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Assignment: Cardiovascular Case Study Total Points: 50

Purpose

This assignment evaluates your ability to apply clinical judgment when caring for a patient with

acute coronary syndrome due to a right-sided myocardial infarction complicated by

atrioventricular conduction abnormalities. Emphasis is placed on correct rhythm interpretation,

understanding the impact of myocardial ischemia on cardiac conduction, anticipating appropriate

treatment, prioritizing patient perfusion, and documenting sound nursing judgment.

Case Overview

A 68-year-old male presents with chest pressure radiating to the left arm, diaphoresis, and nausea.

Diagnostic findings are consistent with acute coronary syndrome involving a right-sided

myocardial infarction. The patient is admitted to a telemetry unit for continuous cardiac

monitoring.

Past medical history includes hypertension and hyperlipidemia.

Part I: Progressive Rhythm Interpretation and Treatment Anticipation

Stage 1

Telemetry findings:

Regular atrial activity is present. PR intervals are constant on conducted beats. Intermittently, atrial

impulses fail to conduct to the ventricles. QRS complexes are wide when present. The ventricular

rate is slower than the atrial rate.

Instructions:

1. Name the rhythm.

2. Explain why a right-sided myocardial infarction places this patient at risk for this

conduction abnormality, including the coronary artery involved and the portion of the

conduction system affected.

3. Identify the expected treatment approach if conduction worsens and explain the rationale

for this treatment.

Stage 2

New clinical information:

Troponin levels continue to rise. Blood pressure is trending downward. The patient reports

dizziness and increasing fatigue. Telemetry shows a greater frequency of non-conducted atrial

impulses.

Instructions:

1. Name the rhythm.

2. Explain how ongoing ischemia from a right-sided myocardial infarction worsens

atrioventricular conduction.

3. Explain how this conduction change affects cardiac output and perfusion. Be specific.

4. Describe the expected escalation of treatment at this stage and explain why delaying

treatment increases patient risk.

Stage 3

New clinical information:

The patient becomes hypotensive and confused. Urine output decreases. Telemetry shows atrial

activity and ventricular activity occurring independently.

Instructions:

1. Name the rhythm.

2. Explain how this rhythm affects perfusion, particularly in a patient with a right-sided

myocardial infarction.

3. Identify the expected definitive treatment at this stage and explain why this intervention is

required to restore perfusion.

Part II: Clinical Error Analysis

Review the following nursing progress note.

1500: Nursing Progress Note

Patient admitted with acute coronary syndrome related to a right-sided myocardial infarction and is

currently on continuous telemetry. Telemetry was interpreted as sinus bradycardia. The patient

reports dizziness, and blood pressure is lower than previous readings; however, this was attributed to

the myocardial infarction. Provider was notified of rhythm interpretation. No additional nursing

interventions were initiated at this time. Will continue to monitor patient status.

Instructions:

1. Identify three clinical reasoning errors in the note.

2. For each error, explain why the reasoning is unsafe and describe the potential harm to the

patient.

Each explanation must use the following structure:

This error occurs because the nurse assumed ___ instead of recognizing ___.

Part III: Progress Note (Paragraph Format)

Write one cohesive progress note paragraph based on the patients condition as it progressed from

Stages 1 to 3.

Your paragraph must demonstrate all of the following:

Recognition of the problem

Identify the priority clinical problem affecting this patient and support it with relevant

assessment findings. Explain how a right-sided myocardial infarction contributes to

impaired atrioventricular conduction and decreased cardiac output or perfusion.

Nursing interventions

Describe at least two appropriate nursing interventions. One must address immediate

patient risk. One must demonstrate anticipation of deterioration or escalation of care.

Interventions must be appropriate for the RN role and aligned with expected treatment for

this condition.

Evaluation

Explain how you would evaluate the patients response to your interventions. Include

findings that would indicate improvement and findings that would indicate worsening or

need for escalation of care.

Your paragraph must end with the following sentence (wording may vary slightly):

The patients greatest risk at this time is ___ because ___.

Formatting:

APA (Please also include APA referencing including in-text citations for each question as indicated

along with a separate reference page)

Typed submission