Pharm chapter 53 - Management of ST-Elevation Myocardial Infarction
In acute MI, if blood flow is not restored within ________ minutes, cell death begins.
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STEMI what causes it
ACUTE MI complete interruption of regional myocardial blood flwo
When caring for a patient during a STEMI who is prescribed alteplase, the nurse would question the prescriber if which drug was also prescribed?
Abciximab
Research suggest which treatments improve outcomes in STEMI?
Administration of aspirin, Beta blocker, ibuprofen, morphine, SL nitroglycerin,
To lower the risk of a second MI
All patients should decrease cardiovascular risk factors (smoking, hypercholesterolemia, hypertension, diabetes), exercise for 30 minutes at least 3-4 days a week, and undergo long-term therapy with four drugs: a beta blocker, an ACE inhibitor or an ARB, an anti platelet drug or warfarin and statin.
Remodeling of the myocardium that occurs with MI is driven in part by local production of ______________.
Angiotensin II
Almost all coronary occlusions occur at the site of a ruptured _______________ _____________.
Atherosclerotic plaque
In patients undergoing acute STEMI
Beta blockers reduce cardiac pain, infarct size, short-term mortality, recurrent ischemia, and reinfection. Continues used increases long-term survival. All patins should receive a beta blocker in the absence ion specific contraindications.
The major complication of fibrinolytic therapy
Bleeding, intracranial hemorrhage is the greatest concern.
The ED triage nurse answers the call of a patient who has a history of angina pectoris and chronic obstructive pulmonary disease. The patients reports chest pain that has not been relived by three doses of nitroglycerine. The patient had been told by the physician that he should take chewable aspirin should this occur, but he does not has any aspirin. Wha should the nurse tell the patient to do?
Call 911
What is an expected response within minutes of administering IV morphine during a STEMI
Decrease in pain and improved hemodynamics
ACE inhibitors
Decrease mortality, severe heart failure and recurrent MI in patients with acute MI. All patins should receive one of these in the absence of specific contraindications or an ARB can be used instead.
STEMI
Diagnosed by the presence of chest pain, characteristic ECG changes and elevated serum levels of cardiac troponin
Fibrinolytic drugs
Dissolve clots by converting plasminogen into plasmin, an enzyme that digests the fibrin meshwork that holds clots together
Which laboratory result in the history of a patient who is experiencing STEMI would be most important to report to the prescriber who has just ordered catopril?
Estimated glomerular filtration rate 38 mL/min
In Addition to age, genetics, and sedentary lifestyle, risk factors for ST elevation myocardial infarction (STEMI) include ________________, ______________, _______________, and _______________.
High sclerotic cholesterol, hypertension, smoking and diabetes
The medical term for a heart attack is ________ ___________.
Myocardial infarction
In myocardial infarction, heart muscle is _______________ secondary to local ischemia.
Necrosed
Myocardial infarction
Necrosis of the myocardium secondary to cause occlusion of a corollary artery.
Which drug prescribed for acute STEMI should be withheld and the prescriber consulted immediately if the patins pulse is 118 beats/min?
Nitroglycerin - Nitroglycerine should be avoided in patients with tachycardia due to increased risk of reflex tachycardia
There is some evidence that _____________- may be harmful.
Oxygen
routine therapy suspecter for STEMI
Oxygen, Morphine and Nitroglycerin, These should be started as appropriate, soon after symptom onset
Reperfusion can be accomplished with
PCI or with fibrinolytic drugs, both approbates are highly effective, but PCI is now generally preferred.
Cause of MI
Platelet plugging and thrombus formation at the site of a ruptures atherosclerotic plaque.
Glycoprotein IIb/IIIa inhibitors (abcximab)
Powerful IV anti platelet drugs that can enhance benefits of primary PCI.
Aspirin combined with clopidogrel
Recommended for all patients under going repercussion therapy with a fibrinolytic drug.
Myocardial inactions where there is partial blockage of the coronary artery are called non- __________________ MI.
ST-elevation
The abbreviation for an MI with complete blockage of the coronary artery is ____________.
STEMI
Increase the risk for bleeding. The nurse must be diligent in assessing for and reporting signs and symptoms of bleeding including decreased level of consciousness, painful or swollen joints, oozing gums, hematuria, or decrease in platelet or hemoglobin values
Safety alert: All of the anticoagulant and anti platelet drugs
Aspirin
Suppresses platelet aggregation, decreasing mortality, reinfarction, and stroke. All patients should chew a 162- 325 mg dose on hospital admission and should take 81 to 162 mg/day intently after discharge.
Reperfusion Therapy
The most beneficial treatment for STEMI, restores blood flow through blocked coronary arteries.
Alteplase
The most effective fibrinolytic drug when treatment is initiated within 4-6 hours of pain onset. Otherwise all fibrinolytic drugs are equally effective.
Intracellular proteins release when cardiac muscle cells are damage called ______________ and _____________.
Troponin's and creatine kinase
A patient who is undergoing an acute STEMI is prescribed metoprolol 50 mg by mouth every 6 hours. It would be a priority to immediately contact the prescriber if which assessment finding was present?
Wheezing - Patents with asthma or other similar diseases should not receive Beta lockers, including metoprolol. because of its relative B1 selectivity, however, metoprolol may be used with caution in patients with asthma who cannot tolerate other treatments. Since beta1 selectivity is not absolute, a beta2 stimulating agent should be administered concomitantly, and the lowest possible dose of metoprolol used. In this instance, the nurse should clarify the dose (which totals 200 mg/day) with the prescriber.
all patients undergoing fibrolynic therapy should receive
anticoagulant, antiplatelet drugs
all post MI (stemi) patients should take four drugs, all four should be taken indefinitely
beta blocker, ace inhibitor, antiplatelet/anticoagulant, statin
when do ventricular dysrhythmias happen
develop frequently and are major cause of death after MI (stemi -prophylactic antidysrhythmics not successful -amiodarone.
estrogen therapy for postmenopausal women is not effective as secondary prevention and should not be
initiated
Heparin
recommended for all patients undergoing fibrinolytic therapy or PCI
The nurse knows that nitroglycerine decrease the workload of the heart by
reducing venous return to the heart
cardiogenic shock
results from tissue perfusion reduction during STEMi
PCI
usually consists of balloon angioplasty coupled with placement of a drug-eluting stent.
complications from stemi
ventricular dysrhythmias and cardiogenic shock