to time, place and person.
• He has a swollen and tight abdomen typical of ascites and bilateral leg oedema.
• Blood test results show Hb 85 g/L, decreased WBC, platelets and albumin, and a
marked increase in both serum ammonia and total bilirubin levels. 6 months ago he
underwent an eosophagogastroduodenostomy (EGD) which showed grade 2
oesophageal varices.
• He is ordered the following medications: Vitamin K 1 mg IV stat, aldactone 25mg
PO TDS, lactulose 15mls PO TDS, and vitamin B12 100mg IV TDS.
• He is awaiting a CT abdomen scheduled for this afternoon.
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