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Dynamic Health in Practice: Myocardial Infarction
Male Nurse: The ED has been busy, and I get called in early to start a twelve-hour shift.
I’m immediately assigned a patient with chest pain on arrival who is being taken via wheelchair to an observation room by a nurse resident.
I have a few minutes to review information before entering the patient’s room.
I turn to the workstation and sign into Dynamic Health to access and review the Chest Pain sign-symptom topic as a refresher.
I immediately see the important red flags and review the media graph related to common symptoms associated with chest pain.
I then navigate to the Care Interventions section of the topic.
Here, I can quickly identify assessment, care goals, interventions, and diagnostic tests for a patient with Chest Pain.
After introducing myself to the patient, I take a rapid, focused history of the patient’s present illness including onset, duration, characteristics, and severity of pain, recent illness or injury, exposure to drugs or chemicals, other medical conditions and medications.
The patient is fatigued and in acute distress, and complains of chest and upper abdominal pain, which they refer to as “like indigestion”.
I remember from the quick review I did before entering the patient room that these symptoms can indicate cardiovascular issues in women.
I assess vital signs and perform a focused assessment.
The patient’s blood pressure is low and their heart rate is elevated, but I auscultate no extra heart sounds or murmurs.
They are placed on continuous cardiac monitoring and supplemental oxygen at 5 liters per minute via a face mask.
I immediately perform a 12-lead ECG and discuss the results with the ED physician.
The 12-lead ECG suggests myocardial ischemia, so I realize time is of the essence.
It is determined that the patient needs angiography and revascularization, so I work with the nurse resident to prepare the patient for percutaneous transluminal coronary angioplasty, or PTCA, with probable stent placement.
As the patient is readied for the cardiac catheterization lab, I mentor the Nurse Resident.
I instruct them to print off the Skill checklist for “Interpreting a Cardiac Rhythm Strip in Adults” as well as “Interpreting a 12-Lead Electrocardiogram in Adults from Dynamic Health and read through the skill and procedure steps.
I ask the nurse resident to perform a focused patient assessment and interpret the patient’s cardiac rhythm strip.
I review the nurse resident’s performance and sign off on their competency checklist.
My patient is taken to the cardiac catheterization lab for the procedure.
I provide a hand-off report and the patient enters the cath lab for the procedure.
Female Nurse: I’m the nurse caring for the patient after a successful PTCA procedure.
I need a refresher on the prevention of potential complications associated with PTCA as this is my first day back to work after being on medical leave of absence.
I use my mobile device to navigate quickly to pull up the PTCA intervention topic in Dynamic Health.
I am not as familiar with the adverse effects related to the procedure, so I use the drop-down accordion to find additional information about what to monitor for to prevent complications.
I then review the patient’s care plan and medical record for specific clinician orders, and I see there is an order to remove the femoral arterial sheath when the activated clotting time is less than 150 seconds.
I quickly pull up the skill topic on removing a femoral arterial sheath to see what additional assessment information I need before making plans to pull the sheath.
I also learn that the patient will be prescribed antiplatelet therapy on discharge so I access the drug monograph to get information on dosing, contraindications and adverse reactions.
I go into the patient’s room, introduce myself, check the patient’s vital signs, and perform a focused cardiovascular assessment.
I check the dressing over the femoral sheath for bleeding, palpate for masses, auscultate for bruits, and remind the patient to keep their leg straight.
I palpate the pedal pulses to ensure good circulation to the affected leg.
I use our point-of-care system to assess the patient’s ACT, which comes back at 140 seconds.
I review the skill topic again to ensure that I am following evidence-based practice guidelines regarding arterial sheath removal, then remove the sheath without incident.
The patient is ordered to remain on bedrest for 2 hours after sheath removal, so I spend a portion of that time reviewing patient-family education recommendations from the Care Interventions topic for PTCA.
During the engagement, the patient asks me questions about what the stent looks like in her body.
I use the images in Dynamic Health to show the patient and explain how the procedure was done.
We also review signs and symptoms to report to the provider and follow-up care.
At the end of my shift, I spend a few minutes claiming Continuing Education credit for the topics I reviewed in Dynamic Health while caring for my patients.
This will help with my re-licensure and certification.
Throughout this shift, Dynamic Health has been a trusted advisor to all of the nurses involved in the care of our patient by providing us with evidence-based best practices, resources to strengthen our own skills, and reliable information to deliver the best care possible for our patient and their family.