Mr. Jones, a 38-year-old white male with no known previous chronic illness, was admitted six hours ago after being involved in a single motor vehicle accident. He was the unbelted driver of a vehicle that skidded off the road and hit a tree at approximately 45mph. He reported losing consciousness at the scene. Mr. Jones was admitted in stable condition with a diagnosis of myocardial contusion and fractured ribs (4,5, & 6) on the left thorax.
Vital signs on admission were:
-BP 138/84
-P 80
-R 18
-T 98 degrees F.
Past Medical History: No chronic illness. No previous hospitalizations. No medications. Patient is a non-smoker and does not drink ETOH.
Family History: Father died at the age of 50 from a "heart attack". Mother is alive and has lung cancer. No siblings.
Patient: Mrs. Smith
Mrs. Smith, a 64-year-old female with known coronary artery disease, was admitted for coronary artery bypass surgery. Her risk factors for arteriosclerosis include a strong family history, smoking, and hypertension. She has been admitted to the CCU several times with angina. Cardiac catheterization demonstrated a high grade (>90%) stenosis of the left anterior descending (LAD) artery. Surgery was performed 3 days ago with a left internal mammary artery (LIMA) graft.
Mrs. Smith stayed in the Cardiovascular Surgical Intensive Care Unit (CVSICU) for two days. On the second day, her Swan-Ganz catheter was removed, IV medications tapered off, and her Foley catheter removed. On this, the third day, Mrs. Smith was transferred to the step-down unit with a heparin lock IV in place.
The Situation
Welcome to the night shift!
You are an experienced nurse working with three new graduate nurses on a 16-bed multitrauma acute care unit in a remote community hospital. You just finished receiving a brief report on your patients and return to the main nursing station to find two call lights activated. You answer both lights over the in-room intercom, asking the patients what they request.
Patient A, Mr. Jones, states that he is experiencing difficulty breathing.
Patient B, Mrs. Smith, states that she is experiencing chest pain.
Your shift is only 30 minutes old, and it appears that it will be a long night!
