NR 305 Week 4 Discussion Topic, Assessment of Cardiac Status
Esther Jackson is a 56-year-old black female who is 1-day post-op following a left
radical mastectomy. During morning rounds, the off-going nurse shares with you during
bedside report that the patient has been experiencing increased discomfort in her back
throughout the night and has required frequent help with repositioning. She states that
the patient was medicated for pain approximately 2 hours ago but is voicing little relief
and states that you might want to mention that to the doctor when he rounds later this
morning. With the patient appearing to be in no visible distress, you proceed on to the
next patient's room for report.
Approximately 1 hour later, you return to Ms. Jackson's room with her morning pills and
find her slumped over the bedside stand in tears. The patient states, "I don't know what
is wrong, I don't feel right. My back hurts and I'm just so tired. What is wrong with me?"
The patient refuses to take her medications at this time stating that she is starting to feel
sick to her stomach.
Just then the nursing assistant comes into the patient's room to record Ms. Jackson's
vital signs, you take this opportunity to quickly research the patient's medication record
to determine if she has a medication ordered for nausea. Upon return, the nursing
assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she
couldn't get the patient's pulse because "it is all over the place."
Please address the following questions related to the scenario.
Hello Professor and class,
1. What do you suspect is the cause of the patient's symptoms?
Based on the symptoms of Esther Jackson I would suspect myocardial infraction. She
has elevated blood pressure, nausea, unrelieved back pain, extreme fatigue, her heart
rate is all over the place and one-day post-op. According to the American College of
Cardiology, Black women have a higher chance of AMI over other ethnic groups. As a
nurse, I must differentiate the symptoms of fatigue and increased discomfort in her
back after surgery or possible AMI, but it would be wise to assume that it is an AMI due
to the unexplained fatigue and discomfort in her back (Jarvis, 2016).
2. Describe the course of action that you will take to confirm this suspicion and
prevent further decline.
My first course of action would be to activate the rapid response. The priority of my
action is controlling the pain and stabilize her heart rhythm to reduce her hearts
workload. I would notify the doctor as well as the charge nurse.
As soon as I suspect AMI I would start oxygen, Peripheral IV line, and get the patient
on pain medication. Next, I would order a 12 lead EKG, STAT labs (CBC, CMP, PT,
PTT, Cardiac enzymes test (troponin levels, CK-MB), Myoglobin levels, and a Chest X-
ray at bed side. I would ask for the Doctors choice of vasodilation therapy and possible
administration of tpA if needed.
Esther Jackson is a 56-year-old black female who is 1-day post-op following a left
radical mastectomy. During morning rounds, the off-going nurse shares with you during
bedside report that the patient has been experiencing increased discomfort in her back
throughout the night and has required frequent help with repositioning. She states that
the patient was medicated for pain approximately 2 hours ago but is voicing little relief
and states that you might want to mention that to the doctor when he rounds later this
morning. With the patient appearing to be in no visible distress, you proceed on to the
next patient's room for report.
Approximately 1 hour later, you return to Ms. Jackson's room with her morning pills and
find her slumped over the bedside stand in tears. The patient states, "I don't know what
is wrong, I don't feel right. My back hurts and I'm just so tired. What is wrong with me?"
The patient refuses to take her medications at this time stating that she is starting to feel
sick to her stomach.
Just then the nursing assistant comes into the patient's room to record Ms. Jackson's
vital signs, you take this opportunity to quickly research the patient's medication record
to determine if she has a medication ordered for nausea. Upon return, the nursing
assistant hands you the following vital signs: T 37, R 18, and BP 132/54, but states she
couldn't get the patient's pulse because "it is all over the place."
Please address the following questions related to the scenario.
Hello Professor and class,
1. What do you suspect is the cause of the patient's symptoms?
Based on the symptoms of Esther Jackson I would suspect myocardial infraction. She
has elevated blood pressure, nausea, unrelieved back pain, extreme fatigue, her heart
rate is all over the place and one-day post-op. According to the American College of
Cardiology, Black women have a higher chance of AMI over other ethnic groups. As a
nurse, I must differentiate the symptoms of fatigue and increased discomfort in her
back after surgery or possible AMI, but it would be wise to assume that it is an AMI due
to the unexplained fatigue and discomfort in her back (Jarvis, 2016).
2. Describe the course of action that you will take to confirm this suspicion and
prevent further decline.
My first course of action would be to activate the rapid response. The priority of my
action is controlling the pain and stabilize her heart rhythm to reduce her hearts
workload. I would notify the doctor as well as the charge nurse.
As soon as I suspect AMI I would start oxygen, Peripheral IV line, and get the patient
on pain medication. Next, I would order a 12 lead EKG, STAT labs (CBC, CMP, PT,
PTT, Cardiac enzymes test (troponin levels, CK-MB), Myoglobin levels, and a Chest X-
ray at bed side. I would ask for the Doctors choice of vasodilation therapy and possible
administration of tpA if needed.
