Case study 3 Rainey is a 64-year-old woman of Maori descent who has been married for 42 years and has two grown-up children. Both of Rainey’s parents died when they were in their mid-60s of ‘heart attacks’.

CASE STUDY 3

Rainey is a 64-year-old woman of Maori descent who has been married for 42 years and has two grown-up children. Both of Rainey’s parents died when they were in their mid-60s of ‘heart attacks’. Two of her four brothers have had heart attacks and have high blood pressure, and her remaining uncle has had ‘two heart attacks and a stroke’. Rainey leads a sedentary life and her diet is moderately high in fat and sugar. Rainey is 162cm tall and 105kgs. Her body mass index (BMI) is 40 and her waist measurement is 101 cm.

Rainey began experiencing central chest pain radiating to her back and neck after walking up stairs at the shopping centre. She was short of breath, sweaty and sat down clutching her chest. Her daughter was with her and called an ambulance. The ambulance arrived after 5 minutes and took her to ED.

Her observations are as follows:

Blood pressure is 220/160

Pulse 92, radial pulse is present but weak and thready

Temperature 36.7

RR: 16

SpO2: 98RA

Skin is cool and clammy

ECG is below

Question 1

• Interpret the ECG and explain what the Dr will likely diagnose.
• Considering the PQRST, what is the area affected and why?

Ensure you link your answer back to the case study.

300 words

Question 2

​​​​​​​Rainey has been prescribed the following medication:

Aspirin 300mg oral

Ticagrelor 180mg oral

Heparin 5000 iu IV

• Why is it recommended in this case study to use all three of these medications?
• Formulate a response to the patient in your own words regarding the pharmacokinetics and pharmacodynamics of each medication.

Ensure you link your information back to the case study.

300 words

Question 3

• ​​​​​​​​​​Describe how you would differentiate Rainey's chest pain to exclude a pulmonary embolus and diagnose a cardiac condition.

Ensure you link your information back to the case study.

300 Words