Acute Coronary Syndrome/Acute MI
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of progressive
weakness. She denies chest pain, but
...
Acute Coronary Syndrome/Acute MI
History of Present Problem:
JoAnn Smith is a 68-year-old woman who presents to the emergency department (ED) after having three days of progressive
weakness. She denies chest pain, but admits to shortness of breath (SOB) that increases with activity. She also has
epigastric pain with nausea that has been intermittent for 20-30 minutes over the last three days. She reports that her
epigastric pain has gotten worse and is now radiating into her neck. Her husband called 9-1-1 and she was transported to
the hospital by emergency medical services (EMS).
Personal/Social History:
JoAnn is a recently retired math teacher who continues to substitute teach part-time. She is physically active and lives
independently with her spouse in her own home. She has smoked 1 pack per day the past 40 years. JoAnn appears anxious
and immediately asks repeatedly for her husband upon arrival.
What data from the histories are RELEVANT and have clinical significance to the nurse?
RELEVANT Data from Present Problem: Clinical Significance:
d3 days of progressive weakness
Denies chest pain, reports epigastric pain with
nausea radiating to her neck and shortness of
breath
dWomen can present with alternative symptoms than men when
experiencing a myocardial infarction so it is important to consider them in
this context as opposed to ruling out MI since it is not the “typical”
presentation
RELEVANT Data from Social History: Clinical Significance:
Lives with a spouse
Heavy smoker, 40 year history
Anxious appearing
Patient has a support person who lives with her and can help provider care
which is important to keep them involved in the care as appropriate (and
legally - patient gives consent to share information). Significant smoking
history means patient has had prolonged vasoconstriction and diminished
lung capacity; smoking also leads to heart disease. Anxiety can alter vital
signs like increased heart rate and blood pressure.
What is the RELATIONSHIP of your patient’s past medical history (PMH) and current meds?
(Which medications treat which conditions? Draw lines to connect)
PMH: Home Meds: Pharm. Classification: Expected Outcome:
● Diabetes mellitus type II
● Hypertension
● Hyperlipidemia
● Cerebral vascular
accident (CVA) with no
residual deficits
● Gastro-esophageal reflux
disease (GERD)
● Anemia-Iron deficiency
1. Iron Sulfate 325
mg PO daily
2. Lisinopril 5 mg PO daily
3. Simvastatin 20 mg PO daily
4. Aspirin 81 mg PO daily
5. Clopidogrel 75 mg PO daily
6. Omeprazole 20 mg PO daily
7. Metformin 500 mg PO bid
1. Iron supplement
2. ACE inhibitor
3. Antihyperlipidemic
(-statin)
4. Salicylate
5. Platelet aggregation
inhibitor
6. Proton pump inhibitor
7. Biguanide antidiabetic
1. Replace iron
2. Reduce BP
3. Reduce cholesterol
4. Reduce platelets/prevent
clotting
5. Reduce platelets/prevent
clotting
6. Reduces stomach acidity
7. Reduces blood glucose
levels
One disease process often influences the development of other illnesses. Based on your knowledge of
pathophysiology (if applicable), which disease likely developed FIRST that created a “domino effect” in her life?
Christina Hammack and Cash Thomas
● Bold what PMH problem likely started FIRS
[Show More]
.png)
.png)
 Chamberlain College Of Nursing (100 Correct Q & A.png)
