Patient comes in for a cold that devolved into a sinus infection.

Full Answer Section

Patient Assessment

Signs and Symptoms (S&S):

• Chest pain radiating to the left arm
• Shortness of breath
• Diaphoresis
• Nausea and vomiting

Assessment:

• Vital signs: Blood pressure 140/90 mmHg, heart rate 100 bpm, respiratory rate 24 breaths/min, oxygen saturation 92% on room air
• Physical exam: Tachycardia, irregular heart rhythm, decreased breath sounds on the left side
• Electrocardiogram (ECG): Showed ST-segment elevation in the anterior leads, suggesting an acute myocardial infarction (AMI)

Plan of Care:

• Immediate intervention: Administer oxygen, aspirin, and nitroglycerin.
• Cardiovascular evaluation: Arrange for a cardiac catheterization to confirm the diagnosis and assess the extent of the blockage.
• Pain management: Administer pain medication as needed.
• Monitoring: Monitor vital signs, cardiac rhythm, and cardiac markers.
• Education: Educate the patient and family about the importance of lifestyle modifications, such as a healthy diet, regular exercise, and stress management.

Differential Diagnoses

1. Acute Pulmonary Embolism: This was considered a differential diagnosis due to the patient's shortness of breath. However, the ECG findings were more consistent with an AMI.
2. Costochondritis: This was considered a differential diagnosis due to the patient's chest pain. However, the patient's other symptoms, such as diaphoresis and abnormal ECG findings, made this less likely.
3. Esophageal Reflux: This was considered a differential diagnosis due to the patient's nausea and vomiting. However, the patient's chest pain and ECG findings were not consistent with esophageal reflux.

Health Promotion Intervention

I would recommend the patient participate in a cardiac rehabilitation program to improve his overall cardiovascular health and reduce the risk of future heart attacks. This program may include exercise training, dietary counseling, and stress management techniques.

Learning from Experience

This clinical experience has reinforced the importance of effective communication, even in challenging situations. I learned the value of using visual aids and interpreters to ensure that patients and their families understand the plan of care. Additionally, I gained experience in assessing and managing acute cardiac events, which will be invaluable in my future practice as an advanced practice nurse.

Research Guideline

The American College of Cardiology/American Heart Association (ACC/AHA) guidelines for the management of acute myocardial infarction were used to inform the plan of care for this patient. These guidelines provide evidence-based recommendations for the initial management of AMI, including the use of antiplatelet agents, beta-blockers, and statins.  

References

• American College of Cardiology/American Heart Association Task Force on Practice Guidelines. (2021). 2021 Guideline for the Management of Acute Myocardial Infarction. Journal of the American College of Cardiology, 78(24), e142-e228.

Sample Answer

Challenges and Successes

This week, I faced a few challenges while caring for a 59-year-old male patient. One of the main challenges was communicating with the patient's family members, who were not fluent in English. I relied on the patient's interpreter to facilitate communication and ensure that the patient's needs were being met.

Despite this language barrier, I was able to successfully assess the patient's condition and develop a comprehensive plan of care. I found that using visual aids and simple language was helpful in communicating with the patient and his family.