Week 1
Nursing Simulation Laboratory
Introduction to Mr. Jones
Mr. Kevin Jones, aged 67 years, is admitted to the cardiac ward with a history of increased frequency of chest pain over the last couple of weeks. His GP prescribed Glyceril Trinitrate (Anginine) 400mcg spray S/L when pain occurs. This medication helped with the chest pain last week but since yesterday the chest pain has been more frequent, occurring at rest and lasts between 10-15 minutes, accompanied by sweating and nausea. His wife has been concerned about him over the last 2 days and has decided to take him to the emergency department.
On presentation to the emergency department Mr. Jones is immediately assessed and admitted. The following actions are undertaken:
- Placed on cardiac monitor
- O2 therapy is applied via a Hudson mask at 10L/min
- S/L Anginine 600mcg given
- 12 lead ECG taken (indicating ischaemic changes)
- IV cannula inserted into right hand and Bloods taken, including cardiac enzymes, troponin, FBC, EUC, Mg
- Initial Observations are taken which are: HR: 92/min, BP: 150/89, RR: 18/min, SpO2: 95%, monitoring in SR.
The patient states to you, “I have pain in the middle of my chest and down my left arm. I also feel nauseated and frightened”. The registered nurse informs the doctor immediately who orders I.V. Morphine 2.5mg and I.V. 10mg Metoclopramide hydrochlorideto be administered immediately. Within minutes Mr. Jones is pain free and feeling less nauseated.
Mr. Jones is reviewed by the cardiologist and has been diagnosed with unstable angina pectoris. The following orders have been written in the patient’s notes:
- Admit
- Anticoagulant Enoxaparin Sodium SC 1mg/kg Daily
- Beta blockers- Metoprolol Tartrate 50mg daily
- Anticholesterol/satins-Atorvastatin Calcium 20mg nocte
- Antiplatelet- Daily Clopidogrel Hydrogen Sulfate 75mg
- Repeat bloods in 8 hours
- For pain: PRN nitrates/morphine
- Strict bedrest
Nursing History
Mr. Jones smokes 20 cigarettes a day; he has been eating a fatty diet and drinks 1 glass of brandy every night before bed. He has suffered from constipation for several years and says he has no urinary problems. Mr. Jones walks with his wife every morning for 1 hour but has been unable to do this for the last couple of months due to painful back after a fall off a ladder. He states he develops chest pain when he exerts himself or gets very stressed.
Social History
Mr. Jones lives at home with his wife and runs his own retail business. He is frightened that his life is over and is feeling very stressed. He lives on a second floor apartment that does not have elevator service.
Observations on the Cardiac Ward
Cardiac monitor- Sinus Rhythm
- HR: 89
- BP: 145/85
- RR: 16
- Wt: 98kg, Ht: 175cm
- U/A: SG 1020, Ph 6.0, NAD
- BSL: 4.8mmol/L
Simulation Laboratory Activities
It is now 1600 hrs and you are the registered nurse assigned to Mr. Jones on the cardiac ward. You have received a handover from the emergency department RN and the initial nursing history, critical pathway and other relevant hospital documentation has been completed. You are required to:
- Perform a full cardiac physical assessment
- Assess Mr. Jones’s chest pain using the PQRST system
- Commence cardiac health teaching
- Document current vital signs
- Write a nursing report at the end of your shift
- Review Multidisciplinary Careplan (MDCP)
Critical Thinking Question
1. Consider what you would do as the RN when Mr. Jones refuses to use a bedpan to open his bowels.
