RL is a 54 yo WM who is 5’8″ tall and weighs 285 pounds. He presented to the ER,

RL is a 54 yo WM who is 5’8″ tall and weighs 285 pounds. He presented to the ER, being brought in by EMS, with acute shortness of breath and substernal chest pain radiating into the left side of the face and left arm. The pain subsided with NTG treatment. However, RL was not a candidate for reperfusion therapy. Blood tests show elevated Troponin and CK-MB and an INR of 2.1. A hemoglobin A1C returned with a level of 11. The EKG shows Right axis deviation and a Q wave in leads I, aVL, V5-6 with ST –T changes. An echocardiogram showed dilated cardiomyopathy with an EF of 32%.
During a subsequent assessment, the nurse hears a new high pitched blowing systolic murmur at the left 5th ICS in the mid-clavicular line with radiation to the axilla. The BP has dropped to 88/50 and HR is 58.
least two paragraphs, referring to chapters 12-14 in the Urden, L. D., Stacy, K.M., Lough, M.E. (2022). Critical care nursing: Diagnosis and management(9th ed.). St. Louis, MO: Elsevier-Mosby. (ISBN: 978-0-323-64295-8)
expound on the above findings and delineate the aspects of critical care nursing called for in this scenario.