NU 460 Percutaneous Coronary Intervention Case Study

NU 460 Percutaneous Coronary Intervention Case Study You are in the middle of your shift in the coronary care unit (CCU) of a large urban medical center. Your new admission, C.B., a 47-year-old woman, was just flown to your institution from a small rural community more than 100 miles away. She had an acute anterior wall myocardial infarction (MI) last evening. Her current vital signs (VS) are 100/60, 86, 14. After you make C.B. comfortable, you receive this report from the flight nurse: “C.B. is a full-time homemaker with four children. She has had episodes of ‘chest tightness’ with exertion for the past year, but this is her first known MI. She has a history of hyperlipidemia and has smoked one pack of cigarettes daily for more than 30 years. Surgical history consists of total abdominal hysterectomy 10 years ago after the birth of her last child. She has no other known medical problems. Yesterday at 8 PM , she began to have severe substernal chest pain that referred into her neck and down both arms. She rated the pain as 9 or 10 on a 0-to-10 scale. She thought it was severe indigestion and began taking Maalox with no relief. Her husband then took her to the local emergency department (ED), where a 12-lead ECG showed hyperacute ST elevation in the inferior leads II, III, and aVF and V5 to V6. Before tissue plasminogen activator (TPA) could be given, she went into ventricular fibrillation (V-fib) and was successfully defibrillated after two shocks. She then was given TPA and started on nitroglycerin (NTG), heparin, and lidocaine drips. She also was given IV metoprolol and aspirin 325 mg to chew and swallow. This morning, her systolic pressure dropped into the 80s, and she was placed on a dopamine drip and urgently flown to your institution for coronary angiography and possible percutaneous coronary angioplasty (PTCA). Currently, she has lidocaine infusing at 2 mg/min, heparin at 1200 units/hr, and dopamine at 5 mcg/kg/min. The NTG has been stopped because of low blood pressure. Lab work that was done yesterday showed Na 145 mEq/L, K 3.6 mEq/L, HC O 3 19 mEq/L, BUN 9 mg/dL, creatinine 0.8 mg/dL, WBC 14,500/mm 3 , Hct 44.3%, and Hgb 14.5 g/dL.”