Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)-sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes type 2 diabetes mellitus, heart failure, hypertension, and osteoarthritis. Home medications include furosemide (Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), metformin (Glucophage), and ibuprofen (Motrin). Clinical Assessment Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free. His only complaint is shortness of breath and swelling in his ankles, feet, and hands. Physical assessment reveals bilateral breath sounds with basilar crackles; dressing at catheter site; right femoral clean, dry, and intact; peripheral pulses 2+ bilaterally; and 2+ edema noted in lower extremities. Mr. X has a body mass index (BMI) of 35 kg/m2 and weighs 100 kg. IV fluids have been discontinued, and saline lock is in place in preparation for transfer to the telemetry unit. Diagnostic Procedures Admission diagnostic studies: Electrocardiogram (ECG) with ST segment elevation in V1-V4; elevated cardiac enzymes; electrolytes and glucose within normal limits; blood urea nitrogen (BUN), 26 mg/dL; serum creatinine, 1.8 mg/dL; cholesterol, 250 mg/dL; and serum B-type natriuretic peptide (BNP), 300 pg/mL. Current vital signs are as follows: blood pressure of 138/80 mm Hg, heart rate of 108 beats/min (sinus tachycardia), respiratory rate of 28 breaths/min, temperature of 99° F, and O2saturation of 92% on oxygen at 2 L per nasal cannula. Urine output for the past 6 hours is 100 mL. The health care provider is notified of Mr. X’s urine output, and repeat diagnostic studies are ordered that reveal the following: BUN, 56 mg/dL; serum creatinine, 5.6 mg/dL; and potassium, 5.8 mEq/L. Medical Diagnosis Acute anteroseptal myocardial infarction STEMI (ST elevation myocardial infarction) Contrast-induced nephropathy (CIN) QUESTIONS What major outcomes do you expect to achieve for this patient? What problems or risks must be managed to achieve these outcomes? What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)-sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes type 2 diabetes mellitus, heart failure, hypertension, and osteoarthritis. Home medications include furosemide (Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), metformin (Glucophage), and ibuprofen (Motrin). Clinical Assessment Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free. His only complaint is shortness of breath and swelling in his ankles, feet, and hands. Physical assessment reveals bilateral breath sounds with basilar crackles; dressing at catheter site; right femoral clean, dry, and intact; peripheral pulses 2+ bilaterally; and 2+ edema noted in lower extremities. Mr. X has a body mass index (BMI) of 35 kg/m2 and weighs 100 kg. IV fluids have been discontinued, and saline lock is in place in preparation for transfer to the telemetry unit. Diagnostic Procedures Admission diagnostic studies: Electrocardiogram (ECG) with ST segment elevation in V1-V4; elevated cardiac enzymes; electrolytes and glucose within normal limits; blood urea nitrogen (BUN), 26 mg/dL; serum creatinine, 1.8 mg/dL; cholesterol, 250 mg/dL; and serum B-type natriuretic peptide (BNP), 300 pg/mL. Current vital signs are as follows: blood pressure of 138/80 mm Hg, heart rate of 108 beats/min (sinus tachycardia), respiratory rate of 28 breaths/min, temperature of 99° F, and O2saturation of 92% on oxygen at 2 L per nasal cannula. Urine output for the past 6 hours is 100 mL. The health care provider is notified of Mr. X’s urine output, and repeat diagnostic studies are ordered that reveal the following: BUN, 56 mg/dL; serum creatinine, 5.6 mg/dL; and potassium, 5.8 mEq/L. Medical Diagnosis Acute anteroseptal myocardial infarction STEMI (ST elevation myocardial infarction) Contrast-induced nephropathy (CIN) QUESTIONS What major outcomes do you expect to achieve for this patient? What problems or risks must be managed to achieve these outcomes? What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

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Question

Mr. X is a 64-year-old male admitted to the unit with acute myocardial infarction (AMI) after emergent left (L)-sided heart catheterization/percutaneous coronary intervention (PCI). Past history includes type 2 diabetes mellitus, heart failure, hypertension, and
osteoarthritis. Home medications include furosemide (Lasix), digoxin (Lanoxin), captopril (Capoten), carvedilol (Coreg), Byetta (exenatide), metformin (Glucophage), and ibuprofen (Motrin).
Clinical Assessment
Twenty-four hours after admission to the unit, Mr. X is alert; oriented to person, place, and time; and pain free. His only complaint is shortness of breath and swelling in his ankles, feet, and hands. Physical assessment reveals bilateral breath sounds with basilar crackles; dressing at catheter site; right femoral clean, dry, and intact; peripheral pulses 2+ bilaterally; and 2+ edema noted in lower extremities. Mr. X has a body mass index (BMI) of 35 kg/m2 and weighs 100 kg. IV fluids have been discontinued, and saline lock is in place in preparation for transfer to the telemetry unit.
Diagnostic Procedures
Admission diagnostic studies: Electrocardiogram (ECG) with ST segment elevation in V1-V4; elevated cardiac enzymes; electrolytes and glucose within normal limits; blood urea nitrogen (BUN), 26 mg/dL; serum creatinine, 1.8 mg/dL; cholesterol, 250 mg/dL; and serum B-type natriuretic peptide (BNP), 300 pg/mL. Current vital signs are as follows: blood pressure of 138/80 mm Hg, heart rate of 108 beats/min (sinus tachycardia), respiratory rate of 28 breaths/min, temperature of 99° F, and O2saturation of 92% on oxygen at 2 L per nasal cannula. Urine output for the past 6 hours is 100 mL. The health care provider is notified of Mr. X’s urine output, and repeat diagnostic studies are ordered that reveal the following: BUN, 56 mg/dL; serum creatinine, 5.6 mg/dL; and potassium, 5.8 mEq/L.
Medical Diagnosis
Acute anteroseptal myocardial infarction
STEMI (ST elevation myocardial infarction)
Contrast-induced nephropathy (CIN)
QUESTIONS
What major outcomes do you expect to achieve for this patient?
What problems or risks must be managed to achieve these outcomes?
What interventions must be initiated to monitor, prevent, manage, or eliminate the problems and risks identified?

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