I. Initial Scenario
History of Present Problem:
Agnes Peters is an 82-year-old Caucasian female with a medical history of heart failure, COPD, and chronic kidney
disease who resides in a skilled care facility. Agnes puts her call light on and says she is having chest pain and difficulty
breathi...
, I. Initial Scenario
History of Present Problem:
Agnes Peters is an 82-year-old Caucasian female with a medical history of heart failure, COPD, and chronic kidney
disease who resides in a skilled care facility. Agnes puts her call light on and says she is having chest pain and difficulty
breathing. Upon entering the room, you notice that she is pale, diaphoretic and has labored breathing. Her breath sounds
are diminished bilaterally and she has coarse bibasilar crackles. Her VS are T: 97.9 F/36.6 C (o) P: 98 (irreg) R: 32 BP:
148/90 O2 sat 86% room air.
Recognizing a problem, you push the call for immediate assistance button and delegate another nurse to call 911.
Oxygen is administered per face mask. In ten minutes an ambulance arrives and the paramedics are given report. A
peripheral IV is placed by the paramedics and a 12 lead EKG reveals sinus rhythm with frequent multifocal PVCs and 3-4
mm ST elevation in leads V1-V4. She receives ASA 325 mg PO, nitroglycerin 0.4 mg subl. and is transported emergently
to the emergency department (ED).
Personal/Social History:
Agnes is widowed and has no children. She has a brother, Dennis, who is 78 years old and visits her once a week. She has
a living will which states that she is a DNI (do not intubate) but wants to be resuscitated if her heart stops.
What data from the histories is important & RELEVANT; therefore it has clinical significance to the nurse?
(Reduction of Risk Potential)
RELEVANT Data from Present Problem: Clinical Significance:
RELEVANT Data from Social History: Clinical Significance:
II. The Dilemma Begins…
Current Concern:
During transport to the ED, Agnes went into the following rhythm:
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