F. M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest. Subjective Data
Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying complaints of nausea or dizziness
Recently the chest pain has become severe and is no longer relieved by rest, is now complaining of being slightly nauseated
His father died of a heart attack at age 62
Denies alcohol or drug use
Smokes one pack of cigarettes per day . .
Describes his lifestyle as sedentary
Objective Data
Physical Examination
Blood pressure 180/96, pulse 98, temperature 99.8 F, respirations 20 .
Height 5'11",weight 210 lbs, BMI 29.3 kg/m2 .
Alert and oriented to person, place, and time
Skin diaphoretic and clammy Heart rhythm regular, no murmurs or extra heart sounds .
Lungs are clear to auscultation
Diagnostic Studies .
Hemoglobin 14 g/dL .
Chemistry panel is normal .
Cardiac markers- pending
Electrocardiogram showing changes that correlate with non-ST-segment-elevation myocardial infarction (NSTEMI)
Interprofessional Care
0.9% NaCl infusing into lV catheter at 75 mL/hr
Nitroglycerin and morphine given with relief of pain .
Discussion Questions
1. What are F. M.'s modifiable risk factors for coronary artery disease (CAD)? What are his nonmodifiable risk factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction?
3. What diagnostic studies are indicated for F. M. Case Study Progression F. M. is diagnosed as having a myocardial infarction (MI).
4. What is the priority nursing care for F. M.?
5. What other interventions do you anticipate for F. M. at this time?
6. What are common complications after an MI? Case Study Progression After an uneventful hospital stay, F. M, is preparing for discharge
7. Prior to F. M.'s discharge from the hospital after having an MI, what patient teaching should he receive? 8. Would F. M. benefit from any referrals and why?