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MI and Complications The nurse is caring for a 59-year-old man…


MI and Complications

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The nurse is caring for a 59-year-old man presenting to the emergency department with left shoulder and back pain.

This case consists of six clinical judgment questions. Read each question carefully and select the best answer(s). Use the chart to help answer the question. The chart is dynamic and may change as the case progresses. 


  • Medical/Surgical history: Hypertension for 2 years, treated with medications. Prediabetes for 1 year. Colon polyps removed 3 years ago. Motor vehicle crash at age 17 resulted in multiple bone fractures and extended hospital stay.
    Social history: Smokes 2-3 packs of cigarettes per week because “smoking helps me relax from my high-stress sales job.” Drinks 2-3 alcoholic beverages a month. Denies illicit drug use.
    Family history: Mother died of a heart attack at age 53 years. Brother died at age 49 of heart disease. Father alive and healthy.
    Physical Assessment: Overweight male with a BMI of 37. Alert and oriented. Mild diaphoresis. Lungs clear; S1, S2 heart sounds with an occasional irregular beat. 2+ pedal pulses with 2+ edema of both lower extremities.
    Medications: Lisinopril 10 mg daily, atorvastatin 40 mg daily, baby aspirin daily.
  • Nurses’ Notes
  • Vital Signs
  • Laboratory Results

Nurses Notes

Patient reports experiencing left shoulder and back pain over the last 2 hours that is unresolved with rest and positioning. States pain is “sharp” and a 7 on a scale of 0 to 10. Patient reports that the pain became worse as he walked from his car to the ED. Respirations labored but regular. Denies nausea, vomiting, or dizziness. Mild diaphoresis. Color pale.
Vital signs obtained, oxygen applied; 18-gauge IV line placed in RFA. Serum blood drawn and sent to the lab. Preparing for medication administration.
Lab results returned. Provider notified.

Lab and ECG results consistent with acute MI. Patient transferred to cardiac unit with oxygen and portable cardiac monitor. Provider orders reviewed in handoff report with cardiac nurse.
Administered NTG and morphine for chest pain of 3 out of 10.



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