Passage / Scenario

History and Physical
1000:

Client reports after eating breakfast this morning at 0630 that they began feeling tightness in chest that radiates to left arm. History:

Hyperlipidemia, hypertension, type 2 diabetes mellitus. Non-smoker. Denies use of alcohol or recreational drug use.

Nurses' Notes
1000:

Client reports tightness in chest that radiates to left arm. States pain as 7 on a scale of 0 to 10. Started to feel nauseous after breakfast. Client states, "I had scrambled eggs and bacon like I do every morning." Client is diaphoretic and short of breath. Heart rate irregular and tachycardic. Alert and oriented to person, place, and time. Lungs clear to auscultation in all lobes. Bowel sounds are present in all 4 quadrants. +1 pedal pulses. Skin is cool to touch. Capillary refill less than 2 seconds.

Vital Signs
1000:

ÔÇó Temperature 37.1┬░ C (98.8┬░ F)
ÔÇó Heart rate 110/min and irregular
ÔÇó Respiratory rate 24/min
ÔÇó Blood pressure 164/80 mm Hg
ÔÇó Oxygen saturation 93% on room air
Diagnostic Results
1000:
ÔÇó Myoglobin 100 mcg/L (less than 90 mcg/L)
ÔÇó Creatine kinase 180 units/L (55 to 170 units/L)
ÔÇó Troponin T 0.40 ng/mL (less than 0.1 ng/mL)
ÔÇó Troponin 10.35 ng/mL (less than 0.03 ng/mL)
ÔÇó Cholesterol 244 mg/dL (less than 200 mg/dL)
ÔÇó Triglycerides 180 mg/dL (40 to 160 mg/dL)
ÔÇó LDL cholesterol 148 mg/dL (less than 130 mg/dL)
ÔÇó HDL cholesterol 42 mg/dL (greater than 45 mg/dL)
ÔÇó C-reactive protein 2 mg/mL (less than 1.0 mg/mL)
ÔÇó Blood glucose 103 mg/dL (74 to 106 mg/dL)

12-lead electrocardiogram: tachycardia with ST segment elevation and T wave changes
Chest x-ray: lungs are clear in all lobes

Provider prescriptions
1020:

ÔÇó Nitroglycerin 0.5 mg SL may repeat every 5 min up to 3 doses as needed for chest pain
ÔÇó Aspirin 160 mg PO daily
ÔÇó Morphine 6 mg IV bolus every 3 hr PRN pain
ÔÇó Metoprolol 25 mg PO every 6 hr x 48 hr, then metoprolol 100 mg PO twice daily
ÔÇó Initiate peripheral IV site
ÔÇó 0.9% sodium chloride 50 mL/hr by continuous IV infusion
ÔÇó Oxygen at 2 L/min via nasal cannula if oxygen saturation is less than 90%
ÔÇó Schedule stat echocardiogram
ÔÇó 2 g sodium diet