complete the CAD case study for Mr. N.
CASE STUDY: CORONARY ARTERY DISEASE

Mr. N is a 56 year old overweight financial analyst who arrives in the ER complaining of substernal chest pain radiating to his left arm. He has had the pain for 3 hours and thought it was indigestion. His wife insisted that he seek treatment, but he was resistant to coming to the ER. Mr. N has smoked 1 ½ packs of cigarettes/day for 30 years. He has been on a mild diuretic (Hydrochlorothiazide) for the management of hypertension. He states he had an elevated blood sugar during a recent employment physical; but, he has been too busy at work to see his primary physician. His lipid profile shows a cholesterol level of 280, LDL 190, HDL 25. His father died of an MI at age 60.
THE FOLLOWING ORDERS WERE WRITTEN ON ADMISSION:
H&H, CBC, Chem profile, PTT, PT
Cardiac enzymes (CK-MB, troponin) q8 hours x 3
Continuous cardiac monitoring
12 lead EKG upon admission and QD x 2
12 lead EKG with complaint of chest pain
NTG gr 1/150 S.L. may be repeated after 5 minutes max 3 doses
If pain is not relieved by NTG may give Morphine 2mg IVP, may repeat x 1
Lopressor (Metoprolol) 100 mg P.O. qd
O2 via NC 2l/min to maintain SpO2 greater than 92%
VS q 4h and PRN
IV Normal Saline 1000ml @75cc/hr
Daily weights
1800 calorie full liquid 2 Gm Na low cholesterol, no fat, no caffeine diet
Bed rest with OOB to commode with assistance
Aspirin 325 mg P.O. qd

CASE STUDY QUESTIONS
1) What risk factors are present in Mr. N.’s case? Describe which risk factors are modifiable and which are non-modifiable.
2) What would you expect to find on the EKG and enzymes of a client with ischemia that is eventually resolved by therapeutic measures? (no necrosis or cell death)
3) What would you expect to find on the EKG and enzymes of a client with unresolved ischemia leading to a MI (cell death)?
4) Compare and contrast the actions of Lopressor and Aspirin in the treatment of Mr. N.
5) Mr. N. asks about the significance of his cholesterol profile in relation to his CAD. How would you respond?
6) What assessments/diagnostic tests are critical to monitor during treatment with Lipitor?
7) Mr. N’s lab values reveal the following abnormalities:
BUN- 30mg/100 ml and Creatinine- 1.0 mg/dl – both above normal levels
Glucose- 190 mg/ml- high
Serum Potassium – 3.2 mEQ/L – low
What do these labs suggest? Should the nurse report these findings to the physician? What would be appropriate priority interventions?
8) Mr. N’s pain is not relieved after the administration of oxygen, aspirin and nitroglycerin. He is given Morphine Sulfate 2mg IV. His blood pressure is 170/90 and his pain is 5 on a scale of 10. His troponin level returns from the lab and is elevated above normal. The ST segment is elevated in at least 2 leads. What are priority nursing diagnoses and interventions at this time?
9) Are there any contradictions in Mr. N’s history and current lab work that would preclude him from receiving thrombolytic therapy if the ischemia is unresolved? What specific lab work is important to look at?
10) What are the priority nursing diagnoses for Mr. N?

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