Hirad Nursing Ax

Presenting Problem: The patient is a 68-year-old male presenting with acute onset of severe central chest pain and shortness of breath that started approximately 2 hours prior to arrival. He reports no recent medical events other than his usual stable angina, which has now worsened significantly. He denies any recent trauma or falls. Onset: The severe chest pain began suddenly while the patient was resting at home, accompanied by a feeling of breathlessness. The pain is described as crushing and radiates to his left arm and jaw. He initially took his prescribed sublingual glyceryl trinitrate, but it provided no relief. Symptoms: * Severe central crushing chest pain * Radiation to left arm and jaw * Shortness of breath * Diaphoresis * Nausea * Palpitations Current Rx: * Aspirin 75mg OD * Metoprolol 50mg BD * Atorvastatin 20mg OD * Isosorbide Mononitrate 60mg OD * Glyceryl Trinitrate spray PRN for angina Relevant Medical Hx: The patient has a history of stable angina pectoris diagnosed 5 years ago, hypertension for 10 years, and hyperlipidaemia. He underwent a coronary angiogram 3 years ago which showed multi-vessel disease managed conservatively. He is a former smoker, having quit 10 years ago, and has no known history of diabetes or chronic kidney disease. Red flags / Allergies: * Allergies: Penicillin (rash) * Red flags: Acute severe chest pain, elevated troponin levels, ECG changes suggestive of acute myocardial infarction. Assessment Airway: Patent and clear. No stridor or signs of obstruction. Breathing: Tachypnoeic, respiratory rate 24 breaths/min. Bilateral equal chest expansion. Auscultation reveals clear breath sounds, no wheezes or crackles. Oxygen saturation 92% on room air. Circulation: Heart rate 105 bpm, irregular. Blood pressure 98/60 mmHg. Capillary refill time 4 seconds. Peripheral pulses are weak but present. Skin is cool and clammy. Disability: GCS 15 (E4 V5 M6). Pain level 9/10 on a visual analogue scale. Pupils equal and reactive to light. Exposure / Environment: Patient is diaphoretic. Environmental temperature is comfortable. No visible injuries or rashes. Fluids: Signs of mild dehydration, dry mucous membranes. Received 500ml normal saline IV bolus en route. Glucose: Blood glucose level 6.2 mmol/L (random). Social: Patient lives with his wife. He is retired and generally independent. No significant recent social stressors reported. Family history includes a father who had a myocardial infarction at 60 years of age. Interventions: Oxygen therapy via nasal cannula at 4L/min initiated. ECG performed and showed ST elevation in inferior leads. Aspirin 300mg chewable administered. IV access established (right antecubital fossa). Initial bloods taken including cardiac enzymes. Medical officer has been informed and is en route for further assessment and management. PLAN: * Continue oxygen therapy to maintain SpO2 >94%. * Administer Morphine 2-4mg IV PRN for pain, assess every 5 minutes. * Monitor vital signs and cardiac rhythm continuously. * Prepare for transfer to cardiac catheterization lab upon medical officer's assessment for primary percutaneous coronary intervention (PCI). * Nil by mouth in preparation for potential procedure. * Repeat ECG in 15 minutes or with any change in symptoms. * Inform family of patient's condition and plan of care.