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CCU Case Studies. The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care.

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slide1

CCU Case Studies

The following is a series of case studies to review different patient types and how they are captured on the form. The information is provided in sequence to reflect the natural progression of a patient’s care.

As the case is presented, mark off the required information in the appropriate fields on your Macstrak form.

At the end of each case study, the form will be reviewed with the correct answers supplied.

If you have any questions, please refer to your Macstrak manual or contact us at the Macstrak Project Office.

The Macstrak Project

ccu case study

CCU Case Study

The Macstrak Project

slide3

CCU Case Study

MLA is a 56-year-old man (19/02/50) with no previous cardiac history.

The Macstrak Project

slide4

CCU Case Study

MLA is a 56-year-old man (19/02/50) with no previous cardiac history.

On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25. While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He receives metoprolol 5 mg IV with a reduction in HR to 104. He is transferred to your CCU.

The Macstrak Project

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CCU Case Study

In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2.

The Macstrak Project

slide6

CCU Case Study

In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2.

On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are:

amiodarone

coumadin

The Macstrak Project

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MACSTRAK

CCU

CCU Case Study

Patient Initials:

F M L

Birth Date:19

Day Month Year

Gender: Male Female

Centre:CCU ICU

Date:20

Day Month Year

M L A

19 02 50

X

MLA is a 56-year-old man (19/02/50) with no previous cardiac history.

The Macstrak Project

slide8

MACSTRAK

CCU

CCU Case Study

Patient Initials:

F M L

Birth Date:19

Day Month Year

Gender: Male Female

Centre:CCU ICU

Date:20

Day Month Year

M L A

19 02 50

15 03 06

X

On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast, irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25.

The Macstrak Project

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CCU Case Study

Past Medical History:<30 days >30 days

MI …………………………….

Angina ………………………..

CABG ………………………..

PCI ……………………………

CHF …………………………..

TIA/CVA ……………………..

Diabetes (oral agents/insulin) ...

None of the Above…………….

MLA is a 56-year-oldman (19/02/50) with no previous cardiac history.

X

The Macstrak Project

slide10

CCU Case Study

On the morning of 15/03/06 MLA starts out for his regular 10:00 walk when he experiences extremely fast irregular heartbeats. A neighbour sees him and, even though his heart rate returns to normal, drives him to the hospital where they arrive at the ER at 10:25.

Patient Origin:

ER EMS Walk In

Dr.’s Office/Clinic (Direct)

Other Hospital

Inpatient Medical Ward

Surgical Ward

Other ICU

Other: ………………

X

X

The Macstrak Project

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CCU Case Study

While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU.

VS at Presentation:(complete for all patients)

Dyspnea/Rales:None

Mild

Mod/Severe

Systolic BP: < 100

101-130

131-160

161-190

>190

Heart Rate:< 80

80-100

>100

X

X

X

The Macstrak Project

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Admitting Diagnosis:(Check one only)

Acute AMI (48 hrs)

UA R/O MI

UA

RSCP NYD

CHF

Arrhythmia

Aortic Dissection Non ACS

Pericardial Disease

Other: …………………

ACS

CCU Case Study

While waiting to be assessed, MLA has another episode of fast, irregular heartbeats and shortness of breath. Nursing assessment reveals blood pressure 90/55, heart rate 130, and moderate dyspnea. He is placed on a monitor which shows atrial fibrillation. He is transferred to your CCU.

X

The Macstrak Project

slide13

Diuretics………………………

Inotropes IV…………………..

ETT/Vent……………………..

PA Line……………………….

TTVP…………………………

IABP………………………….

ACS:

RSCP - Ischemia – Definite….

– Probable…

CK (+ve)………………...……

Troponin (+ve)………………..

NTG IV……………………….

Heparin – UFH…………….....

– LMWH…………….

Other Antithrombin………...…

GP 2b/3a Inhibitor IV……...…

Clopidogrel (or ticlopidine)..…

Cardiac Cath………………....

PCI…………………………...

Outcomes:

VF/Sustained VT………….…

Infarction (new/repeat)*(1) …...

Thrombolysis (new/repeat)*(2)..

Stroke*(3) …………………….

Major Bleed*(4) ………………

Transfusion…………………..

Crs1: ………………………....

Crs2: ……………………..…..

None of the Above……….…..

RN Initials ………………..….

CCU Case Study

Date:

In CCU, he is treated with heparin (LMWH) sc and loaded with amiodarone IV. Later that evening he converts to NSR but with a slow rate at 30/min and becomes hypotensive. A temporary transvenous pacemaker (TTVP) is placed with the rate set at 70. He is then alert and responsive and BP is 110/70. He remains stable over the next 24 hours and the TTVP is removed. He has had no chest pain and his CK and troponins are negative throughout his stay. Coumadin is started on day 2.

16

17

15

D

N

D

N

N

D

Acuity: Shift:

X

X

X

X

X

X

X

SM

SM

KD

KD

KD

The Macstrak Project

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Discharge Diagnosis:

Acute MI

Unstable Angina

Chest Pain NYD

CHF

Arrhythmia

Other Cardiac Problem: …………..................

Non Cardiac Problem:…..….............……….....

CCU Case Study

Time:

Date: 20

17 03

06

0930

On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin

Day Month Year

Peak CK:

Trop:

X

The Macstrak Project

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CCU Case Study

Discharged To:

Cardiac Ward

Med/Surg Ward

Step Down Unit

CV Surgery

Other ICU

Other Hospital

Home

Death

Other:..............

Discharge Meds:

ASA

Clopidogrel (or ticlop.)

Heparin (UF or LMW)

Nitrates (po/top)

B Blocker

ACEI

A2 Blocker

Statin

None of Above

On the 17/03/06 at 09:30 MLA is discharged home with a diagnosis of atrial fibrillation. His discharge medications are: amiodarone coumadin

X

X

The Macstrak Project