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CRITICAL THINKING SUMMARY
Student _Katelynn Jurek_______ Client Dx__NSTEMI______ Age _39___ Allergies _NKA_______________
The MEDICAL DIAGNOSIS that brought the client to the hospital is:
Non ST segment elevation myocardial infarction
PATHOPHYSIOLOGY of diagnosed disease: (From text)
Usually occurs by developing a partial occlusion of a major artery or complete occlusion of a minor coronary
artery previously affected b atherosclerosis. Most commonly a thrombus forms when atherosclerotic plaque
ruptures and aggregates. Blood supply to part of the myocardium is interrupted. Irreversible damage and death
to cells result in a NSTEMI.
nstemi.org
SYMPTOMS typically seen with this diagnosis include (as identified in your text):
Chest pain, nausea, vomiting, sweating, shock and shortness of breath.
CLIENTS’ SYMPTOMS of the diagnosed disease include:
Chest pain that was intermittent for a month. Associated symptoms are shortness of breath that occurs with
exertion and pain radiation to left shoulder.
NUTRITIONAL ASSESSMENT:
Height (actual or estimated) _6 ft_______ Weight (actual or estimated) __211 lbs__________
Estimate Ideal Body Weight ( Male: 105lb + 6 lb/inch > 5’. Female: 100lb + 5lb/inch > 5’) __177 lbs_________
Does this client have characteristics of a well-nourished person? Yes __X___ No ______
Explain your answer.
This client appears to be nourished. He is overweight for his height and that can be a reason for the NSTEMI.
While he was in the hospital he was eating junk food and drinking Mt. Dew. So he probably does not have a
well-balanced diet.
PSYCHOSOCIAL STAGE OF DEVELOPMENT
What is the client’s developmental stage?
Although he is 39 years old I feel he is the Generativity vs. Stagnation Stage
Has he/she met the necessary accomplishments? Yes _X____ No _____
Explain
He has a fulltime job. He is married and has two small children.
How is this illness affecting the client’s ability to meet these necessary accomplishments?
He has to take two weeks off of work to recover. From now on he is going to need to have his health as a top
priority. He has a family to take care of and if he can’t manage his health he won’t be able to meet
accomplishments.
STRESS MANAGEMENT: Identify coping mechanisms used by this client during stress.
Client does not handle stress well. He smokes less than a pack of cigarettes per day. He drinks on the weekend.
He does not have any healthy coping mechanisms for stress.
NURSING DIAGNOSIS/OBJECTIVES/INTERVENTIONS
Indicate below the 2 priority nursing diagnosis that are most relevant for your client.
#1 NURSING DIAGNOSIS (problem r/t)
Ineffective Denial r/t to fear, deficient knowledge about heart disease
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Delays seeking health care attention to the detriment of health, displays inappropriate affect, does not perceive
personal relevance of danger.
OBJECTIVE/CLIENT OUTCOME for this diagnosis:
Seek out appropriate health care attention when needed
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis:
1. Determine the
2. Spend
clients understanding of symptoms of illness, treatments, and expected outcomes
time with the client and allow time for responses
3. Have the
client make choices regarding treatment and actively involve him or her in decision making
process
#2 NURSING DIAGNOSIS (problem r/t)
Situational low self-esteem r/t crisis of NSTEMI
DEFINING CHARACTERISTICS (S/S) that support this diagnosis:
Indecisive behavior, nonassertive behavior, verbally reports current situational challenge to self-worth
OBJECTIVE/CLIENT OUTCOME for this diagnosis:
Demonstrate self-perceptions are accurate given physical capabilities
NURSING INTERVENTIONS that will assist the client to resolve the above identified diagnosis:
1. Assess
for unhealthy coping mechanisms such as substance abuse and make appropriate referrals
2. Assess
clients environmental and everyday stressors including evidence of abusive relationships
3. Assess
the persons support system and involve them if desired
COMPLICATIONS:
If this client’s condition were to worsen, what would be the most likely reason and why?
