Case #4: William Miller (adapted from Unfolding Case Studies, 2001)

Day 1, 0200. William Miller is a 51yo AA male admitted to the CCU to r/o MI. William
presented in the ER at 0010 with severe substernal chest pain radiating to the back,
neck, and down the left arm. He received MSO4 4mg IV at 0030, 0040, and 0100. He
now reports his pain level as a 5/10, down from a 10/10 before the pain medication.
Admission interview notes a positive family history of cardiovascular disease with his
mother dying of a CVA at age 62 and his father dying of a MI at age 58. He also has a
hx of HTN, which has been effectively treated with HCTZ for the past 5 yrs. VS B/P
188/95, P 115, R 24, T 99.8 oral. Ht. 58, wt. 244 lbs.

1. This client is presenting with what risk factors for an acute MI?
The patient is an African American male. His mother died of a Cerebrovascular accident
and his father died of a Myocardial Infarction.
The patient is an African American male and both his parents have a history of heart
related diseases.
His dad died from MI and his mom died from CVA

2. What other patient history questions might you want to ask?
I would also ask the patient if he has any history of smoking.
I would ask when did he first have this pain.
I would ask if he has had recurring pain .

3. What is the significance of his weight based on the updated 1998 weight
recommendations? (1 kg = 2.2 lbs, 1in. = .0254m, BMI = kg/m2)
The patient is obese with a BMI of 37.1. I would recommend that the patient go on a diet
and start exercising.
The patient is overweight and that could be contributing to his heart over working and
dying.
The patient is overweight which could have caused him to be having these symptoms.

4. Do any of his vital signs concern you? Which ones and why?
His blood pressure is too high and so is his pulse and temperature.
His Temperature is a little high, his pulse, blood pressure, and respirations are high as
well.
His blood pressure, pulse, respirations, and temperature are all above the normal
average.




5. What test/labs would you expect to be done in order to confirm MI?
An ECG
You can use a CT scan and blood tests
you can use Blood Tests, Echocardiogram, cardiac catheterization,

6. Why did the patient receive MS04?
He receives MSO4 because it is an Analgesic, and analgesics reduce the pain.
To help reduce the patients pain.
To reduce pain

7. Why is he taking HCTZ and is it still effective based on the current patient status?
He is taking HCTZ because he has hypertension and needs a fluid-pill. It is not effective
because he is in the CCU with a r/o MI
HCTZ is taken for high blood pressure and it is not effective for the patient.
He is taking HCTZ because he has high blood pressure, but it hasnt helped the patient
any because his has been admitted to the CCU

8.O2 @ 2L n/c was applied. What is this and why was it given?
O2 @ 2L n/c is Oxygen at 2 liters nasal cannula. It is given because the doctor needs
to increase the available oxygen and decrease the cardiac oxygen.
It is a way for the doctor to help the patient increase the amount of oxygen he is
receiving.
Its a device used to deliver supplemental oxygen to a patient or person in need of
respiratory help. It was given to the patient to help him breathe.

9. Day 3, 1300. Mr. Miller has been observed during this hospital stay with no
complications. His medications have been adjusted and he is being d/cd to home with
a follow-up appointment in 2 wks.?What dietary recommendations would you make for
him prior to sending him home
I would tell him to do exercise and maintain a good food diet to keep his weight on the
good side.
I would recommend that the patient start eating healthier foods and being working out
for at least 30 min a day.
I would recommend for him to go on a low sodium diet. He should also do workouts
heavy in cardio.


10. What modifiable risk factors should he avoid?
He should avoid drinking and smoking if he has any of those habits.
He should try to lower his stress and eat healthier.
The patient should exercise more, and tell the doctor if he has any more medical problems.