Quote from ctran
I am stumped on this care plan. My pt woke up c/o chest pain an hour before he arrived to hospital. He was given two NTG by ems prior. He got diagnosed with STEMI and got emergent PCI. Two stents were placed in LAD and an IABP and had a transvenous pacemaker in him and he is on the vent. He had a hx of htn, dm, and high cholesterol. 51 year old.
We have to pick three dx and prioritize which one are the most important. I picked:
Nursing Dx #1
Decreased Cardiac Output r/t myocardial injury secondary to AMI aeb decreased in BP, elevation in HR, dyspnea, dysrhythmias, diminished pulses, pulmonary edema, and elevation in CK-MB and Troponin levels.
Nursing Dx #2
Ineffective Tissue Perfusion r/t cardiac ischemia, interrupted blood flow and impaired transport of oxygen aeb 100% occlusion of LAD, decrease in CO, EF <15, tachycardia, dyspnea, chest pain, and weak peripheral pulses
Nursing Dx #3
Deficient knowledge r/t family unfamiliarity with procedure of PCI and IABP, with new condition: AMI, treatment, and the complexity of the treatment aeb family anxiety and stress about patient current status, family questioning RN about PCI and IABP regarding how the treatment works and how the treatment helps patient, RN providing written information about the treatment and MI, and RN demonstrates to family members how IABP machine looks like and what each signal/button indicates.
But I'm confused because would he still have decrease CO considered he already have a balloon pump? Would he still have ineffective perfusion considered he is on the vent? Is deficient knowledge really an important diagnoses consider all that is going with this patient? I am also stumped that he has bloody drainage around his penis but has no sign of infection. No elevated WBC, no fever, nothing. So what can cause bloody drainage? Low level UTI?, prostate problem?, kindney problem? Please help, I'm pulling out my hair!
I know I have told you before.....the care plan is all about the patient assessment of the patient and how it applies to the patients diagnosis. Are these diagnosis that we provided to you or you gave your patient based on the assessment.http://allnurses.com/nursing-student...ml#post6364564
What is this patients underlying diagnosis?
They came to the ED with a complaint of CP got rushed to the Cath Lab. The patient suffered a massive MI AEB ejection fraction is less than 15% the patient is intubated and on a ventilator and has gone through an invasive intervention.
When a heart attack is bad enough the heart goes into shock..... what is cardiogenic shock? what is the treatment for cardiogenic shock? What is an IABP...what does it do? Is this patient on any meds to elevate the B/P? Are they still having pulmonary edema?
Yes a patient can still have a decreased cardiac output even with the IABP if there was extensive damage to the myocardium...the IABP helps the heart rest and heal but the damage is done.
My question is does this patient still have ineffective tissue perfusion now that they have had their PCI....the blockage is gone correct? Could they have ineffective tissue perfusion related to the poor EF? The balloon pump in the femoral artery to the affected extremity. Are the still having chest pain after the procedure? Could poor perfusion be caused from a poor EF?
I am guessing that this patient coded, somewhere along the line, from a 100% occluded LAD was intubated. They suffered a massive MI went to cath lab had a PCI.....despite intervention the remained unstable and in cardiogenic shock a balloon pump was inserted and the patient transferred to ICU. I will bet he has a foley and sometimes if a male has an enlarged prostate it is difficult to pass they foley and if there is some trauma upon insertion that can lead to some bleeding around the meatus. OR they are hypercoagulated due to the procedure and IABP and need their coags rechecked. Knowledge deficit can be the patient and the family. Their loved one is critically ill...their lives have changed forever.
so tell me about your patient.....what is a priority for this patient. nursing care plan