Name: Elaine Marie Semillano

Section: BSN 3-YA-7

Scenario 1: Angina Pectoris

Lita a 65 year-old retired secretary, is admitted to the medical surgical area for management of chest
pain caused by angina pectoris. (10 points)

1. The patient asked the nurse “What is causing this pain?” What is the best response by the
nurse?

 Angina usually feels like pressure, tightness or squeezing in your chest. This can feel
painful or like a dull ache. You might also feel it in your shoulders, arms, neck, jaw, back
or stomach. Pain can be caused by physical activity, emotional distress, cold weather, or
eating.

2. The patient is diagnosed with chronic stable angina. The nurse can anticipate that her pain may
follow what type of pattern?
 Tell the patient that if she has angina, note the patterns of her symptoms. Pay attention
to what causes her chest pain. Note what it feels like, how long the pain lasts, and if
medicine relieves her pain. Angina occurs when the heart muscle doesn't get as much
blood as it needs. This usually happens because one or more of the heart's arteries is
narrowed or blocked, also called ischemia

3. Lita has nitroglycerin at her bed side to take PRN. The nurse knows that nitroglycerin acts in
what ways?

 Nitroglycerin is used to prevent angina (chest pain) caused by coronary artery disease.
This medicine is also used to relieve an angina attack that is already occurring. This
medication belongs to a class of drugs known as nitrates. Angina occurs when the heart
muscle is not getting enough blood. This drug works by relaxing and widening blood
vessels so blood can flow more easily to the heart. This medication will not relieve chest
pain once it occurs. It is also not intended to be taken just before physical activities
(such as exercise, sexual activity) to prevent chest pain.

4. Lita took a nitroglycerin tablet at 10:00 AM, after her morning care. It did not relieve her pain, so
5 minutes later, she repeated the dose. 10 minutes later, and still in pain, she calls the nurse.
What is the priority intervention of the nurse?

 When an angina attack begins, give 1 dose of nitroglycerin right away. If the symptoms
improve but do not completely resolve after the first dose, the physician may prescribe
a second dose 5 minutes later. 5 minutes after the second dose, administer a third dose.
It is important to note that more than three are required.

Scenario 2: Decreased Myocardial Tissue Perfusion

Mr. Santos, a 46-year-old teacher, is brought to the ER by ambulance with a suspected
diagnosis of MI. He appears ashen, is diaphoretic, and tachycardic, and has a severe chest pain.
The nursing diagnosis is Decreased Cardiac Output related to Decreased Myocardial Tissue
Perfusion. (10 points)

1. The nurse is aware that there is critical time period for this patient. When should the
nurse be most vigilant in monitoring this patient?

 The nurse should be aware about cardiogenic shock. Cardiogenic shock, also
known as cardiac shock, happens when your heart cannot pump enough blood
and oxygen to the brain and other vital organs. This is a life-threatening
emergency. It is treatable if diagnosed right away, so it's important to know the
warning signs

2. The nurse is interpreting the result of the ECG. What findings does the nurse
understand are indicative of initial myocardial injury?

 According to Mr. Santos' scenario, initial myocardial injury findings include

tachycardia, which will be interpreted or seen on the ECG. Furthermore, Mr.
Santos has complained of severe chest pain. Tachycardia may indicate or be
observed in the early stages of an acute condition. Significant myocardial
damage is associated with myocardial injury. It is also linked to increase in
hospital mortality, emphasizing the importance of early aggressive treatment.

3. What laboratory test are positive indicators of MI?

 Cardiac Troponin I or Troponin T are the recommended laboratory tests for MI

diagnosis because they are both sensitive and specific.

4. The nurse should closely monitor the patient for a complication of an MI that leads
to sudden death during the first 48 hours. Which complication should the nurse
monitor for?

 The complication that the nurse should monitor is dysrhythmias because it may
signal another MI or impending complications. The nurse should also be alert for
increased anxiety, which may cause pain and lead to a secondary infarction.
Anxiety and fear are highly likely but secondary in importance to monitoring the
patient for dysrhythmias. Metabolic acidosis and reactions to new medications
are not likely but should still be included as part of overall assessment of the
patient.