Case Study #1 – Cardiac

 This case study is meant to be completed individually.  Please place questions and answers into a Word document and upload into the drop box when complete.  APA formatting is not necessary, but you must cite your work and avoid copy/pasting from any source…paraphrase!

Mr. Jones is a 52-year-old obese man with a medical history of gastric reflux and degenerative arthritis.  He arrives at the emergency department with his wife. They had been to dinner and a movie. During the movie Mr. Jones began experiencing excruciating chest pain that radiated to his jaw and left arm.  He appears short of breath and diaphoretic. He reaches the registration window when he suddenly collapses. The nurses place him on a stretcher. He has no pulse, and the monitor reveals ventricular tachycardia.  He was successfully converted to sinus rhythm after one minute of CPR and one defib/shock at 300 joules.

Mr. Jones regains consciousness after his rhythm converts.  He has a blood pressure of 130/92, a heart rate of 112, and a respiratory rate of 24.  O2 is immediately started at 3 liters/minute. Three 18 g IV’s are started, lab work is drawn (CPK-MB, Troponin, CBC, PT, PTT, type and screen & Chem 21) and a 12-lead EKG is preformed. He still complains of chest pain (8/10) and nausea. Sublingual NTG 1/150 gr is given.  The 12-lead EKG reveals sinus tachycardia, a PR interval of 0.24, and 3 mm ST-segment elevation in leads V2, V3, & V4. 

After being admitted to the CCU Mr. Jones complains of chest pain continuing at 8/10. Mr. Jones is given IV morphine 4mg and a nitroglycerin gtt.  This drip was started 10 mcg/min and titrated up every 3-5 minutes until the pain was relieved at 50 mcg/min.  His blood pressure drops to 84/40.  He is pale and diaphoretic.  He is prepared for a percutaneous coronary intervention (PCI) and taken to the cardiac cath lab.

Questions

1. What classic signs and symptoms did Mr. Jones experience which would indicate myocardial infarction (MI)? What are the specific pathophysiological reasons for each of these signs and symptoms?
2. What ECG changes indicate myocardial injury? According to the ECG, which coronary arteries were experiencing occlusion and subsequently what area of the heart was being affected? (List the type of change and the coronary artery most often associated with changes in V2, V3, and V4.
3. What are three things the nurse can do to speed up the time between admission and intervention? 
4. How is a heparin drip calculated and what is the nurses’ role in maintaining this medication?
5. If the blood pressure drops while the patient is receiving nitroglycerin, should the nitro be shut off completely?
6. Why is morphine the drug of choice for cardiac pain?
7. With this type of MI, an intra-aortic balloon pump may be inserted.  What are the two main functions of the IABP?
8. What are three differences between CKMB’s and Troponin blood tests?
9. After the angioplasty and stent placement, Mr. Jones is admitted to the CCU for monitoring.  What are the nursing considerations and assessment priorities for a patient with an arterial sheathe in place?
10. Once admitted to the CCU, what nursing diagnosis would be the top priority? (The diagnosis must include the “related to” and “as evidenced by”). 
11. After angioplasty, the patient begins experiencing frequent PVC’s.  What does this indicate and what should be done about it?
12. If the patient begins to experience chest pain post angioplasty, what is the first thing the nurse should do?
13. Patient teaching should consist of education about risk factors and lifestyle modifications.  What are three things the nurse could teach Mr. Jones about prior to discharge?
14. Mr. Jones is going to be discharged on Plavix, Lopressor, Zocor, and Aspirin.  List one teaching point for each of these medications.
15. Discuss the American Association of Critical Care Nurses (AACN) Synergy Model and how this concept would be important in this patient’s care.

Watch three videos (“Measure of Center ‘Mean,'” “Measure of Center ‘Median,'” and “Measure of Center ‘Mode'”) in the Calculations section of “The Visual Learner: Statistics,” located in the Topic 2 Resources.  

Go to the Random.org website, provided in the Topic 2 Resources, to generate a set of random numbers. Click on the “Get Sets’ link at the bottom left of the page to generate some data. (Note: If you are not able to access the link, you can randomly generate 10 numbers yourself for this calculation.)

