CXA240 : Pathophysiology for Health Care – Lucy Ng Case Study – Health Assignment Help

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Assignment Task :

Lucy Ng, a 58-year-old age-care worker, presents to the emergency department with complaints of severe  substernal chest pain. Mrs Ng states that the pain began after lunch, about 4 hours ago. She initially  attributed the pain to indigestion. She described the pain, which now radiates to her jaw and left arm, as  ‘really severe heartburn’. It is accompanied by a ‘choking feeling’, severe shortness of breath and  diaphoresis. The pain is unrelieved by rest, antacids or three sublingual glyceryl trinitrate tablets (0.4 mg). 

Mrs Ng’ medical history includes type 2 diabetes, stable angina and hypertension. She has a 25-year history  of cigarette smoking, averaging 1.5 to 2 packets per day. Family history reveals that Mrs Ng’ father died at  age 42 of AMI and her paternal grandfather died at age 65 of AMI. Mrs Ng is taking the following  medications: metformin, hydrochlorothiazide, atorvastatin, and isosorbide mononitrate.  

 

IMMEDIATE INTERVENTIONS 

Oxygen is started through a Hudson mask at 5 L/min because SpO2 is noted to be 92%. Central and  peripheral intravenous lines are inserted. Glyceryl trinitrate is infusing at 200 μg/min. A 12-lead ECG is  obtained. The registrar requests the following tests: cardiac troponins, CK and CK isoenzymes, VBGs, FBC,  urea and electrolytes, and coagulation profile. Intravenous morphine relieves Mrs Ng’s pain.  

Based on ECG changes and cardiac markers, an acute anterior MI is diagnosed. Mrs Ng is administered  300mg of aspirin and 600mg of clopidogrel, orally. She is referred for emergency percutaneous stenting,  after which she will be transferred to the coronary care unit (CCU). 

 

ASSESSMENT  

Mrs Ng is alert and oriented to person, place and time. Vital signs are T 37.5°C, HR 118, RR 24 with adequate  depth and BP 172/92. Auscultation reveals an S4 and fine crackles in the bases of both lungs. The ECG shows  sinus tachycardia. Her skin is cool and slightly diaphoretic. Capillary refill is less than 3 seconds and  peripheral pulses are strong and equal. Her nail beds are pink.  

The peripheral intravenous line has a saline lock. Mrs Ng states, ‘The pain is better since the nurse in the ED  gave me a needle. But it has been coming and going. I would rate it a 4 right now, but it was terrible before. The doctor told me that this procedure I’m having will quickly open up the artery that is blocked. I hope it  works! Do many people have this done?’  

 

DIAGNOSIS  

• Hypoxaemia related to impaired myocardial function. 

• Risk of decreased cardiac output related to altered cardiac rate, rhythm, and contractility. 

• Acute pain related to ischaemic myocardial tissue.  

• Anxiety and fear related to change in health status.  

 

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