Patient: Ivanna Alyanna Malasin

A 73-year-old retired teacher who presented to the emergency department at 7am this morning,
Monday, with complaints of indigestion and mid-back pain. She has a history of diabetes and
gastroesophageal reflux disease. Atypical presentation of myocardial infarction was suspected, and she
was admitted for monitoring and further evaluation. The scenario takes place on Monday at 12:45pm in
the medical-surgical unit. During the scenario, Mrs. Malasin experiences crushing chest pain,
hypertension, and nausea. She becomes concerned and frightened that she is now having a real heart
attack. If students perform correct interventions with therapeutic communication, Mrs. Malasin calms
easily. If interventions are not performed with therapeutic communication, she becomes increasingly
anxious, increasing her oxygen demand and the potential for damaging effects of the evolving
myocardial infarction.

General - I am 73 years old.

- My birthday is June 23.
- I have no allergies.
During initial - What is happening? I don't feel right again.
assessment - My chest really hurts. It's crushing. It's 8 out of 10.
- I have a headache, too.
- I am nauseated.
- I had 1 nitroglycerin tablet in the emergency department and I
had 2 here. They seemed to help for a while.
- Am I having a heart attack?
- I am so worried. You've got to help me!
If both IV morphine Both medications must be administered for adequate pain control.
and nitroglycerin IV - If IV morphine (2 mg) is administered:
infusion (45 - My headache is better.
mcg/minute) are - My chest still hurts, though. What is happening to me? Am I
administered having a heart attack?

If nitroglycerin IV infusion is started at 40 mcg/minute:

- I don't feel much relief of the chest pain.

If nitroglycerin IV infusion is titrated to 45 mcg/minute:

- The chest pain is better now.

If the appropriate dosages of both medications are administered:

- My chest and back feel so much better. The pain is gone.
Thank you.
- What is the plan for me now?
If therapeutic Ivanna calms easily.
communication is used - Thanks for being patient with me. I am just so nervous and
worried.
If therapeutic Ivanna becomes increasingly anxious.
communication is NOT - Are you going to be able to help me?
used or neither - I am so nauseated. Bleh! Bleh! (vomits)
morphine nor - I am so scared that I am going to die!
nitroglycerin are - Please, help me! I'm terrified!
administered