Help with Care Plan for R/O MI, rule out myocardial infarction

[NurseLady78]

i need some help with prioritizing 2-3 nursing dx including 1 short term and 1 long term goal for each dx.

i am an lpn that has been working in pre-op for years and i haven't done a care plan in years, my job is pretty routine and even when complications occur we act not write about it, lol.

i was given this scenario in school so there was no actual assessment done and i have no additional information, please help with any suggestions. we were told we will be doing a teaching plan which i can work on his smoking cessation and nutrition status. we also were told we cannot use a 'knowledge deficit' as a dx on this care plan.

i remember that the dx should be prioritized, and to use "related to" as "as evidenced by" and site where the rationale came from but i am having a real difficult time getting started, please help!!!

scenario:

time is 1900 hrs. you are working in a small, rural hospital. it has been snowing heavy all day, and the medical helicopters at the large regional hospital medical center, 4 hrs away by car (in good weather), have been grounded until morning. the roads are barely passable. "w.r.", is a 48 yr old male, works construction w/ a 36 pack a year smoking history, is admitted to your floor with a diagnosis of rule out myocardial infarction (r/o mi). he has significant male pattern obesity ("beer belly", large waist circumference) and barrel chest, and he reports a dietary history of high fat food. his wife brought him to the er after he complained of unrelieved "indigestion". his admission vitals were 202/124, pr 96, rr 18 and temp 98.2 f. w.r. was put on oxygen by nasal cannula titrated to maintain sao2 over 90%, and an iv of nitroglycerin was started in the er. he was also given aspirin 325mg and admitted to dr a's service. there are plans to transfer him by helicopter to the regional medical center for cardiac catheterization in the morning when the weather clears. meanwhile you have to deal with the limited laboratory and pharmacy resources. the minute w.r. comes through the door of your unit, he announces he's just fine in a loud and angry voice and demands a cigarette.

help is much appreciated:)))

[JROregon, ASN, BSN, RN]

So, what assessments or actions would you take/do first? It would usually take me an hour or more to think through 3 nursing diagnoses and come up with goals. Do you have a nursing diagnosis handbook perhaps?

[NurseLady78]

I have a care

[NurseLady78]

I have a care plan book but nothing in r/o MI with only the B/P being elevated. I'm think something with decreased tissue perfusion AEB high B/P but I can find a source to help filter through that thought??? I could figure out goals and interventions but getting the prioritized dx is my issues. Any ideas? Thxs for the help!

[NurseLady78]

*can't find s source.

[AgentBeast, MSN, RN]

Getting the patient to calm down would be something to look at as it's probably only exacerbating his situation. Although other than the saying "I'm fine" when the evidence says otherwise in a loud and angry voice and demanding a cigarette aren't really enough evidence to support anxiety.

You prioritize things by Airway, Breathing, Circulation then by targeting the "root" cause. What I mean by that is that you wouldn't diagnose a patient as being a Risk for Impaired Skin Integrity when the reason they are at Risk of Impaired Skin Integrity is because they have Urinary Incontinence.

[NurseLady78]

I totally understand your response, I'm still kinda stuck tho???