City of San Fernando 2500 La Union
College of Nursing
NCM 103 First Semester School Year 2013 – 2014
Case Study: Management of Patients With Dysrhythmias and Conduction Problems
Abby, is 21 years of age and is a female patient who received a permanent atrial-ventricular pacemaker for the diagnosis of sick sinus rhythm, a disorder that leads to periods of tachycardia and periods of extreme bradycardia or sinus arrest. The nurse received the end-of-shift report and arrives at Ms. Abby’s’s room where she assesses the patient’s incision dressing on the upper left chest and it is dry. The patient’s left arm is edematous and ecchymotic and twice the size of the other arm. The patient states that her left arm feels numb and tingling. The distal pulses are present and at baseline. None of the findings were noted in the end-of-shift report.
1. What nursing management should the nurse provide immediately? 2. Explain the general care of the patient after receiving an implanted pacemaker.
Case Study: Management of Patients With Coronary Vascular Disorder
Eduard Karlo is 55 years of age and is a male patient who is admitted to the emergency department via ambulance with acute onset of midsternal chest pain radiating down the left arm and radiating up the left side of the neck. The patient complains of shortness of breath and is cool, pale, and diaphoretic. The vital signs include: BP 160/90, HR 110, R 26, and T 99°F. The 12 lead ECG reveals an anterior wall ST-elevation myocardial infarction (STEMI).
1. What first actions should the nurse take after the patient has arrived in the emergency department? 2. The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention (PCI) in less than 60 minutes from the door-to-balloon time. Explain the reasoning for this action based upon evidence- based guidelines and