Assignment: Case Study Nursing Interventions arrived at Emergency department

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Assessment
Case study

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1.
The order of nursing intervention based on the condition is 2, 3, 4, 5, and 1.
(the breathing rate is low that why 2 that will manage the breathing, cardiac monitoring that will
show beats and breathing rate improvement, in case reliable results is not there 12-lead ECG,
blood pressure and systolic BP and lastly collection of blood for pathology). (Felton et al., 2019)
2.
Central crushing chest pain with radiation to the jaw is defined as the pain that is located in the
right or either left chest. It can be symptoms of the condition or an indication that a particular
condition is there (New South Wales, 2019). Radiation of the chest pain to the jaw is the severe
one that is indicating the serious condition of the patient and indicates the risk of life. In case the
patient is facing such sort of pain, the probability is there that there are heart condition lies or
there is any blockage present.
- ST elevation indicates the total blockage of the coronary artery and implies that heart muscle is
currently dying. ST elevation in an ECG can be seen if the vertical distance inside the ECG trace
and the baseline are at the point of 0.04 seconds followed by the J-point that is at least at 0.1 mV
(Khan et al., 2018). It shows the current injury in the heart cells. Pathogenesis of ST elevation
shows that it takes place due to the occlusion in one or more arteries that is leading to the
myocardial injury.
Elevated troponin (35ng/l), troponin is the diagnostic marker present that is indicating the
damage to the heart. A very high level of troponin indicates a sign of heart attack. In the majority
of patients, the level of troponin gets rises within the 6 hours of the heart attack (Bhatia et al.,
2019). The range of the troponin is indicative that there is a severe problem lies with the heart.
3.
Category 2 pharmacological intervention is provided to the patient to take control over the
symptom that is imposing the risk to the life. In addition, the medication administration will lead
to the regain of the vitals in the patient.
Morphine (IV) is the drug present that is provided to the patient suspected of any kind of heart
problem. The action of the drug is related to the residual platelet activity. It gives relief to the
chest pain when there is the presence of ST elevation. The rationale for giving the drug is that it
will lead to the dissolution of the clot if anyone is present in the vessel (Guo et al., 2019). In
addition, it controls the sensation of the pain with the binding to the CNS.
Nitroglycerin is a vasodilator drug that serves the primary function in terms of relieving chest
pain in the case of angina chest pain (radiation to the jaw). The rationale for using the drug is that

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it will lead to the formation of the free radical of nitric oxide that further activates the guanylate
cyclase that is resulting in an increase in the GMP in the smooth muscle and tissue. It gives rise
to the contractile movement in the smooth muscle (Szőke et al., 2019). The drugs are provided
with the sublingual route of administration that is leading to rapid absorption in the blood. The
mean peak value of the drug is going to attain in the time of 6 to 7 minutes the post-dose of the
drug. The comparison of the route of administration of drug shows that it is the sublingual one
that is creating an instant effect. That's why in this case also the patient is provided with the SL
route (Aggarwal, 2021).
Aspirin is used to reduce the fever and moderate rate of pain that is taking place due to muscle. It
is also a type of blood thinner that is having the ability to reduce the red blood cells to clump
together. In this case, the medication is provided so that if there is any kind of clotting or blood
dynamic gets changed it can be improved (Batchelor et al., 2020).
Heparin is used to prevent or treat blood vessels or heart conditions. It acts as a drug that
prevents blood clotting in the vessel. The medication is sued in the treatment of heart attacks and
unstable angina. The rationale behind using the drug involves the acceleration of the rate of
coagulation factor by anti-thrombin (Zhu et al., 2022).
Clopidogrel is the class of medication present that is considered antiplatelet medication. It works
with the prevention of collection and forming clots that are resulting in a heart attack or stroke.
The rationale for giving the drug is that it will lead to a reduction in platelet aggregation
(Buckley, 2019). In addition, it will help in the clearance of the passage that will lead to the
effective flow of the blood. With the sake of this pharmacological intervention, the main
causative of the situation can be overcome.

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References:
Batchelor, R., Liu, D. H., Bloom, J., Noaman, S., & Chan, W. (2020). Association of
periprocedural intravenous morphine use on clinical outcomes in ST‐elevation
myocardial infarction (STEMI) treated by primary percutaneous coronary intervention:
Systematic review and meta‐analysis. Catheterization and Cardiovascular
Interventions, 96(1), 76-88. https://doi.org/10.1016/j.ejps.2019.02.020
Bhatia, S., Anstine, C., Jaffe, A. S., Gersh, B. J., Chandrasekaran, K., Foley, T. A., ... &
Anavekar, N. S. (2019). Cardiac magnetic resonance in patients with elevated troponin
and normal coronary angiography. Heart, 105(16), 1231-1236.
http://dx.doi.org/10.1136/heartjnl-2018-314631
Buckley, T. (2019). Alterations to cardiovascular function across the lifespan In J, Craft. C,
Gordon. S, Heuther. K, McCance. V, Brashers. & N, Rote. Understanding
pathophysiology (3rd ed., pp 627-634). Australia: Elsevier.
https://www.elsevier.com/books/understanding-pathophysiology-anz/craft/978-0-7295-
4264-7
Guo, M. Z., Wang, T. Y., Yang, J., Chang, H., Ji, S., & Tang, D. Q. (2019). Interaction of
clopidogrel and fufang danshen dripping pills assay in coronary heart disease based on
non-target metabolomics. Journal of Ethnopharmacology, 234, 189-196.
https://doi.org/10.1016/j.jep.2019.01.030
Khan, E., Brieger, D., Amerena, J., Atherton, J. J., Chew, D. P., Farshid, A., ... & Chow, C. K.
(2018). Differences in management and outcomes for men and women with ST‐elevation
myocardial infarction. Medical Journal of Australia, 209(3), 118-123.
https://doi.org/10.5694/mja17.01109
New South Wales. (2019). Pathway for Acute Coronary Syndrome Assessment (PACSA).
https://www1.health.nsw.gov.au/pds/ActivePDSDocuments/GL2019_014.pdf
Szőke, K., Czompa, A., Lekli, I., Szabados-Fürjesi, P., Herczeg, M., Csávás, M., ... & Tósaki, Á.
(2019). A new, vasoactive hybrid aspirin containing nitrogen monoxide-releasing
molsidomine moiety. European Journal of Pharmaceutical Sciences, 131, 159-166.
https://doi.org/10.1002/ccd.28561
Aggarwal, P. (2021). High-Dose Nitroglycerin Bolus for Sympathetic Crashing Acute Pulmonary Edema: A
Prospective Observational Pilot Study. The Journal of Emergency Medicine, 61(3), 271-277.
https://doi.org/10.1016/S0140-6736(00)03539-X
Zhu, H., Hu, J., Dong, Z., Liu, Y., Sun, X., & Sun, A. (2022). ALDH2 mutation results in excessive basal
nitric oxide production and a delayed response to nitroglycerin. Cardiology Plus, 7(2), 85-91.
https://doi.org/10.2147%2FOAEM.S340513

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Felton, L. A., Lauber, D. A., Koury, J., & Nawarskas, J. J. (2019). Readers' Comments An Explanation for
the Effect of Different Storage Conditions on Sublingual Nitroglycerin Tablet Stability. The
American Journal of Cardiology, 124(6), 990.
https://www.proquest.com/openview/d68a5e356fec50dac86bf803fdfc090d/1?pq-
origsite=gscholar&cbl=41200