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 (MI). Laboratory specimens were drawn in the emergency department. She was given an intravenous (IV) line, oxygen (O2) at 2 L via nasal cannula, and 325 mg chewable, nonenteric-coated aspirin. 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 simvastatin (Zocor), ibuprofen as needed for bone and joint pain, and herbs. Her admission vital signs (VS) are blood pressure 132/84 mm Hg, pulse 88 beats/min, respirations 18 breaths/min, and oral temperature 99 F (37.2 C). Her weight is 114 lb and height is 5 ft, 4 in. Moderate edema of both ankles is present; capillary refill is brisk and peripheral pulses are 1 +. You hear a soft systolic murmur. She denies any discomfort at present. You place her on telemetry, which shows the rhythm in the following figure. Case Study Progress After some rest, R.K.'s chest pain has subsided, and she tells you she feels much better now. You review her laboratory results. Chart View Laboratory Results 12-lead ECG: Light left-axis deviation, normal sinus rhythm with no ventricular ectopy Serial CPK tests are 30 units/L at admission, 32 units/L 4 hours after admission Cardiac troponin T is less than 0.01 ng/mL (at admission) and same result 4 hours after admission Cardiac troponin T is less than 0.03 ng/mL (at admission) and same result 4 hours after admission D-dimer test result less than 250 ng/mL Case Study Progress R.K. has no further episodes of chest pain, and she is discharged to home the next day. She is to see a cardiologist this week and set up an appointment for outpatient testing. As you present the discharge instructions, you review the proper technique for taking sublingual nitroglycerin for chest pain. QUESTION: REASON FOR SEEKING HEALTH CARE: Priority Assessment: four Problem/ Nursing, 5 interventions and 5 responses and evaluation for each diagnosis. four Goal/Outcome, Concept Map for CardiacConcept Map for Cardiac.

1. 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 (MI). Laboratory specimens were drawn
in the emergency department. She was given an intravenous (IV) line, oxygen (O2) at 2 L via
nasal cannula, and 325 mg chewable, nonenteric-coated aspirin. 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 simvastatin (Zocor),
ibuprofen as needed for bone and joint pain, and herbs. Her admission vital signs (VS) are blood
pressure 132/84 mm Hg, pulse 88 beats/min, respirations 18 breaths/min, and oral temperature 99
F (37.2 C). Her weight is 114 lb and height is 5 ft, 4 in. Moderate edema of both ankles is
present; capillary refill is brisk and peripheral pulses are 1 +. You hear a soft systolic murmur. She
denies any discomfort at present. You place her on telemetry, which shows the rhythm in the
following figure.
Case Study Progress
After some rest, R.K.'s chest pain has subsided, and she tells you she feels much better now. You
review her laboratory results.
Chart View
Laboratory Results
12-lead ECG: Light left-axis deviation, normal sinus rhythm with no ventricular ectopy
Serial CPK tests are 30 units/L at admission, 32 units/L 4 hours after admission
Cardiac troponin T is less than 0.01 ng/mL (at admission) and same result 4 hours after admission
Cardiac troponin T is less than 0.03 ng/mL (at admission) and same result 4 hours after admission
D-dimer test result less than 250 ng/mL
Case Study Progress
R.K. has no further episodes of chest pain, and she is discharged to home the next day. She is to
see a cardiologist this week and set up an appointment for outpatient testing. As you present the
discharge instructions, you review the proper technique for taking sublingual nitroglycerin for chest
pain.
QUESTION:
REASON FOR SEEKING HEALTH CARE:
Priority Assessment:
four Problem/ Nursing, 5 interventions and 5 responses and evaluation for each diagnosis.
four Goal/Outcome,
Concept Map for CardiacConcept Map for Cardiac