The patient could possibly have another NSTEMI or STEMI. The reason that this would happen would be
because he is not compliant with medication regimen and diet/exercise plan.
How would you know this is happening?
He would experience the same symptoms as this past episode
What will you do if this happens?
As the nurse I would apply oxygen, administer pain medication, nitroglycerin, and beta blockers to stabilize.
Streptase could be administered to dissolve the clot. A heart catheterization will be necessary.
EVALUATION:
Was the patient able to achieve the objectives identified on the first clinical day? Yes
If no, list new objectives.
Did you choose the appropriate nursing diagnosis on the first clinical day?
If no, list nursing diagnosis that would have been more appropriate.
Were the interventions appropriate? Yes
If no, list more appropriate interventions.
Yes
PHYSICIAN PRESCRIBED MEDICATIONS AND INTERVENTIONS
MEDS/IV’S/TX/DIET
(Include dose, route,
frequency)
REASON PRESCRIBED
(Drug Classification
What is it treating?)
NURSING IMPLICATIONS
FROM TEXT
(Checking for adverse reactions,
preparation & administration
concerns)
Aspirin
81mg PO daily
Antipyretic
Prophylaxis of transient
ischemic attacks and MI
Atorvastatin
20mg PO qhs
Lipid-lowering agent
Management of
hypercholesteremia and
dyslipidemia
Isosorbide Mononitrate
30mg PO daily
Antianginals
Prophylactic management of
angina pectoris
Metoprolol
25mg PO daily
Antianginals/anti-hypertensive
Angina pectoris and
hypertension
Ticagrelor
90mg PO BID
Antiplatelet
Inhibit platelet aggregation
Adverse reactions; GI bleeding,
allergic reactions, hemolysis,
and dyspepsia.
Use lowest effective dose and
administer with meals
Adverse reactions; Erectile
dysfunction, rhabdomylosis,
heartburn and diarrhea
Avoid grapefruit and notify
doctor if muscle weakness, pain,
and tenderness occur
Adverse reactions; hypotension,
Tachycardia, dizziness,
headache, and flushing
Swallow whole
Advise on orthostatic
hypotension
Adverse reaction; Bradycardia,
HF, pulmonary edema, erectile
dysfunction, fatigue
Take apical pulse
Administer with meals
Adverse reactions; Bleeding,
dyspnea, bradycardia, and
gynecomastia
Avoid >100mg aspirin daily
PATIENT DATA FROM
YOUR ASSESSMENT
(What data is important to know
before & after giving)
Monitor hepatic function
Monitor for adverse reactions
Monitor for bleeding and
hematocrit value
Obtain diet history
Monitor liver function test and
CPK
Assess for angina pain
Monitor BP and P
Advise patient to avoid alcohol
Monitor BP, P, ECG
Monitor BUN and uric acid
Assess angina attacks
Assess stroke, MI, and
peripheral vascular disease risk
Monitor uric acid and creatinine
Analysis of Diagnostic Tests
DIRECTIONS:
1.
List all diagnostic and laboratory tests pertinent to the patient's medical diagnosis or medical treatments (i.e. medications)
and provide the patient values for each test. Explain why they are pertinent for this patient.
2.
List any screening diagnostic and laboratory tests that are not within normal limits. Explain why these tests are increased
or decreased in relation to your patient's medical condition.
Diagnostic/Lab Test
Cardiac Labs
Cardiac Catheterization
Patient Values
<.11-Troponin 44-HDL
200-Cholesterol 98-LDL
289-Triglyceride
95% blockage of Proximal second
obtuse marginal artery
70% Obtuse marginal artery
Narrative Charting Sample
Analysis of Values
Troponin is elevated which may indicate
cellular damage to heart. His cholesterol is
right at the desirable range. His triglyceride
level is high which can be indicative to a
high risk for cardiovascular disease.
These two arteries were severely blocked.
Both were stented and angioplasty was
completed.