The ISBAR Handover:
\nIntroduction: Mrs Helen Georgopoulos is a 64-year-old lady.
\nSituation: Mrs Georgopoulos arrived at the Emergency Department at 1130 hrs with central crushing chest pain radiating to her jaw since 1100 hrs. Findings from the 12 lead ECG recorded by paramedics showed ST elevation in leads V2, V3, V4. Aspirin 300mg administered on route to hospital.
\nBackground: Hypertension (Captopril 12.5mg bd); Hyperlipidaemia (Simvastatin 40mg nocte); Type 2 Diabetes Mellitus (DM) (diet controlled) and Allergy – Penicillin.
\nAssessment:
\n-Airway patent
\n\u2013 Breathing: Respiratory rate 24, bilateral air entry, breath sounds clear. SpO2 on room air 91%
\n– Circulation: Sinus Tachycardia 120 bpm. BP 110\/60. Diaphoretic and peripherally cool. Central crushing chest pain radiating to the jaw.
\nCOLDSPA:
\nCharacter: crushing chest pain
\nOnset: 11am
\nLocation: Central, radiating to jaw
\nDuration: ongoing
\nSeverity: 8\/10
\nPattern: at rest, not relieved by SL Anginine Spray x 2
\nAssociated symptoms: diaphoresis
\nDisability: Alert & oriented. Pupils equal and reacting to light (PEARL); Equal strength in all four limbs.
\n– Exposure: IVC Left cubital fossa.
\n– Fluid: NBM. NO IVF
\n– Glucose: 14.0 mmol\/l
\n– Weight 88kg<\/p>\n
Nursing Interventions:
\n1. Perform venepuncture to collect pathology \u2013 Troponin, UEC, FBC, TFTs, LFTs, BSL
\n2. Initiate supplemental oxygen if SpO2 < 93%
\n3. Attach Continuous Cardiac Monitoring
\n4. Record a 12-lead ECG
\n5. Monitor blood pressure and report systolic BP
\nPathology Results:
\n – Elevated Troponin 35ng\/L troponin
\n– 12 lead ECG: ST elevation (>2mm) V2, V3, V4
\nThe diagnosis of Acute Anterior STEMI is made
\nMedications:
\nMorphine 2.5mg IVI 2\/24 (PRN maximum 4 x 2.5mg doses = 10mg total)
\nNitro-glycerine 600mcg SL (PRN maximum 3 doses); monitor systolic BP >100 mmHg
\nClopidogrel 300mg PO STAT
\nHeparin 5000IU IV STAT
\nAs per STEMI reperfusion flowchart:
\nTransfer to Cardiac Cath Lab for urgent primary PCI when ready (<90min)
\nIf PCI delayed, give Tenecteplase 45mg IV as per PACSA @ 1230pm<\/p>\n
Short Answer Questions:<\/p>\n
1.\tYou are the registered nurse caring for this patient. List and prioritise the order that you will complete each of the five Nursing Interventions (indicated above):
\n2.\t(200 words)Critically analyse, and then concisely explain using your own words, each of the clinical manifestations and related pathogenesis for the following: i) Central crushing chest pain with radiation to the jaw (ii) ST elevation (iii) elevated Troponin (35ng\/L)
\n3.\tQuestion 3: (500 words)
\n(i) Select one Category only, from the three (3) categories given below.
\n(ii) Provide a rationale for each of the interventions listed for the category that you have selected.
\n (iii) You must critically analyse the available evidence-based literature and\/or pathophysiology texts to support your rationale. You must then concisely explain the rationales using your own words.
\nCategory 1 Non-pharmacological interventions
\n\u2022 Supplemental oxygen if SpO2<93%
\n\u2022\t12 lead ECG within 10 minutes of arrival and then every 30 minutes.
\n\u2022\tTroponin at 0 and 2 hours
\nCategory 2 Pharmacological interventions
\nMorphine 2.5mg IV
\n \u2022 Nitro-glycerine 600mcg SL
\n\u2022 Aspirin 300mg
\n\u2022 Heparin 5000iu IV
\n\u2022 Clopidogrel 300mg<\/p>\n
Category 3
\n Reperfusion interventions
\n\u2022 Tenecteplase 45mg IV
\n\u2022 Primary Percutaneous Coronary Intervention<\/p>\n","protected":false},"excerpt":{"rendered":"
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