Imagine these numbers are the care satisfaction scores from a recent sample of discharged patients. Randomly select one row of numbers to use for the following calculations:

• What was the mean?
• What was the median?
• What was/were the mode/s?
• Given that the range of data was between 1 and 20, what do these numbers tell you about the overall satisfaction of the patients?
• If you were reporting these scores back to your supervisor, how would you explain or interpret these satisfaction scores?

Initial discussion question posts should be a minimum of 200 words and include at least two references cited using APA format. Responses to peers or faculty should be 100-150 words and include one reference. Refer to “Discussion Question Rubric” and “Participation Rubric,” located in Class Resources, to understand the expectations for initial discussion question posts and participation posts, respectively.

In this article review, you will explore ethical issues and discuss their implications.

Step 1 Read the article, Moral Courage and the Nurse Leader Download Moral Courage and the Nurse Leader by Cole Edmonson.

Step 2 Based on the article, answer the following questions:

• What are the sources of ethical dilemmas for nurse leaders?
• How should nurse leaders handle those issues?
• Explain the 4As Framework recommended by the Association of Critical Care Nurses (AACN).
• What are the recommendations that can increase moral courage in nurse leaders?

Step 3 Save and submit your assignment.

When you have completed your assignment, save a copy for yourself in an easily accessible place and submit a copy to your instructor.

Cite all sources in APA format.

Activity Time:

1 hour

Additional Time for Study, Research, and Reflection:

1 hour

Directions:

In this discussion, emphasis is on awareness of client quality and safety and in particular what is a “culture of safety.”

Based on the review of the following websites at the Institute of Healthcare Improvement and Agency for Healthcare Research and Quality answer the following questions.

What values ensure a culture of safety?

How can healthcare facilities establish a culture of safety?

What is the nurse's role in maintaining a culture of safety?

Please make your initial post by midweek, and respond to at least two other student's post by the end of the week. Please check the Course Calendar for specific due dates.

It is one of the most cliché of clichés, but it nevertheless rings true: The only constant is change. As a nursing professional, you are no doubt aware that success in the healthcare field requires the ability to adapt to change, as the pace of change in healthcare may be without rival.

As a professional, you will be called upon to share expertise, inform, educate, and advocate. Your efforts in these areas can help lead others through change. In this Assignment, you will propose a change within your organization and present a comprehensive plan to implement the change you propose.

 To Prepare:

• Review the Resources and identify one change that you believe is called for in your organization/workplace.
  • This may be a change necessary to effectively address one or more of the issues you addressed in the Workplace Environment Assessment you submitted in Module 4. It may also be a change in response to something not addressed in your previous efforts. It may be beneficial to discuss your ideas with your organizational leadership and/or colleagues to help identify and vet these ideas.
• Reflect on how you might implement this change and how you might communicate this change to organizational leadership.

The Assignment (5-6-minute narrated PowerPoint presentation):

Change Implementation and Management Plan

Create a 5- or 6-slide narrated PowerPoint that presents a comprehensive plan to implement changes you propose. 

Your narrated presentation should be 5–6 minutes in length.

Your Change Implementation and Management Plan should include the following:

• An executive summary of the issues that are currently affecting your organization/workplace (This can include the work you completed in your Workplace Environment Assessment previously submitted, if relevant.)
• A description of the change being proposed
• Justifications for the change, including why addressing it will have a positive impact on your organization/workplace
• Details about the type and scope of the proposed change
• Identification of the stakeholders impacted by the change
• Identification of a change management team (by title/role)
• A plan for communicating the change you propose
• A description of risk mitigation plans you would recommend to address the risks anticipated by the change you propose

Alternate Submission Method

You may also use Kaltura Personal Capture to record your narrated PowerPoint. This option will require you to create your PowerPoint slides first. Then, follow the Personal Capture instructions outlined on the Kaltura Media UploaderLinks to an external site. page. This page will walk you through downloading the tool and help you become familiar with the features of Personal Capture. When you are ready to begin recording, you may turn off the webcam option so that only “Screen” and “Audio” are enabled. Start your recording and then open your PowerPoint to slide show view. Once the recording is complete, follow the instructions found on the “Posting Your Video in the Classroom Guide” found on the Kaltura Media page for instructions on how to submit your video. For this option, in addition to submitting your video, you must also upload your PowerPoint file which must include your speaker notes.