Problem
Junetta's husband brought her to the emergency department this morning at 0815 because she was experiencing angina unrelieved by nitroglycerin. She was evaluated in the emergency room and is now awaiting cardiac catheterization tomorrow to assess the extent of the coronary artery disease.
Mrs. Cooper is a 75-year-old African American woman who has had primary hypertension since age 55. She has a 1-year history of stable (exertional) angina pectoris secondary to coronary artery disease (CAD). Her blood pressure has been treated with antihypertensive drugs. Her pain has been successfully controlled with the nitroglycerin patch and sublingual nitroglycerin tablets.
When she arrived at the ED, vital signs were BP 154/90 mmHg, HR 90/min, RR 14/min, and SpO2 96%. The first set of cardiac enzymes was negative, and she had no ECG changes indicating that she was not experiencing a myocardial infarction, but the angina pain persisted intermittently. The provider ordered sublingual nitroglycerin, morphine, and aspirin to relieve her immediate symptoms and clopidogrel and fondaparinux as a safety precaution. She is not complaining of pain currently. She took her daily meds for hypertension at home before coming here. The provider included her home meds in the orders, as she will need to continue these while she is here. Oxygen is running at 1 L/min by nasal cannula, and an IV with lactated Ringer's and 5% dextrose is infusing at 100 mL/hr.
Mrs. Cooper's vital signs are continuously being monitored and documented every hour, and she is due for pain and vital signs assessment per the provider's orders.
Task
A. Tell us about your client. What were your professional findings of Junetta Cooper, including chest pain (location, quality, severity, factors that make pain worse/better, associated symptoms: nausea, vomiting, or dizziness) and vital signs?
B. What medications did you administer during the simulation experience?
C. What education did you provide regarding the medications you administered?
D. What additional teaching points should be provided prior to discharge?