You are working in a rural hospital with 10 beds. There are only three patients in the department, two of whom are being stitched up and are ready...

Question Answered step-by-step You are working in a rural hospital with 10 beds. There are only threepatients in the department, two of whom are being stitched up and are ready for discharge. You are working as a third nurse helping out.You receive the following report from the night shift:”Your only real patient is Mr. D., a 56 year-old man admitted yesterday with a fractured hip post fall. His vital signs are stable and his pain is under control. He is awaiting transfer to the regional hospital for surgery.” 1. What are your initial thoughts? Specifically, what more information do you need about his history leading to admission?You introduce yourself to Mr. D who appears awake and alert. Here are your Primary Assessment findings:A: Speaking clearlyB: RR 22, non-laboured, lying semi fowlers, colour pinkC: HR: 108, skin pink warm and dryD: Alert, oriented x 3, complaining of chest pain 5/10, 2/10 hip painF: BP 140/90, SPO2: 95% on room air, T: 362. Would you consider Mr. D sick or not sick? Stable or unstable? Provide rationale. You do an initial assessment of Mr. D.’s chest pain, which reveals:Location: Central chestOnset: Sudden about 1 hour agoType, Timing: Tightness and sharp at times, constantAggravating and Alleviating factors: Sharp pain increases with deep breath, nothing makes tightness better or worseRadiation: Radiates to left breastPrecipitating Event and Past History of Same: Started after moving in bed upon awakening, never had this beforeSeverity: 5/10PRN – Use your notes/review material from N 421 Decreased Cardiac Output Module. If you have not already watched this video (in N 421), please do! https://www.youtube.com/watch?v=2kLlhlsesRQ3. Answer the following questions in the table below: a. Name and prioritize three possible causes of Mr. D.’s chest painb. List all of the questions about Associated Symptoms that you will ask Mr. D. in order to rule in/rule out EACH possible cause of his chest pain (hypothesis) c. List any other questions that you would ask Mr. D to rule in/rule out each hypothesesd. List two (2) diagnostics that you would anticipate being ordered for EACH possible hypothesis. Briefly explain rationale for each diagnosticPossible HypothesisAssociated Symptoms QuestionsOther QuestionsDiagnostics1.2.3.Mr. D is diagnosed with a ST Elevation MI (STEMI). He continues to complain of chest pain associated with SOB nausea and palpitations. He now appears alert and anxious, his skin is slightly pale, warm and clammy. VS: HR: 112, RR 22, BP: 190/95. The physician is considering giving Mr. D thrombolytics to open up the clot in his coronary artery. In the meantime, the physician orders the following:ASA 160 mg PO chewedClopidogrel 300 mg PONitroglycerin 0.4 mg spray SL PRNMetoprolol 5 mg IV x 3Use the following resources (and others PRN) to answer questions 4-7:a. Read this short editorial on MONA in treatment of acute MI: https://www.onlinecjc.ca/article/S0828-282X(15)01566-4/pdfb. Review relevant sections of Myocardial Infarction Treatment & Management Section on Emedicine, located at: https://emedicine.medscape.com/article/155919-treatment#d254. Which medication would you administer first and why? 5. Based on his presentation and the absolute/relative contraindications for thrombolytics, should Mr. D be given thrombolytics? Provide rationale. 6. What is the most common adverse effect of receiving thrombolytics? Where would this adverse effect be most detrimental? What would be an initial sign of this complication? 7. What are the indications for a Percutaneous Coronary Intervention (PCI)? Use the following article (or your notes from N 421 or other resource on Cardiogenic Shock) to answer the questions 8 & 9: https://nurseslabs.com/cardiogenic-shock/8. Briefly explain 4 of the following S&S of Cardiogenic shock (why they occur):· Hypotension· Urine output < 30 ml/hour· Cool, clammy skin· Tachycardia· Crackles in lungs on auscultation· Tachypnea· Jugular vein distension (JVD)· Confusion, restlessness9. Name the pharmacological classification of the each of the following medications and briefly explain their purpose in cardiogenic shock management:· Nitroglycerin· Furosemide· Dobutamine· Morphine Health Science Science Nursing NURSING 443 Share QuestionEmailCopy link Comments (0)