[Expert Solution]: Joanna Smith is a 73 y

Joanna Smith is a 73 y.o female with a (+) H/O HTN, DM, and acute myocardial infarction x 2 years ago. After awaking this am, Ms. Smith began c/o sx including angina, nausea and fatigue to care takers at the nursing home she resides at. Per protocol, an ambulance was called. On the way to the ER, an EKG was completed. Once in the Emergency Room, the physician interprets the EKG findings which indicate significant ST-segment elevation in the anterior leads and Q waves. Once at the ER, VS are collected and are as follows: B/P: 80/50 mmHg HR: 111 bpm (w/ frequent PVCs on the monitor) RR: 32 bpm at rest. Temp: 37 C SPO2: 91% on 2L NC. With a frantic look on her face, the patient states “I am having trouble breathing.” The patient is then placed on a portable monitor to go into the cath lab. At that time, the nurse notices that the cardiac rhythm has increased and the patient is in SVT at 180 bpm. The nurse notes that there isn’t P waves present anymore and the QRS portion of the wave is wide. The monitor alarms loudly and Joanna’s eyes then close, a Code Blue is then called. The ER physician initiates rapid sequence intubation, and an endotracheal tube is placed. Respiratory therapy brings a ventilator to assist with Joanna’s respirations. The patient is then taken to the cath lab. Joanna’s family is waiting in the ER because they are requesting the patient be sent to a larger hospital for open-heart surgery. The patient will come back to the ER instead of being admitted to the small ICU. The cath lab calls with a report and confirms the nurse’s suspicions of blocked coronary arteries. The patient has an EF of only 15%. Joanna’s urinary catheter reveals scant, dark urine. Her extremities are cool to the touch. She is sedated for the ventilator support but when sedation is paused for assessment, she does not wake up at all. Her family then asks why she is not being transferred right away. Another staff member interrupts the nursing during her discussion with the family to say that Joanna’s MAP is only 50. The nurse then prepares to call in a report to a larger facility to transfer Joanna too. Scenario Questions: 1.) The nurse should initiate what protocol with this information? Why? 2.) What s/s did Joanna have that caused the nursing home staff to call 911? 3.) How does the nurse interpret this rhythm? What should she do first? 4.) What does the nurse think the cardiac catheterization will show? 5.) Are there devices to help Joanna’s heart stop pumping (similar to the ventilator to help her breathe)? 6.) What s/s of shock is Joanna exhibiting? What other clues does the nurse have indicating this could be cardiogenic shock? 7.) How can the nurse best explain the situation to the family? 8.) How does the nurse interpret this number (MAP 50) calculated? 9.) What type of medication might the nurse request from the provider or ask about starting? 10.) How can the nurse explain the course of tx to the family