Discussion 3: Nursing Med Surg Case Study

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 Discussion 3: Nursing Med Surg Case Study
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)
Collaborative Care

9% NaCl infusing into IV catheter at 75 mL/hr
Nitroglycerin and morphine given with relief of pain

What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his non-modifiable risk factors?
What is the difference between chronic stable angina pain and pain associated with myocardial infarction?
What are diagnostic studies indicated for F.M.?
F.M. is diagnosed as having a myocardial infarction (MI).
What is the priority nursing care for F.M.?
What other interventions do you anticipate for F.M. at this time?

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