Risk Factors of Myocardial Infarction
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Risk Factors of Myocardial Infarction
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Purpose: The student completing the MI case study will apply recent cardiac knowledge and past learning to develop a care plan for a patient with a MI. This task corresponds with the specified course learning outcomes and important employability skills outlined in the Cardiac Course Outline.
- Interpret pathophysiology and pharmacology to ensure safe and effective care of the critically ill patient with cardiac challenges.
- Assess hemodynamic profiles to create a prioritized plan for a patient experiencing critical cardiac challenges.
- Implement a collaborative plan of care to achieve optimal outcomes for a patient experiencing critical cardiac challenges.
- Evaluate patient responses to the cardiac plan of care and reassess or adapt to ensure optimal outcomes.
- Implement best practices and evidenced based research to create a prioritized patient/family centered plan of care for a cardiac patient.
DIRECTIONS
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GRADING RUBRIC
| Criteria | Level 4 | Level 3 | Level | Level 1 |
| Question 1What are the risk factors for a MI? What risk factors are specific to Mr. Campbell? (4 marks) | Demonstrates a comprehensive understanding of the risk factors for an MI and those specific for Mr. Campbell (4 marks). | Demonstrates a thorough understanding of the risk factors for an MI and those specific for Mr. Campbell (3 marks). | Demonstrates a basic understanding of the risk factors for an MI Does not address those specific for Mr. Campbell (2 marks). | Demonstrates a lack understanding of the risk factors for an MI and Does not address those specific for Mr. Campbell (0 marks). |
| Question 2Nursing priorities and intervention: patient assessment and symptoms; medications; lab tests; interventions; patient Teaching; post MI care (20 marks). | Demonstrates a comprehensive understanding of nursing priorities and interventions for a patient diagnosed with a STEMI (20 marks). | Demonstrates a thorough understanding of nursing priorities and interventions for a patient diagnosed with a STEMI (15 marks). | Demonstrates a basic understanding of nursing priorities and interventions for a patient diagnosed with a STEMI (10 marks). | Demonstrates a lack understanding of nursing priorities and interventions for a patient diagnosed with a STEMI (5 marks). |
| Question 3Interpret the cardiac rhythm using the 8-step systematic approach(8 marks). | One mark for each of the eight steps in (correct order) for the systematic approach to cardiac rhythm interpretation (8 marks). | One mark of each of the eight steps | One mark of each of the eight steps | One mark of each of the eight steps |
| Question 4Interpret the 12-lead (8 marks). | One mark for each of the eight steps in (correct order) for the systematic approach to ECG interpretation (8 marks) | One mark of each of the eight steps | One mark of each of the eight steps | One mark of each of the eight steps |
| Question 5PCI and reperfusion drugs. Including eligibility criteria for reperfusion drugs (4 marks) | Demonstrates a comprehensive understanding of PCI & repreferusion drugs including the criteria for reperfusion (4 marks) | Demonstrates a thorough understanding of PCI & reperfusion drugs including the criteria for reperfusion (3 marks) | Demonstrates a basic understanding of PCI & reperfusion drugs. Dose not include the criteria for reperfusion (2 marks). | Demonstrates a lack of understanding of PCI & reperfusion drugs. Does not include the criteria for reperfusion (0 marks). |
Risk Factors of Myocardial Infarction
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CASE PRESENTATION
| On Arrival to the Emergency Department Mr. Denzel Campbell is a 48-year-old, (260 lbs) male that began having chest discomfort at home approximately one hour ago. The chest discomfort was unrelieved by three sublingual nitroglycerin sprays. His wife immediately drove him to the emergency department where he presented with midsternal “pressure” that radiated down his left arm and through to his back. On admission Mr. Campbell was pale, diaphoretic, and short of breath. He denied nausea or vomiting. Further questions revealed that over the last few weeks, he has been having frequent episodes of chest discomfort upon exertion that was relieved by rest.
Past Medical History
Mr. Campbell has a history of diabetes mellitus that is controlled by diet. He reports smoking two packs of cigarettes daily for 30 years. His father died of lung cancer two years ago. His mother, who has hypertension, lives with him, and his wife and their two teenage sons.
On assessment, Mr. Campbell has normal heart sounds, and his lungs are clear. No edema is present and bowel sounds are normal. No jugular venous distension is noted.
Vital Signs
T: 36.9°C HR: 94 bpm and regular RR: 30 breaths per minute BP: 140/98 mm Hg SaO2: 92 % with 2 L O2 via nasal cannula
Blood work was drawn, and a 12-lead ECG is done. Mr. Campbell was diagnosed with an ST-segment elevation MI (STEMI). Labs Hg 149 g/L
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- What are the risk factors for myocardial infarction? What risk factors are specific to Mr. Campbell (discuss both modifiable and non-modifiable risk factors) (4 marks)?
Risk Factors of Myocardial Infarction
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What are the nursing priorities and interventions for a patient diagnosed with a STEMI? Please ensure that you relate the priorities to Mr. Campbell’s situation. Include the following in your discussion and the rationale for each priority/intervention. Please use the following table. You may use bullet points (20 marks).
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- Patient assessment (head-to-toe)
- Medications
- Laboratory and Diagnostic Tests
- Medical and Nursing Interventions
- Patient Teaching
| Criteria | Priorities | Rationale |
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- Interpret the following cardiac rhythm and include the following (8 marks).
| Regularity | |
| Assess P-waves | |
| PR-interval | |
| QRS-interval | |
| Rate | |
| ST and T wave changes | |
| Rhythm | |
| Nursing management |
- Interpret this 12 Lead ECG and include the following (8 marks):
| Regularity | |
| PR-interval | |
| QRS-interval | |
| ST-segment elevation | |
| ST-segment depression | |
| Rate | |
| Rhythm | |
| STEMI location |
- Discuss percutaneous coronary intervention and reperfusion drugs, including the eligibility/exclusion criteria for fibrinolytic therapy. Explore the appropriateness of each for Mr. Campbell (4 marks).
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