SITUATION Mrs Donna Hovey is a 60-year-old female who was admitted to the ward two (2) days ago for pneumonia. She is now complaining of mild pressure in her chest (rated 4/10) that started 10 minutes ago while she was lying on the bed. Mrs Hovey states she also has a slight ache in the underside of her upper left arm.She is diaphoretic and feeling a little nauseated. Mrs Hovey has developed slight shortness of breath. Her peripheries are a little cool to touch BACKGROUND Mrs Hovey has a history of Ischaemic Heart Disease (IHD), hypertension and beginning Peripheral Vascular Disease (PVD). She had Coronary Artery Bypass Graft (CABG) surgery six (6) years ago with Saphenous Vein grafts to her Left Anterior Descending (LAD) coronary artery and diagonal branch. Mrs Hovey also had a Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary Artery (RCA) and Posterior Descending Artery (PDA). ASSESSMENT Her observations at 0700 hours were as follows: Temperature: 37.3ᵒC Pulse: 74bpm, regular, volume strong Respiratory rate: 14/min, regular, normal depth BP: 165/90mmHg (normal for her) SpO2: 98% on room air Her observations NOW: Temperature: 37.2ᵒC Pulse: 116 bpm, regular, volume not as strong as previously Respiratory rate: 26bpm, regular, a little shallower BP: 105/70 mmHg SpO2: 92% on room air RECOMMENDATION You have informed the Team Leader of Mrs Hovey’s complaints and vital signs and the Team Leader will be contacting the treating team. You continue to stay with Mrs Hovey while waiting for the treating team to arrive. Caring for a patient with chest pain Setting the scene Donna Hovey’s holistic assessment by the Doctor indicates: Physical: Weight 95 kg Height 158 cm BP 105/65 mmHg HR 116 bpm Temp 37.2⁰C SaO2: 92% (Room Air) 12 lead ECG: No new changes (previous ECG showed ST depression in leads V3-V6, III andaVF) Past medical history: IschaemicHeart Disease (IHD) Hypertension Peripheral Vascular Disease (PVD) Past surgical history: Coronary Artery Bypass Graft (CABG) six (6) years ago Percutaneous Transluminal Coronary Angioplasty (PTCA) two (2) years ago Medications: Telmisartan 80mg OD Rosuvastatin 40mg ON Aspirin 100mg OD Spironolactone 25mg OD Clopidogrel 75mg OD Venlafaxine hydrochloride (Efexor-XR) 150mg OD Glyceryl Trinitrate 400mcg (1 spray) when required Social: Mrs Hovey says she no longer smokes. She used to smoke 2 packs per day, starting at the age of 19 and ceasing at 49 years old when she was first diagnosed with Coronary Artery Disease (CAD). Mrs Hovey lives alone in a rented flat and has recently retired on a superannuation pension as her only source of income. Her only son lives in Melbourne and due to the pandemic and border closures, has not seen him for nearly a year which is making her depressed. Mrs Hovey is also worried about going home as her chest pain has occurred several times recently when she was doing the housework. Mrs Hovey states that she hates asking anyone to help. QUESTION: From Mrs Hovey’s signs and symptoms, there were abnormal findings including diaphoresis, shortness of breath, cool peripheries, heart rate, blood pressure and oxygen saturations. Choose two (2) of these abnormal findings. Analyse these changes in Mrs Hovey’s clinical presentation and link them to the pathophysiological processes which are occurring?
DOB: 28 Jun 1961 | GENDER: FEMALE
SITUATION
Mrs Donna Hovey is a 60-year-old female who was admitted to the ward two (2) days ago for pneumonia. She is now complaining of mild pressure in her chest (rated 4/10) that started 10 minutes ago while she was lying on the bed. Mrs Hovey states she also has a slight ache in the underside of her upper left arm.She is diaphoretic and feeling a little nauseated. Mrs Hovey has developed slight shortness of breath. Her peripheries are a little cool to touch
BACKGROUND
Mrs Hovey has a history of Ischaemic Heart Disease (IHD), hypertension and beginning Peripheral Vascular Disease (PVD). She had Coronary Artery Bypass Graft (CABG) surgery six (6) years ago with Saphenous Vein grafts to her Left Anterior Descending (LAD) coronary artery and diagonal branch. Mrs Hovey also had a Percutaneous Transluminal Coronary Angioplasty (PTCA) with stenting to her Right Coronary Artery (RCA) and Posterior Descending Artery (PDA).
ASSESSMENT
Her observations at 0700 hours were as follows:
Temperature: 37.3ᵒC
Pulse: 74bpm, regular, volume strong
Respiratory rate: 14/min, regular, normal depth
BP: 165/90mmHg (normal for her)
SpO2: 98% on room air
Her observations NOW:
Temperature: 37.2ᵒC
Pulse: 116 bpm, regular, volume not as strong as previously
Respiratory rate: 26bpm, regular, a little shallower
BP: 105/70 mmHg
SpO2: 92% on room air
RECOMMENDATION
You have informed the Team Leader of Mrs Hovey’s complaints and vital signs and the Team Leader will be contacting the treating team. You continue to stay with Mrs Hovey while waiting for the treating team to arrive.
Caring for a patient with chest pain
Setting the scene
Donna Hovey’s holistic assessment by the Doctor indicates:
Physical:
- Weight 95 kg
- Height 158 cm
- BP 105/65 mmHg
- HR 116 bpm
- Temp 37.2⁰C
- SaO2: 92% (Room Air)
- 12 lead ECG: No new changes (previous ECG showed ST depression in leads V3-V6, III andaVF)
Past medical history:
- IschaemicHeart Disease (IHD)
- Hypertension
- Peripheral Vascular Disease (PVD)
Past surgical history:
- Coronary Artery Bypass Graft (CABG) six (6) years ago
- Percutaneous Transluminal Coronary Angioplasty (PTCA) two (2) years ago
Medications:
- Telmisartan 80mg OD
- Rosuvastatin 40mg ON
- Aspirin 100mg OD
- Spironolactone 25mg OD
- Clopidogrel 75mg OD
- Venlafaxine hydrochloride (Efexor-XR) 150mg OD
- Glyceryl Trinitrate 400mcg (1 spray) when required
Social:
Mrs Hovey says she no longer smokes. She used to smoke 2 packs per day, starting at the age of 19 and ceasing at 49 years old when she was first diagnosed with Coronary Artery Disease (CAD). Mrs Hovey lives alone in a rented flat and has recently retired on a superannuation pension as her only source of income. Her only son lives in Melbourne and due to the pandemic and border closures, has not seen him for nearly a year which is making her depressed. Mrs Hovey is also worried about going home as her chest pain has occurred several times recently when she was doing the housework. Mrs Hovey states that she hates asking anyone to help.
QUESTION:
From Mrs Hovey’s signs and symptoms, there were
abnormal findings including diaphoresis, shortness of
breath, cool peripheries, heart rate, blood pressure and
oxygen saturations.
Choose two (2) of these abnormal findings. Analyse
these changes in Mrs Hovey’s clinical presentation and link
them to the pathophysiological processes which are
occurring?
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