The Client is 60 years old retired chef, married, has 4 children, as you take his

health history, it tells you that he began feeling changes and his heart rhythm
about 10 days ago. He has hypertension and 5 year history of angina pectoris,
during the past week he has had frequent episodes of mild-chest discomfort, the
chest pain has awaken him from sleep but does not respond to nitroglycerin
which he has taken sublingually about 8 to 10 times over the past week, during
the week he has also experienced increase fatigue, he states “I just fell sick all
the time”. The cardiac catheterization done several years ago, reveal 50%
stenosis of the right coronary artery and 50% stenosis of the left anterior
descending coronary artery. He tells you that both his mother and father have
coronary artery disease. They take Metoprolol, amlopidin, aspirin 81 mg/day.

Questions:
1. What other information are you going to ask about his episodes of chest
pain?

- what type of pain; How long

2. What are the common sites for radiation of ischemic cardiac pain?

-pain spreading to neck, shoulder, arms or jaw

3. You know that he has atherosclerosis of the coronary artery but he has
not told you about his risk factors, you need to know his risk factors for
CVA in order to plan teachings on his lifestyle modification. What will you
ask him about?

- daily activities.

4. Although has taking sublingually the nitroglycerin, you want to be certain

in using it correctly. What information would you need to make certain
understanding?

- NTG you will feel tingling sensation SL

5. What risk does the new rhythm past for the patient?
-

6. The pacemaker insertion surgery places him at risk for several serious
complications. List 3 potential problem that you will monitor as care for
him.

- bleeding. cardiac tamponad. Infection. swanganz cath to measure

cardiac output
 7. The client will need some education regarding his new pacemaker. What
information would you give him before he leaves the hospital?

- pacemaker insertion it means that he have complete heart block.

Nausea,Diaphoresis SOB

8. The client and his wife tells you that they have heard that people with
pacemaker can have their heart stop because of theft and security in
stores and airports. Where you can help them find more information?

books; pamplet s;doctors advice; internet