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CCU Case Studies

CCU Case Studies. The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care.

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CCU Case Studies

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  1. CCU Case Studies The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care. As the case is presented, mark off the required information in the appropriate fields on your Macstrak form. At the end of each case study, the form will be reviewed with the correct answers supplied. If you have any questions, please refer to your Macstrak manual or contact us at the Macstrak Project Office. The Macstrak Project

  2. CCU Case Study The Macstrak Project

  3. CCU Case Study MLA is a 56-year-old man (19/02/50) with no previous cardiac history. The Macstrak Project

  4. CCU Case Study MLA is a 56-year-old man (19/02/50) with no previous cardiac history. On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He receives metoprolol 5 mg IV with a reduction in HR to 104. He is transferred to your CCU. The Macstrak Project

  5. CCU Case Study In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2. The Macstrak Project

  6. CCU Case Study In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2. On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin The Macstrak Project

  7. MACSTRAK CCU CCU Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre:CCU ICU Date:20 Day Month Year M L A 19 02 50 X MLA is a 56-year-old man (19/02/50) with no previous cardiac history. The Macstrak Project

  8. MACSTRAK CCU CCU Case Study Patient Initials: F M L Birth Date:19 Day Month Year Gender: Male Female Centre:CCU ICU Date:20 Day Month Year M L A 19 02 50 15 03 06 X On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. The Macstrak Project

  9. CCU Case Study Past Medical History:<30 days >30 days MI ……………………………. Angina ……………………….. CABG ……………………….. PCI …………………………… CHF ………………………….. TIA/CVA …………………….. Diabetes (oral agents/insulin) ... None of the Above……………. MLA is a 56-year-oldman (19/02/50) with no previous cardiac history. X The Macstrak Project

  10. CCU Case Study On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. Patient Origin: ER EMS Walk In Dr.’s Office/Clinic (Direct) Other Hospital Inpatient Medical Ward Surgical Ward Other ICU Other: ……………… X X The Macstrak Project

  11. CCU Case Study While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU. VS at Presentation:(complete for all patients) Dyspnea/Rales:None Mild Mod/Severe Systolic BP: < 100 101-130 131-160 161-190 >190 Heart Rate:< 80 80-100 >100 X X X The Macstrak Project

  12. Admitting Diagnosis:(Check one only) Acute AMI (48 hrs) UA R/O MI UA RSCP NYD CHF Arrhythmia Aortic Dissection Non ACS Pericardial Disease Other: ………………… ACS CCU Case Study While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU. X The Macstrak Project

  13. Diuretics……………………… Inotropes IV………………….. ETT/Vent…………………….. PA Line………………………. TTVP………………………… IABP…………………………. ACS: RSCP - Ischemia – Definite…. – Probable… CK (+ve)………………...…… Troponin (+ve)……………….. NTG IV………………………. Heparin – UFH……………..... – LMWH……………. Other Antithrombin………...… GP 2b/3a Inhibitor IV……...… Clopidogrel (or ticlopidine)..… Cardiac Cath……………….... PCI…………………………... Outcomes: VF/Sustained VT………….… Infarction (new/repeat)*(1) …... Thrombolysis (new/repeat)*(2).. Stroke*(3) ……………………. Major Bleed*(4) ……………… Transfusion………………….. Crs1: ……………………….... Crs2: ……………………..….. None of the Above……….….. RN Initials ………………..…. CCU Case Study Date: In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2. 16 17 15 D N D N N D Acuity: Shift: X X X X X X X SM SM KD KD KD The Macstrak Project

  14. Discharge Diagnosis: Acute MI Unstable Angina Chest Pain NYD CHF Arrhythmia Other Cardiac Problem: ………….................. Non Cardiac Problem:…..….............………..... CCU Case Study Time: Date: 20 17 03 06 0930 On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin Day Month Year Peak CK: Trop: X The Macstrak Project

  15. CCU Case Study Discharged To: Cardiac Ward Med/Surg Ward Step Down Unit CV Surgery Other ICU Other Hospital Home Death Other:.............. Discharge Meds: ASA Clopidogrel (or ticlop.) Heparin (UF or LMW) Nitrates (po/top) B Blocker ACEI A2 Blocker Statin None of Above On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin X X The Macstrak Project

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