Examples Of Unfolding Case Study

NOTES FOR CASE STUDY #1
Create an unfolding case study that focuses on a common condition seen in your area of specialization. The case study should provide information on a fictitious patient and information about one or more health problems that will need to be solved
The unfolding case study must challenge the student and ask questions that encourage critical thinking and problem solving with an emphasis on assessment. The answers to the questions should be complete and include professional literature to support answers
Identify the audience for the case study; it may be an undergraduate nursing student, a novice RN, or a staff RN inservice
Prepare a presentation of your unfolding case study
The unfolding case study must have a minimum
of four (4) references. References should include current nursing journals and other professional medical or related literature
Post a copy of the presentation on the discussion board and place a copy in the digital drop box for that assignment

The assignment will be graded using the following criteria:
Unfolding Case Study Creation Grading Criteria
Possible Score
The infarction is evidenced by eventual elevation of cardiac enzymes (troponin and/or creatine kinase isoenzyme MB [CK-MB]) and ECG changes including ST-segment depressions, inverted T waves, or (the most common finding) non-specific ST-segment changes.
In contrast, a STEMI typically occurs when this same process leads to complete occlusion of a coronary artery with transmural, or full thickness, myocardial wall infarction. The ECG will show ST-segment elevations in the area of the heart fed by the affected blood vessel(emedicine, 2009).

Student learning objectives for this case
15
Assessment
History of Present Illness and Chief Complaint: This patient is a 50 year old female
Past Medical History: Hypertension, high cholesterol and triglycerides.
Family History: Hypertension and high cholesterol
Social History: Nonsmoker, 30 pounds overweight, stressful job, married, does not use drugs, and has 3 young adult children.
Physical Examination: pale, slightly diaphoretic, left side chest pain, neck pain, nausea and vomited x1 prior to arrival. Elevated blood pressure 170/95, heart rate of 90, respiration rate of 24, oxygen saturation of 93% on room air.
Laboratory, Imaging, etc.: Troponin of 0.12, ST elevations noted on EKG, clear chest x-ray.
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Plan of Care
What differentiates STEMI therapy from treatment of other cardiac ischemic conditions is the primary focus on immediate reperfusion with percutaneous coronary intervention (PCI) performed in a cardiac catheterization laboratory or with fibrinolytic agents given intravenously (emedicine, 2009). Pharmacological Treatments:.
Be treated with several medications that protect your heart and relieve pain. These may include a beta blocker, nitroglycerin, and morphine. You will also be given an aspirin tablet to chew, if you haven’t taken one already(cardiosmart,2013). Antiplatelet agents
Aspirin should be administered to all patients unless contraindicated and as mentioned earlier, initial dose of chewed non-enteric aspirin from 162 to 325 mg is recommended. The subsequent dose of aspirin can be 75 to 100mg daily on a long term basis. GI bleeding appears to increase with higher doses.
Clopidogrel is recommended in all patients with an immediate dose of 300 mg followed by 75 mg daily.
In patients considered for a PCI, a loading dose of 600 mg is advised to achieve more rapid inhibition of platelet function. Clopidogrel should be maintained for at least 12 months unless there is an excessive risk of bleeding.
All patients should receive medications to relieve pain. These may include opioid analgesics (morphine sulfate intravenously) where available. Sublingual or intravenous nitrates should be administered if systolic blood pressure is ≥120 mm Hg. If systolic BP is ≥100 mm Hg but less than 120 mm Hg, nitrates must be administered cautiously. Non-steroidal anti-inflammatory drugs (NSAIDs, other than aspirin) should not be given for analgesia (Lal, 2011).
Reducing the total time to reperfusion--the time from the first chest pain or other symptoms to reperfusion in the cath lab--is a critical goal for providers and researchers trying to improve outcomes in patients suffering an ST-segment elevation MI (STEMI).

Non-Pharmacological Treatments: Have blood tests called cardiac biomarkers to check for damage to your heart muscle
Have an electrocardiogram (ECG) to evaluate your heart’s rhythm and look for abnormalities in the heart’s electrical system(cardiosmart,2013).

25
Case Study
Questions

Where is the ST elevation on this ekg rhythm stip? What are the syptoms of a STEMI? What is a STEMI?

Problem Identification:
Desired Outcomes: Reperfusion of the cardiac tissue, Primary percutaneous coronary intervention (PCI) remains the recommended method of reperfusion when it can be performed in a timely fashion by experienced operators (American heart, 2013).
Plan: STEMI are treated by clot-busting medications, or by a set of interventions called PCI (percutaneous coronary interventions). Clot-busting drugs may be administered instead of, or in addition to, an angioplasty or other PCI. In some cases, the STEMI team can deliver the medications directly to the blockage, speeding their impact.
The most commonly used PCI are angioplasty and stenting. During an angioplasty, the cardiologist inserts a balloon-tipped catheter into the patient’s heart. When the catheter is close to the blockage, the balloon is inflated, dislodging the blockage from the artery. Since this process can damage the artery walls, the doctor will often place a stent in the artery. The stent is a thin mesh tube that holds the artery open and provides support while it heals.
Method of Evaluation: What does the patient look like? What are the symptoms? What is the medical history? What are there vital signs?
Patient Education:
25
Clinical Pearls
5
References
5
Total Score

REFERENCES: https://www.cardiosmart.org/Heart-Conditions/Guidelines/Heart-Attack-Guidelines 1/15/2013 12:00:00 AM

1. http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=192
2. When Treating STEMI, Every Second Counts June 15, 2010 | retrieved from: http://blog.rmchealth.com/2010/06/15/when-treating-stemi-every-second-counts/
Approach to STEMI and NSTEMI, Lal C Daga1, Upendra Kaul2, Aijaz Mansoor3 © SUPPLEMENT TO JAPI • dEcEMbEr 2011 • VOL. 59 retrieved from: http://www.japi.org/december_special_issue_2011/04_approach_to_stemi.pdf
3. Lewis,M. (2013). Mnemonic Monday: MONA + LMNOP – What to do 1st when your patient has a “broken heart”… - retrieved from: http://www.firstaidteam.com/6617/mnemonic-monday-mona-lmnop-what-to-do-1st-when-your-patient-has-a-broken-heart http://www.uptodate.com/contents/heart-attack-recovery-beyond-the-basics. Nov 20, 2012. AuthorsJulian M Aroesty, MDJoseph P Kannam, MD
REFERENCES
Aroesty,J. (2012). Patient information: Heart attack recovery (Beyond the Basics). Retrieved from: http://www.uptodate.com/contents/heart-attack-recovery-beyond-the-basics.

Heart Attack Treatment Guidelines. Retrieved from: http://my.americanheart.org/professional/Library/2013-STEMI-Guideline-Data-driven-Recommendations_UCM_447559_Article.jsp https://www.cardiosmart.org/Heart-Conditions/Guidelines/Heart-Attack-Guidelines (2013) http://www.ebmedicine.net/topics.php?paction=showTopic&topic_id=192 Lal,C. (2011). Approach to STEMI and NSTEMI. Retrieved from: http://www.japi.org/december_special_issue_2011/04_approach_to_stemi.pdf
Lewis,M. (2013). Mnemonic Monday: MONA + LMNOP – What to do 1st when your patient has a “broken heart”… Retrieved from: http://www.firstaidteam.com/6617/mnemonic-monday-mona-lmnop-what-to-do-1st-when-your-patient-has-a-broken-heart