Preparation for the Simulation: Chest Pain Telemetry Questions

Questions

1. Risk factors for patients with Coronary Artery Disease (CAD) are divided into two categories: conventional and modifiable. The conventional risk factors are age, genetic presence and race. For age, men over 45 and women over 55 increase the risk of developing CAD. If a person’s family has a pattern of CAD, that person is more likely to develop it in the future. Regarding race, African Americans are hit hardest followed by Asians because of low levels of HDL-C. The modifiable risk factors, factors that can be changed by the person at risk, include high levels of bad cholesterol (LDL), high blood pressure, smoking, diabetes, obesity, sedentary lifestyle, metabolic syndrome and an unhealthy mental state such as depression (Ignatavicius & Workman, 2013). Understanding the risks are the first step to effective health promotion.

For health promotion, patients with CAD have options to make the disease less devastating in their lives. The first one is committing to a more active lifestyle. Complementing this is a diet geared specifically towards bettering the heart. High-fat foods need to be severely limited and fiber needs to account for a high percentage of the diet. Working on mental health is also very helpful considering how stress can trigger an increase in blood pressure (Ignatavicius & Workman, 2013). In addition to risk factors and health promotion, understanding symptoms is also important.

2. Classic symptoms of chest pain and/or unstable angina begin with the pain in the chest concentrated in the center which lasts for several minutes, lessens and then returns. Another symptom is an uncomfortable feeling in the chest due to sweating. Additionally, the pain usually branches out to different parts of the body such as the neck, jaw and arm. Non-classic symptoms, meanwhile, are tiredness, dizziness, shortness of breath and sweating. Women are much more likely to experience the non-classic symptoms than men are. Men are also less likely to have the pain concentrated to the chest and instead experience pain spread across the arm, back and jaw. For elderly people with symptoms of chest pain, fatigue is much more severe as opposed to the pain symptoms (Ignatavicius & Workman, 2013). Should a patient need catheterization, specific management by nurses is essential to ensure there are no complications.

3. There are several steps that need to be completed for the patient post cardiac catheterization. The first is to apply sufficient pressure to the area for about half an hour. Then, the wound needs to be properly bandaged. Second, vitals need to be monitored every 15 minutes for the first two hours and then every hour after. If vitals are normal and there are no complications, every four hours is sufficient. However, if there are complications, vitals should be taken every 5 minutes with physician notification. Third, bed rest should be implemented for at least 8 hours. Fourth, the patient’s circulatory system needs to be examined. Finally, an electrocardiograph (ECG) needs to be scheduled in order to see whether or not the heart has any damage. Common complications include a severe drop in blood pressure and uncontrolled bleeding (Ignatavicius & Workman, 2013). In order for a patient and their family to feel at ease, education plans are essential.

4. In terms of preoperative education, patients can expect to be held in a waiting area for several hours before surgery. Then, the patient will be prepped and brought into the operating room. The anesthesiologist will give the proper amount of drugs for sedation and then tubes will be applied in order to measure vitals. Families are invited to wait and after the procedure, the surgeon will notify the family. The surgical procedure itself is conducted by the doctor taking a blood vessel from the leg, chest or arm with one end connected to the aorta and the other to the artery directly underneath the clogged area. The postoperative course begins with the surgery team declares that the patient is no longer required to stay in ICU for observation. One of the first steps in the postoperative course is exercise. Daily showers help to reduce the risk of infection and medications are often given to reduce symptoms of irregular blood pressure and heart rhythm. Finally, nutrition is vital to postoperative care. Maintaining a healthy weight and eating low fat and low sodium foods is essential. In order to avoid complications, enrolling in cardiac rehabilitation program is a good option. Often these programs have a team of experts ranging from cardiologists to dietitians which help the patient continue on a path of health after surgery (Ignatavicius & Workman, 2013). As with any surgery however, there are complications that can arise that nurses have to deal with.

5. While blood at the catheterization site is undoubtedly scary for the patient, most of the time, additional pressure is all that is needed to correct the problem. If additional pressure does not stop the bleeding, a physician must be notified for additional care.

6. MEDICAL CALCULATION: Morphine 2 mg IVP every 15 minutes up to a total of 10mg for chest pain unrelieved by nitroglycerin. Your morphine vial contains 10mg in 10ml. How many mls will you draw up to administer 2mg?

ANSWER: Since 10ml provides 10mg of morphine, 1ml = 1mg, the number of milliliters needed to draw up 2mg of morphine is 2ml.

Reference

Ignatavicius, D. D., & Workman, M. L. (2013). Medical-surgical nursing: Patient-centered collaborative care. St. Louis, MO: Elsevier.