Myocardial infarction with history of stable angina and mitral valve stenosis

Paper Details
Students are to choose one (1) of the case studies below and answer the associated questions. The assignment is to be presented in a question/answer format NOT as an essay (i.e. no introduction or conclusion).
NRSG353 Assessment Task 2 –Case Study
Due Date: 20th May 2016 at 5pm via Turnitin
Weighting: 40%
Word count: 1600 words (every question has a specific word count, which must be adhered
? Students are to choose one (1) of the case studies below and answer the associated
questions. The assignment is to be presented in a question/answer format NOT as
an essay (i.e. no introduction or conclusion).
? Each answer has a word limit (1600 in total); each answer must be supported with
? A reference list must be provided at the end of the assignment.
? Please refer to the marking guide available in the unit outline for further information.
** The following questions must be answered for your chosen case study **
The following questions relates to the patient within the first 24 hours since
admission to the emergency department (ED):
1. Outline the causes, incidence and risk factors of the identified condition and how it
can impact on the patient and family (400 words)
2. List five (5) common signs and symptoms of the identified condition; for each provide
a link to the underlying pathophysiology (350 words)
a. This can be done in the form of a table – each point needs to be appropriately
3. Describe two (2) common classes of drugs used for patients with the identified
condition including physiological effect of each class on the body (350 words)
a. This does not mean specific drugs but rather the class that these drugs
belong to.
4. Identify and explain, in order of priority the nursing care strategies you, as the
registered nurse, should use within the first 24 hours post admission for this patient
(500 words).
Case Study 1: Myocardial infarction with history of stable angina and mitral
valve stenosis
Mr Tupa Savea is a 54 year old male who has been transferred to the coronary care unit
(CCU) from the emergency department for management of episodic chest pain. He has a
history of stable angina and mitral valve stenosis. Mr Savea is of Samoan background and
has lived in regional Queensland for the last 20 years with his wife and children. He was
brought in by ambulance having had chest pain and shortness of breath. He reports having
similar symptoms on and off for the past two months but did not visit his GP as he assumed
the discomfort was due to indigestion. Mr Savea is an ex-smoker, tobacco free for the last
six months and a social drinker (approx. 10 units/week). He works full-time as an orderly at a
local hospital and is active in the Samoan support community.
On assessment Mr Savea’s vital signs are: PR 90 bpm and irregular; RR 12 bpm; BP
150/100mmHg; Temp 36.9°C; SpO2 98% on oxygen 8L/min via Hudson mask. He has a
body mass index (BMI) of 35 kg/m2
indicating clinical obesity. Blood test results show
elevated cardiac enzymes and troponin levels and cholesterol level of 8.9mmol/L. His ECG
indicates that he has a ST segment elevated myocardial infarction. Mr Savea was
administered sublingual glyceryl trinitrate followed by morphine 2.5 mg IV for pain in the
emergency department. He reports being pain free on admission to CCU.
Case Study 2: Cushing’s Syndrome
Ms Maureen Smith is a 24 year old female who presented to her GP for ongoing
gastrointestinal bleeding, abdominal pain and fatigue which has been worsening, and was
referred to the local hospital for further investigation. Maureen was diagnosed with
rheumatoid arthritis (RA) when she was 15 years old, and has experienced multiple
exacerbations of RA which have required the use of high dose corticosteroids. She is
currently taking 50mg of prednisolone daily, and has been taking this dose since her last
exacerbation 2 months ago. Maureen also has type 2 diabetes which is managed with
metformin. She is currently studying nursing at university and works part-time at the local
pizza restaurant.
On assessment, Maureen’s vital signs are: PR 88 bpm; RR 18 bpm; BP 154/106 mmHg;
Temp 36.9ºC: SpO2 99% on room air. She has a body mass index (BMI) of 28kg/m2 and the
fat is mainly distributed around her abdominal area, as well as a hump between her
shoulders. Maureen’s husband notes that her face has become more round over the past
few weeks. Her fasting BGL is 14.0mmol/L. Blood test results show low cortisol and ACTH
levels, and high levels of low high-density lipoprotein cholesterol. She is awaiting a bone
mineral density test this afternoon, and is currently collecting urine for a 24-hour cortisol level
Case Study 3: Decompensated Liver Cirrhosis
Mr Ronald Stone is a 47-year-old man who was brought in by ambulance to emergency
department with haematemesis. According to his partner he vomited a total of 300 mL of
fresh blood this morning. He reported that he has been spitting blood stained sputum for the
last few weeks with no associated cough or shortness of breath. For the past 3 days he has
complained of increasing abdominal pain but with no diarrhoea or black stools. Mr Stone
tested positive for Hepatitis C virus (HCV) genotype 1A in June 2010. He has cirrhosis and a
history of heavy alcohol use, although he no longer drinks. He ceased intravenous drug use
10 years ago, and stills smokes tobacco and marijuana on a daily basis. He used to work
with City Rail but has been made redundant 13 months ago and has been unemployed
since. He lives with his partner and 2 young children from a previous marriage.
On assessment Mr Stone’s vital signs are: PR 112 bpm; RR 24 bpm; BP 105/64mmHg;
Temp 37.4 °C; SpO2 94% on room air. He has a body mass index (BMI) of 31.5kg/m2
. He is
lethargic but orientated to time, place and person. He has a swollen and tight abdomen
typical of ascites and bilateral leg oedema. Blood test results show Hb 85 g/L, decreased
WBC, platelets and albumin, and a marked increase in both serum ammonia and total
bilirubin levels. 6 months ago he underwent an eosophagogastroduodenostomy (EGD)
which showed grade 2 oesophageal varices. He is ordered the following medications:
Vitamin K 1 mg IV stat, aldactone 25mg PO TDS, lactulose 15mls PO TDS, and vitamin B12
100mg IV TDS. He is awaiting a CT abdomen scheduled for this afternoon.

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