F.M. is a 68-year-old white man who comes to the emergency department (ED) in the early afternoon with a 2-day history of severe chest pain. The pain started on wakening the previous day. The pain increased during the night, but his wife could not convince him to go to the hospital. He comes to the ED today because the pain is severe and no longer relieved by rest.
• Describes recurring chest pain for the past 6 months that was relieved by rest; the pain is a feeling of heaviness in chest with no radiating pain to arm or jaw or accompanying nausea or dizziness
• Recently the chest pain has become severe and is no longer relieved by rest; is now slightly nauseated
• His father died of a heart attack at age 62 years
• Denies alcohol or drug use
• Smokes one pack of cigarettes per day
• Describes his lifestyle as sedentary
• Blood pressure 180/96, pulse 98, temperature 99.8°F, respirations 20
• Height 5’11”, weight 210 lb, BMI 29.3 kg/m2
• Alert and oriented to person, place, and time
• Skin diaphoretic and clammy
• Heart rhythm regular, no murmurs or extra heart sounds
• Lungs are clear to auscultation
• Hemoglobin 14 g/dL
• Chemistry panel is normal
• Cardiac markers – pending
• Electrocardiogram showing changes that correlate with non–ST-segment–elevation myocardial infarction (NSTEMI)
• 0.9% NaCl infusing into IV catheter at 75 mL/hr.
Nitroglycerin and morphine given with relief of pain
1. What are F.M.’s modifiable risk factors for coronary artery disease (CAD)? What are his nonmodifiable risk factors?
2. What is the difference between chronic stable angina pain and pain associated with myocardial infarction (MI)?
3. What diagnostic studies are indicated for F.M.?
Case Study Progression
F.M. is diagnosed as having an MI.
4. What is the priority nursing care for F.M.?
5. What other interventions do you anticipate for F.M. at this time?
6. What are common complications after an MI?