A 62 y/o male is arriving from EMS with chest pain.  …

A 62 y/o male is arriving from EMS with chest pain.   Nurse’s Note:  12/16/23 1010: 62 y/o male c/o crushing sternal pain, radiating down the left arm. States the pain becomes worse with activity and started approximately two hours ago while shoveling snow. Patient states he is also short of breath with activity. Pt is ALOx3. Lungs clear throughout. Abd soft, nontender, bowel sounds active. Pt states urinary output is “normal” with no c/o of odor, pain, pressure. Skin is C/D/I. 18G in the left forearm.      Vital Signs:  98.4 F, HR – 112, RR – 18, BP 162/89, Pulse Ox: 93% on RA    ECG:  Sinus Tachycardia rate 112 bpm. ST elevation noted in V3 and V4    Laboratory Results:  Lab  Results  Reference Range:  WBC  9 x 10^3 cells/mm3  4500–11,000/mm3  RBC  5.3 × 106/μL  4.7-6.1 × 106/μL  Hgb  15.8 g/dL  Male: 14–17.4 g/dL  Hct  44%  Male: 42–52%  Plts  254,000/mm3  140,000–400,000/mm3  Na  144 mEq/L  135-147 mEq/L  Cl  104 mEq/L  95-106 mEq/L  K  4.8 mEq/L  3.5-5.3 mEq/L  CO2  29 mEq/L  22-30 mEq/L  BUN  12 mg/dL  6-20 mg/dL  Cr  1.1 mg/dL  0.6-1.3 mg/dL  Troponin T  0.7 ng/mL  0-0.04 ng/mL  Creatine Kinase MB (CK-MB)  187 IU/L  5-25 IU/L  Cholesterol  265 mg/dL  240 high  The client has now received fibrinolytic therapy post PTCI.  Click to specify whether the intervention is indicated or contraindicated post fibrinolytic therapy.  

The nurse who is caring for a 57-year-old male client in the…

The nurse who is caring for a 57-year-old male client in the Emergency Department (ED)   History and Physical: Past medical history for atrial fibrillation, hypertension, alcohol abuse, and hypothyroidism. Denies illicit drug use. Smokes one pack of cigarettes per day. Recent admission two weeks prior for atrial fibrillation with rapid ventricular rate (RVR) who was found to have severe left ventricular (LV) dysfunction with an ejection fraction (EF) of 20-25%. The client presented to the ED with bilateral lower leg swelling, and complaints of shortness of breath (SOB) that has been going on for the past two weeks. He reports dyspnea on exertion, SOB when he lays flat and states that he can only walk a few steps before feeling SOB. He also reports that over that last few days he has noticed that his leg swelling has gotten worse, and he has started to develop swelling of the scrotum.     Nurses Note: 1/20/23 at 1940: Client arrived in the ED via EMS. Alert and oriented x 3. Client placed on telemetry monitor, showing atrial fibrillation with RVR. Vital signs: 97.1*F, P 164, RR 26, BP 134/102, SpO2 94% on room air. Lung sounds with crackles in bilateral bases. Breathing is labored at times. Jugular venous distention (JVD) is observed. Skin is cool to touch and diaphoretic. Capillary refill

A 62 y/o male is arriving from EMS with chest pain.  …

A 62 y/o male is arriving from EMS with chest pain.   Nurse’s Note:  12/16/23 1010: 62 y/o male c/o crushing sternal pain, radiating down the left arm. States the pain becomes worse with activity and started approximately two hours ago while shoveling snow. Patient states he is also short of breath with activity. Pt is ALOx3. Lungs clear throughout. Abd soft, nontender, bowel sounds active. Pt states urinary output is “normal” with no c/o of odor, pain, pressure. Skin is C/D/I. 18G in the left forearm.      Vital Signs:  98.4 F, HR – 99, RR – 18, BP 162/89, Pulse Ox: 93% on RA    ECG:  Sinus Tachycardia rate 99 bpm. ST elevation noted in V3 and V4    Laboratory Results:  Lab  Results  Reference Range:  WBC  9 x 10^3 cells/mm3  4500–11,000/mm3  RBC  5.3 × 106/μL  4.7-6.1 × 106/μL  Hgb  15.8 g/dL  Male: 14–17.4 g/dL  Hct  44%  Male: 42–52%  Plts  254,000/mm3  140,000–400,000/mm3  Na  144 mEq/L  135-147 mEq/L  Cl  104 mEq/L  95-106 mEq/L  K  4.8 mEq/L  3.5-5.3 mEq/L  CO2  29 mEq/L  22-30 mEq/L  BUN  12 mg/dL  6-20 mg/dL  Cr  1.1 mg/dL  0.6-1.3 mg/dL  Troponin T  0.7 ng/mL  0-0.04 ng/mL  Creatine Kinase MB (CK-MB)  187 IU/L  5-25 IU/L  Cholesterol  265 mg/dL  240 high    H&P:  62 y/o male lives independently at home with spouse of 40 years. Came in on 12/16/23 after shoveling snow c/o crushing sternal pain, radiating down the left arm. States he stopped shoveling after 30mins of pain, and the pain continued. The pain becomes worse with activity and started approximately two hours ago. Patient states he also became short of breath with activity.     Wt: 102.3 kgs  Ht: 5’9”  BMI: 33.2    PMH: DMII, HLD, GERD, Asthma, Sleep apnea, Smoker 1/2 pack per day    Family Hx:  Mother – Alive – DMII, CAD, CHF, COPD  Father – Deceased at 52 – MI, CAD  Sibling – Alive – CAD, DMII     Diet: High in carbohydrates, protein; poor in fresh fruits/vegetables.     Occupation: Owns own business – landscaping     Order:  Morphine 0.5mg IV  Aspirin 325mg PO  Nitroglycerin – titrate gtt per protocol  Metoprolol 50mg PO  Oxygen Therapy- maintain O2 > 92%, up to 6L  Thrombolytic Therapy per protocol  Monitor neuro status  Insert 2nd IV  What is the nurse’s priority action?