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Head of room: Fatima h

Nurse 1 : dinah

Nurse : deti

Fatimah : good morning pseudo- a, praise syuruk kep no almighty God Almighty sump wa on this morning
we can Berkum pul to do preconfrens in good health, this morning ru ang ICU has 10 patients with
category of treatment 2 patients se lf care , 7 patient care party, and 1 patient total care. Next will I leave
to nurse Dinah selak u team leader duty night to read the results of the condition of the patient, the
nurse's office in the morning, please Dinah to read reports of nursing

Dina h: OK, Mrs. Laila , 62 years old , came in with a diagnosis of ACS NSTEMI , last night. Laila experiencing
chest pain are arriving -Arrived with a pain scale 8 s ertai changes in heart rhythm that is tachycardia and
has received pethidine e appropriate advice d r. Satria, and the results obtained nye ri chest is reduced to
the scale of pain 3 and rhythm jant ung back to normal.

D eti: do you still have pain this morning ?


Dinah: ny. Lail had no pain but still felt tight , and received NT G therapy 1mm / hour , continued therapy until
further advice.

Deti: okee , what about the vital signs ?


Dinah: Vital sign this morning, blood pressure 130/80, H R 70 / minute, temperature 36.0 C , R R 25 /
minute, oxygen saturation 95%. For fluid intake for 8 hours it is 21 0 0 mm and the output is 1800m . The
results of the ECB examination this morning showed the presence of ST Depression I at V4, V5 and Lead II.
For her activities Mrs. Laila blm may beraktivita s too fallow t , do not allow the patient to go to the
bathroom k arena has been installed f ole y catheter .

Deti: Well, how the therapy o batnya ? Is it still the same as before?

Dinah: for the therapy, we still continue the previous medication and there is an additional provision of
flame N T G 1mm / hour . He noisy o jat uh because often restless k arena in gin to toile t. Currently
installed nasal cannula 4 l / min ., Syrmpum p with the drug N TG in the right hand , foley catheters and
wires monit or.

Seconds: are there any PCI plans or other checks today ?


So : today at 09.00 an ECH check will be carried out. The approval sheet was signed last night, for dr. Satria
will explain to the patient's family about the procedure and will ask for his consent.

Fatimah: fine, thank you to the local nurse for the report.

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