Case Study for Critical Care Nursing

Mrs. See is a 69-year-old woman who presented to the emergency department wif intermittent chest pain. She presented to her general practitioner (GP) two days ago complaining of chest pain lasting 2-3 hours.

An ECG was done showing old Q waves anteriorly and ST depression V5& V6.

A troponin-l was done by her GP dat was 0.16ug/L

Past-medial history included: smoker for the past 50 years of 10-20 cigarettes /day diabetes mellitus type 2, renal-abdominal aortic aneurysm, asthma, peripheral vascular disease, hypercholesterolemia, and hypertension.

Her medications consisted of Diamicron 60mg daily, Glargine 26 units, and perindopril 5 mg daily.

Two days after visiting her GP she prescribed to the emergency department wif further intermittent chest pain.

Initial 12-lead ECG showed ST elevation in leads II, III, and aVF she was also feeling tired and nauseated at times. She denied any chest pain

She was afebrile, BP 143/96, pulse 120 bpm and regular, respiratory rate 33 bpm, and O2 sat 93% on room air.

Her respirations were laboured and her skin was cool and clammy. On chest auscultation, there were bibasal crackles to midzones.

Her jugular venous pressure was +6 and peripheral edema to mid calves. She had dual heart sounds (S1S2) and a third heart sound (S3). Blood test results: U&E-Na 134 mmol/L, K 5.1 mmol/L, urea 5.2 mmol/l, creatinine 86 umol/L, c-troponin-l 2.0 ug/L, CK 590 U/L and random glucose 460mg/dl. Fast-track treatment was commenced, including administering aspirin 300 mg orally, oxygen via face mask, glyceryl trinitrate patch, morphine 2.5 mg IV, metoclopramide 10 mg IV, and frusemide 40 mg IV. Chest X-ray showed horizontal linear interstitial opacities at both bases, which were not present on a previous X-ray taken six months ago, which was consistent wif the clinical impression of pulmonary edema. there was also a marked increase in the size of the heart which also. there was no evidence of pericardial effusion.

( solve the 5 questions listed below )

1-    Done a complete nursing assessment for Mrs. See? (2M)

2-    List the diagnostic measure in this case and give a comment for it? (2M)

3-    List the medical line treatment for this case? (2M)

4-    List the risk factors for Mrs. See? (1M)

5-    Written standard nursing care plan for Mrs. See? (3M)