A 59-year-old African American female is admitted at midnight with a diagnosis of Chest Pain. She complains of a squeezing type
pain across her chest and into her left jaw area. Although she cannot remember exactly when the pain began, she does remember having indigestion and being nauseas after dinner the night before, around 7:30 p.m. Vital signs are: Blood Pressure-200/110; Pulse-128 beats per minute; Respirations- 26 per minute; Temperature-99.8; Saturation of Oxygen-86% on room air; pain level 9/10. During your initial assessment, she is rubbing her mid-chest, grimacing and is diaphoretic. The pain has been occurring intermittently throughout the evening and night. Her color is pale except around her lips which are bluish. Cardiac auscultation reveals a rapid regular rhythm. She has never had this pain before. Lungs sounds are crackles in both bases with clear upper lobes. She is afraid she is going to die. Per standing orders, a nurse administers Nitroglycerine 0.4mg sublingually; applies cardiac electrodes for continuous cardiac monitoring; obtains an electrocardiogram; places a peripheral intravenous catheter with saline lock; positions patient in low Fowlers. On assessment one hour later, vital signs are Blood Pressure-180/95; Pulse-108 beats per minute; Respirations- 22 per minute; Temperature-99.0; Saturation of Oxygen-90% on 2 liters per minute; Pain level 8/10. She says her chest pain hasn’t changed. Heart and lung sounds are unchanged. Color is pale without previous blue changes. EKG displays ST elevation in leads II, III, and AVF. The MD has decided not to perform a cardiac catherization, and has admitted the patient to the ICU with a cardiology consult.
Required:
a. Is the type of pain this patient is having typical or atypical of cardiac type of chest pain?
b. What other types of pain would indicate a cardiac type problem but would not be specifically in the chest area?
c. Describe how women often present with cardiac problems and how they are different from men.
d. What health history information would the nurse assess for this patient?
e. What abnormals are present in the patient's vital signs (first set)?
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