Group 2

Mercado, Ysabel
Ong, Iravelle
Operaña, Ellayza RB
Pareño, Rafaelle Joy F.
Sepulveda, Joshu Paul F.
Tomelden, Alyssa D.

MYOCARDIAL INFARCTION
Mr. Salazar, a 57-year old male, presents to the Emergency Department (ED) with chest pain. He reports
that the pain started about an hour after dinner, while he was working. He describes the pain as a
“crushing pressure” located midsternally and radiating down his left arm and to his back. He rates the
pain a 4/10. On assessment, Mr. Salazar is diaphoretic and pale and complains of shortness of breath
(SOB).

Guide Questions
1. What further nursing assessments need to be performed for Mr. Salazar?
2. What interventions do you anticipate being ordered by the provider?

Upon further assessment, the patient has no jugular vein distention (JVD), and no edema. His heart
sounds are normal S1 and S2 present and his lungs are clear with scattered wheezes on auscultation. His
vital signs were as follows:

• BP 140/90 mmHg SpO2 90% on Room Air

• HR 92 bpm and regular Ht 173 cm
• RR 32 bpm Wt 104 kg
• Temp 36.9°C

His 12-lead EKG report reads: “Normal sinus rhythm (NSR) with frequent premature ventricular
contractions (PVCs) and three- to four-beat runs of ventricular tachycardia (VT)”. ST-segment elevation
in leads I, aVL, and V2 through V6 (3-4mm). ST-segment depression in leads III and aVF.”

Cardiac enzymes were drawn, and results are still pending. A chest x-ray was ordered as well.
The provider orders the following: Aspirin 324 mg PO once, Nitroglycerin 0.4 mg SL q5min for up to 3
doses, Morphine 4 mg IVP PRN unrelieved chest pain, and Oxygen to keep SpO2>92%.

3. What intervention should you, as the nurse, perform right away? Why
4. What medication should be the first one administered to this patient? Why? How often?
5. What is the significance of the ST-segment changes on Mr. Salazar's 12-lead EKG?

Mr. Salazar’s chest pain was unrelieved after three (3) doses of sublingual nitroglycerin (NTG). Morphine
5 mg intravenous push (IVP) was administered, as well as 324 mg chewable baby aspirin. His pain was
still unrelieved at this point
Mr. Salazar’s cardiac enzyme results were as follows:
• CK 254 U/L
• CK-MB 10%
• Troponin I 3.5 ng/mL

6. Based on the results of Mr. Salazar's labs and his response to medications, what is the next
intervention you anticipate? Why?