An Interesting Case I Attended To Involved An Elderly Man

Mr. Thomas’ has been diagnosed with an acute myocardial infarction (MI). A myocardial infarction is an “infarct of heart muscle caused by occlusion of one or more of coronary arteries” (Frucht, 2012 P.125). The common name for Mr. Thomas’ condition is a heart attack. A heart attack occurs if the flow of oxygen-rich blood to a section of heart muscle suddenly becomes blocked ( ). If the blood flow is not restored quickly, then that section of the heart muscle begins to die. Heart attacks have become the leading killer of both men and women in the United States. The main cause of heart attacks has

To determine if the patient’s chest pain is related to injury, you would look for ST-segment elevation. Myocardial injury represents a worsening stage of ischemia. If ST-segment elevation is greater than or equal to 1mm above the isoelectric line, it is significant and treatment needs to be prompt and effective to try to restore oxygen to the myocardium, and to avoid or limit infarction. The absence of serum cardiac markers confirms that infarction has not

According to the NICE guidelines (2013) as Mr Jones was presented with symptoms associated with a ST-segment-elevation myocardial infarction (STEMI) the recommended emergency treatment that is preferred is percutaneous

The patient described in this paper will be referred to as Jonathan Toews to ensure patients confidentiality. Jonathan Toews, is a sixty three year old man, born on August 23rd 1956, and lives with his eldest son. He was married two times and has three children, two children from his first marriage and one from his second. He lives in northern Ontario but originally was not born here, he moved here shortly following his second divorce. He is of Italian decent and is a practicing catholic. The patient weights 95kgs, is 178cm tall and has a body mas index (BMI) of 28.3. He said he used to play soccer when he was younger but since does not keep active or get the recommended amount of daily activity. Jonathan says he smokes around one pack or cigarettes a day and has a alcoholic drink roughly three to four drinks per week, he also describes that he eats fast food a few times a week. The patient now has congestive heart failure as a consequence of his MI. He was transferred from another hospital at the beginning of November and currently is waiting for more testing before he can be discharged from the hospital or moved to another facility. The patient has some known comorbidities that can exacerbate his CHF, this includes smoking, obesity, and noncompliance with medications.

Based on the medical report dated 04/01/16, the patient complains of pain in the neck with radiation to bilateral upper extremities and pain to the lower back with radiation to the lower extremities with tingling/numbness and weakness. He rates his pain 8-9/10.

Chest pain is posed as life threatening-has many definitions ranging from either stabbing, dull, crushing or burning. In certain cases, pain travels up the neck, the jaw, can radiate to the back or down one or both arms. Many different problems can cause chest pain and it can be difficult to determine the exact cause of chest pain (Burman et al’, 2011). Patients’ experiencing chest pain is symptoms consistent with, myocardial ischemia and is a common reason for presenting to ED (Pub Med Central, 2010).

In her article Gathering “Pearls” of Knowledge for Assessing, Dr. Peg Gray-Vickrey discusses the importance of, but also the difficulties of, distinguishing between ordinary aging changes and possible signs and symptoms of disease. The best way to ensure older adults’ safety, she says, is to “always expect the unexpected” (Gray-Vickrey, 2010). In a patient over the age of sixty-five, a nurse may observe extra heart sounds; however, because the arterial walls of the heart tend to thicken with age, and because this often leads to left ventricular and atrial hypertrophy, it is quite common for older adults to experience, for example, S4 murmurs (Gray-Vickrey, 2010). On the other hand, nurses may mistake legitimate symptoms of disease for normal

Esther Jackson’s symptoms lead me to believe that she is having a myocardial infarction. Her symptoms are similar to Jarvis’ elaboration, “Heaviness or pressure; poorly localized pain lasting 20-30 minutes to hours and does not resolve with rest. Generalized substernal or retrosternal pain with indigestion-like feeling, nausea and or vomiting” (2017, p. 493).

I would definitely stress assessing the risk factors this man could have for having an acute heart attack, MI, like: does anything make it better or worse? If he has any weakness, fatigue, cold sweat, dizziness, indigestion? I would suggest the nurse to assess the possible risk factors, like history of hypertension, family history, smoking history, high cholesterol, diabetes.

A elderly patient by the name of Mr. Nathan was hospitalized for Prostatic surgery. He woke up in the middle of the night and tried to leave. A registered nurse approached him and tried to hold him down. He pushed her into a wall and hit her in the face. As a result, she developed an concussion. There after, the unit clerk that was on duty called for security. Mr. Nathan tried escaping by running to the exit, but he was stopped by two orderlies and a security guard. During this time, Mr. Nathan was making accusations of false imprisonment. A doctor ordered restraining for him to be checked in an hour and ordered the patient to be sedated. Mr. Nathan was bruised in the struggle. In addition, the registered nurse was taken to the emergency room and couldn't go back to work for two weeks. Mr. Nathan said he will be suing the hospital for assault and false imprisonment.

Primary percutaneous coronary intervention (PCI) and PCI with fibrinolysis are current therapy options used for patients who have had an acute ST elevation myocardial infarction (STEMI). These six article discuss multiple elements involved in the discussion comparing the many factors that affect which forms of therapy is preferred to which patients. Concerns regarding the safety and effectiveness of primary PCI have risen. Factors include the optimal time for therapy, the important of hospital staff and volume, and the efficiency of PCI after fibrinolysis.

Chest pain is a “common and often non-specific symptom that can be caused by a number of underlying conditions”, one of the most serious being Acute Myocardial Infarction (AMI), commonly known as a heart attack (Chapman, Leslie, & Sage, 2012, p. 12). High concentration oxygen therapy, levels greater than 60%, has been advocated for the treatment of AMI and chest pain for nearly three quarters of a century (Ranchord, Perrin, Weatherall, Beasley, & Simmonds, 2012). As early as 1922, Barach noted the beneficial effects of high concentration oxygen therapy, at levels of 80-100%, in patients suffering from angina

Patient is a 45 yo male; 5’7”, 221 lbs who entered the emergency room at 6:30 am on 9/7/14 with severe chest pain (onset at 6:00 am) radiating to his arm, L arm numbness and nausea and vomiting. Past medical history reported by wife includes peptic ulcer, tobacco use (1-2ppd for 27 years), elevated blood pressure (controlled by lopressor). Wife did not know of any family history but reports patient’s father is deceased, died at 42 in his sleep. Mother alive and with high blood pressure.

Once at the hospital tests will be done to rule out other chest pain related causes. The first test that will be done is an Electrocardiogram or an EKG, which records the hearts electrical activity. Damaged heart cells are not able to produce electrical impulses which will produce abnormal EKG results. Elevations in the ST waves on an EKG are classified STEMI and are present in over ninety percent of myocardial infarctions who had a complete occlusion to an artery (Cardiac Emergencies, n.d.). NSTEMI is where there is no elevation of the ST wave and is indicative that a full occlusion has not occurred (Cardiac Emergencies, n.d.).

In the case study of the 75 year old woman these are some of the questions that could be added in the assessment process. The relation to the fatigue I would ask more question to get a better understanding in clarifying the direction. Like how long does it lasts when it occurs? Can you rate the level of your fatigue on a scale of 0-10 ten being the worst? Is it accompanied with a type of activity? Have you had any lifestyle changes? It is a gradual or sudden onset? Do you have any sleep disorders i.e. dyspnea? Do you sleep flat or reclined? This helps pinpoint the fatigue from different types. The types of fatigue are tiredness, exercise, depression, stress, medically like anemia, heart disease, emphysema. (Wilson & Giddens 2009)