Nur255 – Acute Care Cardiac Case Study

Total Points: 25 Scenario Your patient, 58-year-old K.Z., has a significant cardiac history. He has long-standing coronary artery disease (CAD) with occasional episodes of heart failure (HF). One year ago, he had an anterior wall myocardial infarction (MI). In addition, he has chronic anemia, hypertension, chronic renal insufficiency, and a recently diagnosed 4-cm suprarenal abdominal aortic aneurysm. Because of his severe CAD, he had to retire from his job as a railroad engineer about 6 months ago. This morning, he is being admitted to your telemetry unit for a same-day cardiac catheterization. As you take his health history, you note that his wife died a year ago (at about the same time that he had his MI) and he does not have any children. He is a current cigarette smoker with a 50–pack-year smoking history. His vital signs (VS) are 158/94, 88, 20, and 97.2 ° F (36.2 ° C). As you talk with him, you realize that he has only a minimal understanding of the catheterization procedure. 1. Before he leaves for the catheterization laboratory, you briefly teach him the important things he needs to know before having the procedure. List five priority topics you will address. 5 points I would teach him that after the procedure he will need to remain in bed with his extremity flat for the first 12 to 24 hours with the HOB elevated at 30 degrees. That we will be placing an IV and giving his heparin and give teaching on antiplatelet med. They may use radial access but can possibly use the femoral access to get the job done. I would tell him that the doctor will be inserting a catheter that has a balloon like device to the blockage(s) and if the needed the doctor may place a stent. Advised the patient that he will have a pressure dressing in place that is to remain there and is not to be touched. The health care team will be monitoring him before during and after the procedure to ensure his wellbeing and safety by checking for pluses, bleeding, procedure complications, ECG monitoring and all vital signs. 2. Look at his past history. What other factors are present that could contribute to his risk for cardiac ischemia? 1 point. The past history of previous MI, HTN, being a male over the age of 45 y.o. and being a smoker, having increased stress trying to cope with the passing of his wife, having increased lipids / CAD, having a poor diet / lifestyle for his diseases and having chronic anemia as well as renal issues.