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HSNS368 Nursing

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Case Study 2: Cardiogenic Shock Mr Jae-Kwang Lee, a 65-year-old male who presented to the EmergencyDepartment stating his chest felt heavy. At the triage desk he was holding his chest, when asked if the heaviness went anywhere he said yes and then proceeded to rub his left arm. When questioned further during the triage process he had associated symptoms of shortness of breath and dizziness. He had not had pain as severe as this before, he said he "has been having pains in his chest for a few months but it stops when I sit down, but it didn't stop this time, I have been w...

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Case Study 2: Cardiogenic Shock Mr Jae-Kwang Lee, a 65-year-old male who presented to the EmergencyDepartment stating his chest felt heavy. At the triage desk he was holding his chest, when asked if the heaviness went anywhere he said yes and then proceeded to rub his left arm. When questioned further during the triage process he had associated symptoms of shortness of breath and dizziness. He had not had pain as severe as this before, he said he "has been having pains in his chest for a few months but it stops when I sit down, but it didn't stop this time, I have been waiting for it to stop, it started yesterday" Mr Lee was taken into the emergency Department and connected to cardiac monitoring, a 12 lead ECG was taken which showed an Inferior Myocardial Infarction (STEMI). Mr Lee also had blood tests taken including UEC, FBC, CK-MB, Trop T, Coags. Mr Leewas also given sublingual GTN for pain 300mcg x2 - 5 minutes apart without effect, he was then given morphine 5mg, in 2.5mg increments with effect.Due to the business of the Department, it was decided to transfer my Lee to the coronary Care unit to wait for cardiology review. You accept the care of Mr.Lee. About 2 hours into your shift, you are assessing Mr Lee and notethatMr.Lee has become tachycardic, hypotensive and hypoxic his observations are as follows:Temp:36.5HR:133BP:87/53RR:25SpO 2 :88%His oxygen saturation's is at 88%, you start him on oxygen via a simple facemask at 6LO2. Mr Lee is awake but lethargic and responds appropriately to questions. Questions 1. Identify whether this patient’s condition indicates a rapid response or clinical review as per the NSW Health Between the Flags? Justify your decision with the data from the case and relevant support(250 words).2. Construct your communication with the Doctor regarding this patients deterioration employing the ISBAR tool(250 words).3. Discuss the pathophysiology of cardiogenic shock in relation to the patient's signs of deterioration(500 words).

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Case Study -2: Cardiogenic ShockAnswer.1 In this case study, Mr. Lee has been diagnosed of STEMI after his condition of acute cardiogenic shock. As per the given situation and assessment, he has been given a sublingual GTN for pain so that the symptoms of MI deteriorate further. Also, he has been diagnosed of tachycardia and is known to be hypotensive and hypoxic. His oxygen saturation levels are at the higher level and therefore, an oxygen mask is been given to him. His blood pressure is much at the lower side and therefore, appropriate medication needs to be given across to him. The blood tests need to check the relevant parameters such as plaque and clot constituents and the reason due to which thrombotic condition was observed. The appropriate drugs should be suggested so as to diffuse the plaque / clot and lead to normal blood flow conditions.  Therapeutic interventions such as the angioplasty or thrombolysis might be suggested to completely cure the condition.  It is further recommended that reasons for formation of atherosclerotic plaque / clot should be known and ways to overcome the occurrence of the same should be approached. Therefore, a complete review of this case is suggested so as to understand the causes and possible treatment interventions of Mr. Lee. 

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