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    Managing care in a Culturally Considerate manner

    CASE STUDY 2

    Patient Profile
    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 511, 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)
    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 are the signs and symptoms of Myocardial Infarction?
    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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