CASE SCENARIO 2

A 63-year-old Filipino, weighing 55 kg and 5’3 in height, female client was rushed to the
Emergency Room because of chest pain. Upon arrival to the ER, you noticed that the patient was
clenching her fist on her chest, she was pale, and diaphoretic. The watcher said that the patient
was doing gardening when she felt excruciating chest pain. The nurse checked her vital signs and
it showed a BP of 190/120 mmHg, heart rate of 102 bpm, respiratory rate of 23 cpm, temperature
of 35.8 C, pain scale of 10/10, and her oxygen saturation was below normal at 89%. Nurses then
placed the patient on a cardiac monitor and a continuous pulse oximeter device for strict
monitoring. They also placed the patient on oxygen therapy via nasal cannula at 4lpm. The
oxygen saturation increased to 95% after administration. They also started an IV line of PNSS
1L at 40 ml/hour.
The patient was given medications immediately to help relieve the pain. The doctor first
ordered to give the patient Nitroglycerine tab 1 tab SL every 5 minutes times 3 doses. However,
the patient was still in pain and there was no sign of relief seen in the patient. The doctor then
ordered to give the patient 1 mg of morphine slow IV to help alleviate the pain. The nurse then
checked the patient’s vitals prior to the administration of the said drug and it showed that the BP
is at 200/120 mmHg, heart rate of 110 bpm, a respiratory rate of 20 cpm, and a temperature of
36.0 C. The nurse then proceeded to give the medication and observed the patient’s condition.
The doctor also ordered laboratories and diagnostics for the patient and was carried out by the
nurse.
While observing the patient, the nurse conducted a short history taking so that he can
learn more about the client’s condition. The companion of the patient said that the patient is
already experiencing this kind of pain but disregards it as she is relieved when she takes a rest.
The watcher also said she is a long time diagnosed hypertensive and diabetic. She’s been on
medication for her hypertension for 2 years now and has been taking her maintenance medication
religiously. The patient has a medication of Losartan 50mg/tab 1 tab PO taken every morning
after she takes breakfast and she also takes Atorvastatin 80mg/tab 1 tab at bedtime PO. Her
diabetes on the other hand was just recently diagnosed, but her doctor already advised her to take
insulins so that her blood glucose will be controlled. Her doctor prescribed her an Insulin
glargine 12 units SQ at bedtime. But the watcher of the patient explicitly said that, although she
is religious in taking her medications, she has no control when it comes to her diet. The Hgt of
the patient showed 200mg/dl and the last meal was 4 hours ago. She was then given with insulin
glulisine 4u SQ as STAT.
After taking a short history, the nurse then checked the laboratory and diagnostic results
of the patient if they are already available. The Troponin I showed a value of 18,345 ng/ml and
the ECG stripped also showed ST elevation. Both are indications of a heart attack. A STAT
Echocardiogram also showed narrowing of the coronary artery which may have led to the
excruciating chest pain experienced by the patient. Other laboratories showed an elevation in the
potassium level at 5.4 but the rest of the electrolyte count is within normal ranges.
The nurse reassessed the patient after 30 minutes of morphine administration and it
showed pain reduction from 10/10 pain scale to 3/10 pain scale and the vital signs showed BP of
150/90 mmHg, heart rate of 90 bpm, respiratory rate of 20 cpm, and a temperature of 36.2 C.
The oxygen saturation of the patient with 4lpm via nasal cannula is at 97%. The doctor then
explained to the patient and the watcher the current health condition of the client and was
advised to be admitted to an intensive care unit for close monitoring.