soluble aspirin

Question 1: In 440 words, critique the care provided for the following patient. Provide reasons (rationale) for all elements of your discussion.
Mrs. Glycerine was admitted to a major metropolitan public hospital with central chest pain at 9am. She was administered O2 at 8 L/min by Hudson mask, ½ soluble aspirin sublingually which within 5 minutes of administration would decrease platelet aggregation in the aorta. After initial observations of Pulse 98, BP 130/70 Resp 28 she was administered GTN 2 sprays at 5 minutely intervals (X 3) with pulse and BP recorded prior to each GTN administration to monitor for hypertension. IV morphine 2mg stat followed by increments of IM morphine 2 mg every 10-15 minutes which also has an effect on decreasing cardiac workload, ECG on admission revealed STEMI and point of care testing revealed a troponin T of 120 ng/L. She was taken for a radial angiogram at 9:30am.

Question 2: In 440 words, discuss what the clinical data in the case below indicates about the diagnosis and presenting condition of Mr. Naturesis. Provide reasons (rationale) for all elements of your discussion.
Mr. Naturesis, 63-years, presents to ED complaining of breathlessness for the past three days. Cardiac history is positive for a myocardial infarction three years ago followed by three-vessel coronary artery bypass surgery. Diagnosed with LVF 2 years ago.
Over the last three months Mr Naturesis noted onset of shortness of breath while unloading groceries and walking up stairs. Two weeks ago, he was unable to complete his daily two-kilometer walk. He noted swelling in his feet and ankles. Four days ago he woke at 0200hrs short of breath and had to sleep in his recliner the rest of the night. He has been unable to lay flat in bed at night since then and has slept on 5 pillows.
T 36.8, P 140, irreg, R 30 and labored, BP 176/52, SaO2 90%, weight 78 kg (usual weight 75 kg). JVP increased; bilateral creps to mid zone. Cough is productive with frothy pink tinged sputum. Extremities: 4+ pitting edema of lower extremities to the knees.
Results of investigations: Na 120, K 2.3, Hb 98, HCT 33%. CXR: Cardiomegaly with diffuse pulmonary infiltrate. BNP 500 pg/mL

 
Question 3: In 440 words, critique information provided for reasons for the prescription of medications for Mr. Diuresis and any possible side effects mentioned. Provide reasons (rationale) for all elements of your discussion.
Mr. Diuresis, diagnosed with Heart Failure NYHA III was prescribed oral frusemide 40 mg at 0800 and 1400hrs, Captopril BD, atenolol BD and Spironalactone once in the morning.
Frusemide was prescribed to inhibit the reabsorption of K+ and therefore of H2O in the loop of Henle. Side effects can include hypovolaemia, hyperkalaemia and hypomagnaesia. Oral frusemide works within 30 minutes and the therapeutic effect lasts for 3 hours.
Captopril was prescribed to decrease the body’s compensatory RAAS mechanism, which is maladaptive in HF. ACEI also results in vasodilatation. Side effects include risk for postural hypotension, dehydration and hypokalaemia. As captopril possess a diuretic action the patient should be advised to increase dietary potassium. Captopril should be administered with food.
Atenolol prescribed to cause vasodilatation as it inhibits SNS system effect on ß1 receptors and its sympatholytic activity reduces heart rate increasing the ejection fraction of the heart. Also prescribed to decreased cardiac remodeling.
Spironalactone prescribed to

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