Nursing Prioritization Delegation Assignment Q 27

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During a class discussion, the 50-year-old professor suddenly feels left-sided chest pain, dizziness, and diaphoresis. What is the priority action when he arrives in the ED triage area?

  

     A. Supply oxygen via nasal cannula

     B. Place intravenous (IV) access

     C. Notify the ED physician

     D. Set the client on continuous electrocardiographic monitoring

    

    

Correct Answer: A. Supply oxygen via nasal cannula

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Increasing myocardial oxygenation is the priority goal. Place the patient on a cardiac monitor, establish intravascular access (IV) access, give 162 mg to 325 mg chewable aspirin, clopidogrel, or ticagrelor (unless bypass surgery is imminent), control pain and consider oxygen (O2) therapy.

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Option B: Intravenous opioids (e.g., morphine) are the analgesics most commonly used for pain relief (Class IIa). The results from CRUSADE quality improvement initiative have shown that the use of morphine may be associated with a higher risk of death and adverse clinical outcomes.

Option C: After providing initial treatment, the physician should be notified. Patients with non-ST elevation myocardial infarction (NSTEMI) and unstable angina should be admitted for cardiology consultation and workup. Patients with stable angina may be appropriate for outpatient workup.

Option D: The other actions are also appropriate and should be done immediately. Electrocardiogram (ECG) preferably in the first 10 min of arrival, (consider serial ECGs). Patients with ST-elevation on ECG patients should receive immediate reperfusion therapy either pharmacologic (thrombolytics) or transfer to the catheterization laboratory for percutaneous coronary intervention (PCI).

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