CASE STUDY: ANGINA
Scenario
R. K. is an 85-year-old woman who lives with her husband, who is 87.
Two nights before her admission to your cardiac unit, she awoke with
heavy substernal pressure accompanied by epigastric distress. The pain
was reduced somewhat when she rolled onto her side but did not
completely subside for about 6 hours. The next night she experienced
the same chest pressure. The following morning, R. K.’s husband took
her to the physician, and she was subsequently hospitalized to rule out
myocardial infarction (R/O MI). Labs were drawn in the emergency
department (ED). She was started on oxygen (02) at 2 L via nasal
cannula (NC) and given non-enteric-coated aspirin 325 mg to be
chewed and swallowed. An IV was started. You obtain the following
information from your history and physical examination. R.K. has no
history of smoking or alcohol use, and she has been in good general
health with the exception of osteoarthritis of her hands and knees and
some osteoarthritis of the spine. Her only medications are ranitidine,
ibuprofen for bone and joint pain, and “herbs.” Her admission vital
signs (VS) are 132/84, P-88, R-18, and 37.2o C. Her weight is 52 kg and
height is 163 cm. Moderate edema of both ankles is present, but
capillary refill is brisk and peripheral pulses are 1 +. You hear a soft
systolic murmur. You place her on telemetry, which shows frequent
premature atrial contractions (PACs) but no ventricular ectopy. She
denies any discomfort at present.
Questions
1. Give at least two reasons an IV would be inserted. What kind of IV fluid
would you expect to be running and at what rate?
2. Why is “non-enteric-coat” aspirin specified? What would be a
contraindication to administering aspirin?
3. R. K. becomes fatigued during the admission process, and you decide to let
her sleep. When she awakens, what additional history and physical
information should you obtain related to (R/T) her admitting diagnosis?
4. List seven laboratory or diagnostic tests you would expect were drawn or
conducted in the ED; suggest what each may contribute.
5. What other source, besides cardiac ischemia, may be responsible for her
chest and abdominal discomfort?
6. Define the concept differential diagnosis.
7. Explain how the concept of differential diagnosis applies to ZR. K.’s
symptoms.
8. Florence Nightingale frequently emphasized the value of good observation
skills in nurses. Explain how a good nursing assessment can contribute to
understanding the cause of R. K.’s symptoms.
While you care for R. K., you carefully observe her. Identify tow possible
complications of Coronary Artery Disease (CAD) and the signs and symptoms (S/S)
associated wit