The priority nursing action for a patient arriving at the ED in distress is always an assessment of vital signs. This indicates the extent of the physical compromise and provides a baseline by which to plan further assessment and treatment. Monitor vital signs every 5 min during the initial anginal attack. Blood pressure may initially rise because of sympathetic stimulation, then fall if cardiac output is compromised. Tachycardia also develops in response to sympathetic stimulation and may be sustained as a compensatory response if cardiac output falls.

Option A: A thorough medical history, including the onset of symptoms, will be necessary. Identify precipitating events, if any: frequency, duration, intensity, and location of the pain. Helps differentiate this chest pain, and aids in evaluating possible progression to unstable angina.
Option B: It is likely that an electrocardiogram will be performed as well, but this is not the first priority. Monitor heart rate and rhythm. Patients with unstable angina have an increased risk of acute life-threatening dysrhythmias, which occur in response to ischemic changes and/or stress.
Option D: Similarly, chest exams with auscultation may offer useful information after vital signs are assessed. Observe for associated symptoms: dyspnea, nausea, and vomiting, dizziness, palpitations, desire to micturate. Decreased cardiac output (which may occur during an ischemic myocardial episodes) stimulates sympathetic and parasympathetic nervous systems, causing a variety of vague sensations that the patient may not identify as related to the anginal episode.

It is always critical that patients being discharged from the hospital take prescribed medications as instructed. In the case of antibiotics, a full course must be completed even after symptoms have resolved to prevent incomplete eradication of the organism and recurrence of infection. Take antibiotics exactly as directed. Do not stop taking the medicine just because you are feeling better. The client needs to take the full course of antibiotics.

Option A: The patient should resume normal activities as tolerated, as well as a nutritious diet. Get plenty of rest and sleep. The client may feel weak and tired for a while, but the energy level will improve with time.
Option B: Healthy and nutritious food, especially those high in vitamin C, should be included in the patient’s diet to speed up recovery and prevent reinfection. To prevent dehydration, drink plenty of fluids, enough so that the urine is light yellow or clear like water. Choose water and other caffeine-free clear liquids until feeling better. If the client has kidney, heart, or liver disease and has to limit fluids, he should talk with his doctor before he increases the amount of fluids he drinks.
Option D: Continued use of the incentive spirometer after discharge will speed recovery and improve lung function. If given a spirometer to measure how well the lungs are working, use it as instructed. This can help the doctor tell how the recovery is going.

When a family member is dying, it is most helpful for nursing staff to provide a culturally sensitive environment to the degree possible within the hospital routine. In the Vietnamese culture, it is important that the dying be surrounded by loved ones and not left alone. Traditional rituals and foods are thought to ease the transition to the next life. When possible, allowing the family privacy for this traditional behavior is best for them and the patient.

Option A: Know the availability of support systems for the patient. If the patient’s main support is the object of perceived loss, the patient may need help in naming other sources of support. Communicate therapeutically with patient and family members and allow them to verbalize feelings.
Option B: Support the patient and significant others share mutual fears, concerns, plans, and hopes for each other. Keeping secrets won’t do any help during this time. These times of stress can be used as an opportunity for growth and family development.
Option D: Initiate a process that provides additional support and resources. The patient and family may benefit from spiritual support resources. Strengthen the patient’s efforts to go on with his or her life and normal routine. Allow the patient and family to feel that they are enabled to do this by supporting them.

The charge nurse planning assignments must consider the skills of the staff and the needs of the patients. The labor and delivery nurse who is not experienced with the needs of cardiac patients should be assigned to those with the least acute needs. The patient who is one-week post-operative and nearing discharge is likely to require routine care.

Option B: A new patient admitted with suspected MI and scheduled for angiography would require continuous assessment as well as coordination of care that is best carried out by experienced staff. Nurse-patient assignments are typically allocated based on estimated direct patient care requirements with little consideration for other activities that must be completed throughout a shift. In an effort to improve upon previous assignment methodologies, new measures and metrics were considered in this study to reduce and balance demands placed on nurses through the assignment of required activities.
Option C: The unstable patient requires staff that can immediately identify symptoms and respond appropriately. In most hospitals, a unit charge nurse is responsible for the shift assignment of patients to nurses based on experience and past practices. The nurse-patient assignment process is also often a manual process in which the charge nurse must sort through multiple decision criteria in a limited amount of time.
Option D: A postoperative patient also requires close monitoring and cardiac experience. Balancing workload among nurses on a hospital unit is important for the satisfaction and safety of nurses and patients. To balance nurse workloads, direct patient care activities, indirect patient care activities, and non-patient care activities that occur throughout a shift must be considered.

Glucagon is given to treat insulin overdose in an unresponsive patient. Patients with decreased levels of consciousness cannot safely consume the oral carbohydrates needed to raise their blood sugar without risk of aspiration, and obtaining IV access can be problematic in the diabetic population, which can prevent prompt administration of IV glucose.

Option A: Following Glucagon administration, the patient should respond within 15-20 minutes at which time oral carbohydrates should be given. Similar to epinephrine auto-injectors, a pre-filled glucagon injector has received approval, which injects into the patient’s thigh. Healthcare providers will most often encounter the emergency kit formulation necessitating reconstitution before injecting the medication, but the intranasal spray may be encountered with increasing frequency in hypoglycemia kits for layperson use.
Option C: Lipoatrophy refers to the effect of repeated insulin injections on subcutaneous fat. Lipoatrophies are considered an adverse immunological side effect of insulin therapy, and in some cases they are mediated by a local high production of tumor necrosis factor-?, which leads to a dedifferentiation of adipocytes in the subcutaneous tissue.
Option D: Glucagon reverses rather than enhances or prolongs the effects of insulin. Glucagon is a reliable method of raising the patient’s glucose and relieving severe hypoglycemia long enough for more definitive correction of the patient’s glucose levels by mouth, particularly when IV access is unavailable to the provider or has failed.