Myocardial Infarction

To determine if the patient’s chest pain is related to cardiac ischemia, you would look for ST-segment depression and/or T wave inversion. If the ST-segment depression is at least 1mm (one small box) below the isoelectric line, it is significant and occurs in response to inadequate supply of blood and oxygen, which leads to an electrical disturbance. Once this is treated, adequate blood flow is restored, the ECG changes will resolve, and the ECG will return back to patient’s baseline.

As Jane was presenting with a symptom of a life threatening event it was important that treatment was immediate. Priority was initially made from assessment of the airways, breathing and circulation, level of consciousness and pain. Jane’s respirations on admission were recorded at a rate of 28 breaths per minute, she looked cyanosed. Jane’s other clinical observations recorded a heart rate of 105 beats per minute (sinus tachycardia), blood pressure (BP) of 140/85 and oxygen saturation (SPO2) on room air 87%. It is important to establish a base line so that the nurse is altered to sudden deterioration in the patient’s clinical condition. Jane’s PEWS score (Physiological Early Warning Score) was 4 and indicated a need for urgent medical attention (BTS 2006). Breathing was the most obvious issue and was the immediate priority.

Assessment: the patient 's vital signs are 108/68, 125 beats per minute, respirations, even and non-labored at 14 breaths per minute, 92% on 2 liters of oxygen via nasal cannula, afebrile 98.5 F.

Every year, up to 249,000 BSIs occur within hospitals in the US. Apparently, 32.2% of these BSIs do occur in the ICUs (Chopra, Krein, Olmsted, Safdar & Saint, 2013)The apparent bias in prevalence of BSIs within the ICUs is associated with the increased utilization of the CVCs within these units since they deal with a majority of critical care situations.

Due to the fact Mr James may have suffered an MI at home the assessment procedures that were carried out in the hospital will be based on Pain, Laboratory examination and an ECG. The assessment of the cardiovascular system is an significant skill when considering patients who have cardiovascular disease .When assessing Mr James there will be a through history and clinical examination to help the nursing staff to make an insightful diagnose, for any

Mr. Steward’s priority problems include impaired cardiac tissue perfusion, impaired gas exchange, and pain. We are concerned about impaired cardiac tissue perfusion because the pt. is exhibiting signs of myocardial ischemia including chest pain and shortness of breath (Gillespie, 2012). Although we acknowledge that impaired cardiac tissue perfusion can decrease the function of the heart and will have the potential to affect the perfusion and delivery of oxygen to other end organs, our primary focus will be a focused cardiovascular assessment (House-Kokan, 2012). At 1800, Mr. Steward was SOB, had shallow and rapid breathing (RR = 44), and a SaO2 of 72% on RA. Due to the fluid buildup in his lungs, Mr. Steward has impaired gas exchange, and requires supplemental oxygen to maintain his SaO2; this warrants a focused respiratory assessment.

- Mitchell et al, Pocket Companion to Robbins and Cotran: Pathologic Basis of Disease, 8th Ed., Elsevier Saunders Inc., 2012.

Pathophysiology: This is a disorder characterized by pressure or squeezing pain in the chest due to insufficient oxygen supply in the heart muscle. It occurs after a buildup of plaque in the arteries supplying blood to the

Cardiovascular. Client denies chest pain, palpitations, murmurs, any arrhythmias, hypertension, awakening at night with shortness of breath, or dizzy spells. Client has not had an electrocardiogram.

As we all know that heart attacks are a medicinal condition, and not every medical condition has a similar symptoms in its patients. For example, symptoms of the heart attack may differ from being an old person,

ALTE has many underlying causes < 5%traumatic and s hospitals when it comes to cardiac diagnoses of ALTE patients and ordering ECGs.

The comparison was between survival rates of the patients with raised and normal concentrations of troponin. Cox proportional hazard was used to determine the relative risk of death both adjusted and unadjusted and 95% confidence intervals. Kaplan- Meir method was used to compute survival curves. After that summarisation if clinical data was done 733 patients. It was founded that majority of patients had increased troponin t as compared to troponin i irrespective of the cut-off criteria used. Again regardless of the cut-off criteria used one, two and three-year combined mortality rates were higher in patients with raised troponin t compared patients having normal levels. Unadjusted for other risk factors for mortality, Regardless of the duration of follow-up, an increase of 2-5 times in risk of death was noted with raised troponin t and 2 times with raised troponin i. Age, history of CAD, time since dialysis were identified as independent risk factors according to the data. Whereas sex, diabetes, and history of myocardial infarction were not found to be predictive independently. It was also found out that there are increase mortality rates with mild, moderate and larger increases in troponin t. Based on pre-dialysis troponin t and troponin i concentrations this was the first study to determine short and long-term survival in ESRD patients. This also found causes for more elevations of troponin t as compared to troponin i. Three different

Dumont, C.J., Keeling, A.W., Bourguignon, C., Sarembock, I.J., Turner, M. (2006, May/June). Predictors of vascular complications post diagnostic cardiac catheterization and percutaneous coronary interventions. Dimension of Critical Care Nursing, 25(3), 137-142. Retrieved from http://journals.lww.com Jerlock, M., Gaston-Johansson, F., & Danielson, E. (2005). Living with unexplained chest pain.

All of the quality indicators are important for hospital quality but the in-patient quality indicators for mortality rates are essential for better care. Research has shown that mortality indicators varying across different hospitals and suggests there could be deficiencies in quality of care that is causing this wide range. Therefore the mortality rates as quality indicators are important to provide better quality of care across our

ECG : ventricular rate 54 beats/min, HR varying from 39 to 60 during a 45 minute period of monitoring, infrequent PVCs, ST elevation in leads II, III and avF indicating inferior injury or ischemia secondary to acute MI.