Posted: August 23rd, 2022

Mrs Helen Georgopoulos is a 64-year-old lady

The ISBAR Handover:
Introduction: Mrs Helen Georgopoulos is a 64-year-old lady.
Scenario: Mrs Georgopoulos arrived on the Emergency Division at 1130 hrs with central crushing chest ache radiating to her jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics confirmed ST elevation in leads V2, V3, V4. Aspirin 300mg administered on path to hospital.
Background: Hypertension (Captopril 12.5mg bd); Hyperlipidaemia (Simvastatin 40mg nocte); Sort 2 Diabetes Mellitus (DM) (weight loss program managed) and Allergy – Penicillin.
Assessment:
-Airway patent
– Respiration: Respiratory fee 24, bilateral air entry, breath sounds clear. SpO2 on room air 91%
– Circulation: Sinus Tachycardia 120 bpm. BP 110/60. Diaphoretic and peripherally cool. Central crushing chest ache radiating to the jaw.
COLDSPA:
Character: crushing chest ache
Onset: 11am
Location: Central, radiating to jaw
Length: ongoing
Severity: eight/10
Sample: at relaxation, not relieved by SL Anginine Spray x 2
Related signs: diaphoresis
Incapacity: Alert & oriented. Pupils equal and reacting to gentle (PEARL); Equal power in all 4 limbs.
– Publicity: IVC Left cubital fossa.
– Fluid: NBM. NO IVF
– Glucose: 14.zero mmol/l
– Weight 88kg

Nursing Interventions:
1. Carry out venepuncture to gather pathology – Troponin, UEC, FBC, TFTs, LFTs, BSL
2. Provoke supplemental oxygen if SpO2 < 93%
three. Connect Steady Cardiac Monitoring
four. Report a 12-lead ECG
5. Monitor blood strain and report systolic BP
Pathology Outcomes:
– Elevated Troponin 35ng/L troponin
– 12 lead ECG: ST elevation (>2mm) V2, V3, V4
The prognosis of Acute Anterior STEMI is made
Drugs:
Morphine 2.5mg IVI 2/24 (PRN most four x 2.5mg doses = 10mg complete)
Nitro-glycerine 600mcg SL (PRN most three doses); monitor systolic BP >100 mmHg
Clopidogrel 300mg PO STAT
Heparin 5000IU IV STAT
As per STEMI reperfusion flowchart:
Switch to Cardiac Cath Lab for pressing main PCI when prepared (<90min)
If PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1230pm

Quick Reply Questions:

1. You’re the registered nurse caring for this affected person. Record and prioritise the order that you’ll full every of the 5 Nursing Interventions (indicated above):
2. (200 phrases)Critically analyse, after which concisely clarify utilizing your personal phrases, every of the scientific manifestations and associated pathogenesis for the next: i) Central crushing chest ache with radiation to the jaw (ii) ST elevation (iii) elevated Troponin (35ng/L)
three. Question Assignment three: (500 phrases)
(i) Choose one Class solely, from the three (three) classes given under.
(ii) Present a rationale for every of the interventions listed for the class that you’ve chosen.
(iii) You could critically analyse the obtainable evidence-based literature and/or pathophysiology texts to Help your rationale. You could then concisely clarify the rationales utilizing your personal phrases.
Class 1 Non-pharmacological interventions
• Supplemental oxygen if SpO2<93%
• 12 lead ECG inside 10 minutes of arrival after which each 30 minutes.
• Troponin at zero and a couple of hours
Class 2 Pharmacological interventions
Morphine 2.5mg IV
• Nitro-glycerine 600mcg SL
• Aspirin 300mg
• Heparin 5000iu IV
• Clopidogrel 300mg

Class three
Reperfusion interventions
• Tenecteplase 45mg IV
• Major Percutaneous Coronary Intervention

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