Situation:

Mr. Tanner, a 49 year old truck driver, was admitted earlier this morning through the ED for chest pain.
He was admitted to the CCU for R/O myocardial infarction (MI). He has no prior history of cardiac
problems, however, he has been treated for the past 5 years for a total cholesterol of 285(HDL 35, LDL
212).He was prescribed Mecavor, which he doesn't take regularly. He was recently diagnosed with
hypertension with his usual BP 160/96 for which he doesn't take medication. He is overweight and
exercise little. His father died of an MI at the age 50.The nurse enters his room and find him lethargic and
dyspneic.

Vital Signs are:

T- 99.2, P- 110 rapid, thready
ECG sinus tachycardia with frequent premature ventricular contractions (PVC's)
R- 30 cpm BP 106/66
SKIN- pale, cyanotic, cold and moist

Questions:
1. Relate Mr. Tanners current manifestation to the pathophysiology of shock to determine what type of
shock to determine what type of shock he could be experiencing.
2. What is your initial response? Why?
3. What stage of shock is he experiencing?
4. What would be the expected laboratory test that must be done?
5. What are expected medical pharmaceutical treatment or interventions, discuss each treatment
implications the development of progress to your clients condition.
6. Develop and prioritize 5 nursing diagnosis and 3 nursing interventions.
7. Pathophysiology.

ANSWERS:
1. Mr. Tanner manifest chest pain and his ECG result is sinus tachycardia with frequent premature
ventricular contractions (PVC). The type of shock that he is experiencing is cardiogenic shock since it occurs
when the hearts ability to contract and to pump blood is impaired and the supply of oxygen is inadequate
for the heart and tissues. The cause of cardiogenic shock is coronary and non-coronary .Since he is
experiencing MI and it is under the cause of cardiogenic shock coronary.
2. Our initial response would be administer oxygen in 2-3L/min but some book says 2-6L/min but it should
prescribed by the doctor in order to achieve an oxygen saturation of 90 since and his experiencing
tachypnea.
3. He is experiencing a progressive shock.
4. Laboratory test:
After collecting patient health history, a series of EKGs should be taken to rule out or confirm MI.
12 leads EKGs can help to distinguish between ST elevation MIs and Non ST elevation MIs.
Arterial blood gas
5. Medications:
MORPHINE analgesic drugs such as morphine are to reduce pain and anxiety, also has other
beneficial effects as a vasodilator and decreases the workload of the heart by reducing
preload and afterload.
OXYGEN to provide and improve oxygenation of ischemic myocardial tissue; enforced
together with bed rest to help reduce myocardial oxygen consumption. Given via nasal
cannula at 2 to 4L/min.
NITROGLYCERIN first line of treatment for angina pectoris and acute MI; causes
vasodilation and increases blood flow to the myocardium.
 ASPIRIN aspirin prevents the formation of thromboxane A2 which causes plateles to
aggregate and arteries to constrict. The earlier the patient receives ASA after symptoms
onset, the greater the potential benefit.
THROMBOLYTICS to dissolve the thrombus in a coronary artery, allowing blood to flow
through again, minimizing the size of the infarction and presenting ventricular function: given
in some patients with MI.
ANTICOAGULANTS given to clots from becoming larger and block coronary arteries. They
are usually given with other anticlotting medicines to help prevent or reduce heart muscle
damage.
STOOL SOFTENERS given to avoid intense straining that may trigger arrhythmias or another
cardiac arrest.
SEDATIVES in order to limit the size of infarction and give rest to the patient. Valium or an
equivalent is usually given.
6. Nursing diagnosis
Pain related to tissues ischemia secondary to coronary occlusion manifested by complaints of
chest pain, facial grimacing.
- Obtain full description of pain from patient including location, intensity, duration, quality,
radiation.
- Administer supplementary oxygen
- Provide calm and quite environment
Ineffective breathing pattern
- Administer oxygen
- Place the patient in MHBR
- Administer medication as prescribed by the doctor
Impaired Gas Exchange
- Note respiratory rate, depth; use of accessory muscles, pursed lip breathing; note areas of
pallor/ cyanosis
- Place the patient MHBR
- Monitor V/S
Altered tissue perfusion related to reduction to blood flow due to vasoconstriction manifested
by thrombo embolitic formation
- Inspect for cyanosis, cold and clammy skin
- Assess for homans sign erythema and edema
- Monitor laboratory details ABGs
Activity Intolerance
- Encouraged patient to perform exercise
- Position the patient in a comfortable position
- Monitor V/S

7. Prognosis

- Survival from a heart attack has improved dramatically over the last two decades. However, some
people experience sudden death and never make it to the hospital, but since our patient was
admitted to the hospital so the prognosis will be GOOD.