NUR390 Nursing Care of the Adult 1
Acute Coronary Syndrome Case Study
Acute Coronary Syndrome Case Study
MP is a 58-year-old male who arrives in the emergency department (ED) complaining of severe,
immobilizing chest pain radiating down his left arm. He is sweating and appears weak. He states the pain
woke him up from sleep. He states that 6 months ago after he had a stent placed in his heart artery. His
vital signs are: HR 115; BP: 90/50; RR: 24; Temp: 100.2; 02 Sat: 94%. The ED physician suspects ACS.
Highlight all abnormal assessment data relevant to the case.
1. What signs/symptoms lead the physician to suspect ACS?
Classic chest pain radiating to left arm
Sudden onset at rest (woke from sleep)
Diaphoresis
Tachycardia
Hypotension
History of coronary artery disease with prior stent
O2 is borderline low.
(ATI, 2023, p. 222)
2. How will you assess this patient's pain?
Use PQRST assessment of angina framework (Harding et al., 2023, p. 830, table 37.8):
P – Precipitating events (What were you doing before the pain began?)
Q – Quality (Crushing? Pressure? Tightness?)
R – Region and radiation (have patient point to spot -Left arm? Jaw? Back?)
S – Severity (0–10 scale)
T – Timing (When did it start? Constant? Or does it change)
(Harding et al., 2023, p. 830, table 37.8)
Also assess:
Associated symptoms (nausea, SOB, dizziness)
Response to nitroglycerin (if given)
3. What other assessment abnormalities will the healthcare workers find if MP is experiencing
myocardial infarction?
Cool, clammy skin
Pale or cyanotic appearance
Decreased urine output (poor perfusion)
Altered LOC (if perfusion compromised)
S3 or S4 heart sounds
Crackles (if left-sided failure develops)
Elevated cardiac biomarkers (troponin)
(ATI, 2023, p. 222)
Acute Coronary Syndrome Case Study
Acute Coronary Syndrome Case Study
MP is a 58-year-old male who arrives in the emergency department (ED) complaining of severe,
immobilizing chest pain radiating down his left arm. He is sweating and appears weak. He states the pain
woke him up from sleep. He states that 6 months ago after he had a stent placed in his heart artery. His
vital signs are: HR 115; BP: 90/50; RR: 24; Temp: 100.2; 02 Sat: 94%. The ED physician suspects ACS.
Highlight all abnormal assessment data relevant to the case.
1. What signs/symptoms lead the physician to suspect ACS?
Classic chest pain radiating to left arm
Sudden onset at rest (woke from sleep)
Diaphoresis
Tachycardia
Hypotension
History of coronary artery disease with prior stent
O2 is borderline low.
(ATI, 2023, p. 222)
2. How will you assess this patient's pain?
Use PQRST assessment of angina framework (Harding et al., 2023, p. 830, table 37.8):
P – Precipitating events (What were you doing before the pain began?)
Q – Quality (Crushing? Pressure? Tightness?)
R – Region and radiation (have patient point to spot -Left arm? Jaw? Back?)
S – Severity (0–10 scale)
T – Timing (When did it start? Constant? Or does it change)
(Harding et al., 2023, p. 830, table 37.8)
Also assess:
Associated symptoms (nausea, SOB, dizziness)
Response to nitroglycerin (if given)
3. What other assessment abnormalities will the healthcare workers find if MP is experiencing
myocardial infarction?
Cool, clammy skin
Pale or cyanotic appearance
Decreased urine output (poor perfusion)
Altered LOC (if perfusion compromised)
S3 or S4 heart sounds
Crackles (if left-sided failure develops)
Elevated cardiac biomarkers (troponin)
(ATI, 2023, p. 222)
