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Case Study Jayla Tibbs, a 56-year-old African Amer

Case Study Jayla Tibbs, a 56-year-old African American female, presents to the emergency room with reports of shortness of breath, tingling in her left arm, and nausea. Mrs. Tibbs’s medical history includes hypertension and type 1 diabetes mellitus, which she controls with diet and insulin injections. Mrs. Tibbs states her signs and symptoms began this morning while she was taking a walk. Mrs. Tibbs reports that she fatigued quickly and had difficulty catching her breath. Subsequently, she felt a little nauseated and experienced a faint burning sensation in her left shoulder. Mrs. Tibbs states when she returned to her home, her husband told her she “did not look right.” Mrs. Tibbs further states she felt that there was no cause for concern and told her husband, “It will go away if I rest.” Despite Mrs. Tibbs’s attempts to reassure her husband that she did not need medical care, her husband insisted that she go to the hospital. First, the nurse must determine if Mrs. Tibbs is in acute distress by gathering objective and subjective data. Using an organized approach, the nurse begins the assessment. The physical assessment reveals that Mrs. Tibbs is diaphoretic and her skin is gray-tinged, especially around the eyes. Her vital signs are B/P 144/72—P 102—RR 28. Her oxygen saturation (SaO2) is 92% on room air. Mrs. Tibbs denies chest pain or discomfort, as well as pain in any other region. She continues to report a burning sensation in her left shoulder and nausea. The nurse administers O2 via nasal cannula to Mrs. Tibbs and applies a cardiac monitor. Mrs. Tibbs’s electrocardiogram (EKG) shows no obvious abnormalities. Nitroglycerin sublingual (SL) as ordered by the ER physician is administered. Two minutes after receiving nitroglycerin SL, Mrs. Tibbs’s B/P is 120/64, and her heart rate (HR) is 84. Her respiratory rate is 22. She continues to receive supplemental O2 via nasal cannula at a rate of 4 liters/minute. Her oxygen saturation has increased to 97%. Mrs. Tibbs states, “I’m not short of breath anymore and that burning in my shoulder is gone now.” Mrs. Tibbs occasionally rubs her left arm but denies tingling or pain. She continues to report mild nausea. She states, “This is all probably from something I ate or an insulin reaction. I’d like to go home.” The physician orders a 12-lead EKG and laboratory diagnostics, including cardiac enzyme tests. Mrs. Tibbs is scheduled for admission to the hospital’s coronary care unit (CCU). Describe additional information that will be required to formulate a plan of care for Mrs. Tibbs in the CCU? Analyze how the nurse should interpret the patient’s desire “to go home” and statement that “This is all probably from something I ate or an insulin reaction” and special considerations when evaluating Mrs. Tibbs’s situation. Appraise how the absence of chest pain supports or refutes the possibility that Mrs. Tibbs is experiencing a myocardial infarction (MI). Explain the following conclusions about the patient’s physical condition: a. impaired oxygenation b. alteration in peripheral perfusion c. fatigue d. nausea

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