Medical History of hypertension

Mr Kowalski has a past medical history of hypertension (Diagnosed in 2014) which is managed with Perindopril, and he has been advised by his GP to reduce his salt intake and lose weight to help reduce his blood pressure. The ED registrar has requested an ECG, continuous cardiac monitoring, blood tests (total cholesterol, cardiac troponin, FBC and UEC), and has ordered a STAT dose of aspirin 300mg, and sublingual glyceryl trinitrate (GTN) 300- 600mcg every 5 minutes for a maximum of 3 doses.

Patient history: Mr Kowalski migrated from Poland over 40 years ago with his family, and he currently lives with his wife and son (age 18) in the regional city of Ballarat in Victoria. He works full time as a civil engineer and is currently working overtime most weeks, averaging 50-60 hours/week. He states that “work has been incredibly busy” and that he “needs to look after multiple work sites due to ongoing staff sick leave”. He usually smokes 1 pack of cigarettes per week, but recently this has increased to 2 packs per week.

Due to his and his wife’s long working hours, the family eat takeout most days and he states he has gained “some weight” over the past few months. Family history: • • Father passed away in 2015 due to an acute myocardial infarction (AMI). • • Mother had breast cancer in 2020 and is in remission currently. She lives in Poland with her sister. Current medications: • • Perindopril 4mg daily Initial vital observations: • • BP 138/95 mmHg • • HR 106 bpm • • RR 22 bpm • • SpO2 95% on RA • • T 37.2ºC Health assessment findings and laboratory results: • • Height 1.67m, Weight 89kg, excess abdominal fat evident.

Waist circumference 101cm • • Alert and orientated to time, place, and person. GCS 15 • • Cool, dry hands and feet. Moist mucous membranes • • CRT 2 seconds • • Total cholesterol level – 8.0mmol/L • • Cardiac troponin – elevated • • FBC and UEC – results NAD Following the review of his laboratory tests and assessment results, Mr Kowalski has been diagnosed with a NSTEMI.

He is to have serial cardiac troponin done 4-8 hourly, repeat ECG with changes to pain level or cessation of chest pain, and continuous cardiac monitoring. Apply supplemental oxygen if SpO2 < 93%. Administer GTN for chest pain and consider IV morphine if pain not controlled with GTN (please consult with medical staff prior to administration). He also needs to be prepared for an angiogram +/- PCI this afternoon. You are the nurse looking after Mr Kowalski, and you are required to plan his care using the CRC and the provided case study information.

 

Step 1 and 2: Consider the patient situation and identify the key elements of assessment by: Providing an initial impression of the patient and identifying relevant and significant features; discussing in detail, the pathophysiology of the disease and how Mr Kowalski’s signs and symptoms reflect the underlying pathophysiology; identifying the key elements of a comprehensive nursing assessment; Including evidence to support your discussion