Week 9 Pharmacotherapy of Angina Pectoris and MI
The nurse has taught the client, who has stable angina, about home care and the most common side effects of nitrates, which have been prescribed to treat the client's angina. The nurse determines that the teaching has been effective when the client makes which statements? Select all that apply. "I may develop a throbbing headache when I take the medication for my angina." "My blood sugar levels will increase. I will have to check my blood sugar levels after each dose." "My skin may become irritated in the area where I have put the patch." "I may feel dizzy or lightheaded after I take my angina medication." "I may feel like my heart is racing while my body is adjusting to the medication."
"My skin may become irritated in the area where I have put the patch." "I may feel dizzy or lightheaded after I take my angina medication." "I may feel like my heart is racing while my body is adjusting to the medication." "I may develop a throbbing headache when I take the medication for my angina." Rational: Nitrates are very effective antianginal and anti-ischemic agents. However, side effects with nitrate therapy are common. A throbbing headache is the most common side effect of nitrates. Nitrate-induced hypotension is also common and is most often asymptomatic. To prevent lightheadedness or dizziness, and to prevent a fall or injury, the nurse must teach clients to get up slowly when they are rising from a seated or lying position. Nitrate skin patches may cause skin irritation, which can be avoided by putting the patch in a different place each time. These side effects are not serious and usually become less severe with continued use of the nitrate medication. Tachycardia may occur as the body is adjusting to the medication. Elevated blood sugar levels are not an adverse effect of nitrates.
Current studies indicate that thrombolytic therapy is of no value if administered after when? 2 hours of onset of MI symptoms 24 hours of onset of MI symptoms 10 hours of onset of MI symptoms 1 hour of onset of MI symptoms
24 hours of onset of MI symptoms Rational: Thrombolytics, which are used to dissolve blood clots, are most effective when administered between 20 minutes and 12 hours after the onset of MI symptoms. Ideally, they should be given within 30 minutes or less. According to current studies, thrombolytic therapy is of no value if administered more than 24 hours after the onset of MI.
What is the primary cause of myocardial infarction (MI)? Excessive weight Coronary artery spasm Prolonged aerobic exercise Advanced coronary artery disease
Advanced coronary artery disease Rational: Advanced coronary artery disease (CAD)-a narrowing of the lumen of one or more coronary arteries-is the primary cause of myocardial infarction (MI). CAD results from atherosclerosis or fatty plaque buildup inside the artery walls that leads to blocked blood flow. Prolonged aerobic exercise, coronary artery spasm, and too much weight all put increased demands on the heart muscle, but are not primary, direct causes of MI.
The nurse has taught the client about the major differences between angina pectoris and myocardial infarction (MI). Which client statement indicates that further teaching is needed? "When a person has an MI, part of their heart muscle actually dies." "I get angina because the oxygen demands of my heart are not being met." "You just taught me that rest and relaxation will decrease my pain by decreasing my heart's demand for oxygen "Angina and MI are two different names for the same condition."
Angina and MI are two different names for the same condition." Rational: Angina pectoris and myocardial infarction are not different names for the same condition. If a client made this statement after nursing education has been provided, further teaching would be warranted. Angina pectoris is chest pain caused by a deficiency in oxygen supply to meet the metabolic demands of the heart muscle and results in myocardial ischemia. Angina occurs due to an increased oxygen demand by the heart muscle (myocardial oxygen demand) and is often associated with physical exertion or emotional excitement. Angina pain is usually relieved by rest and relaxation, which decrease the myocardial oxygen demand. Myocardial infarction (MI), commonly referred to as a heart attack, refers to myocardial cellular necrosis (death of heart-muscle cells), and is a life-threatening event requiring immediate medical attention.
Professor Ethel Lipkin is a 56-year-old female with a history of osteoarthritis, glaucoma, and two episodes of angina pectoris pain. She presents with another angina episode, and is prescribed a sustained-release form of nitrates to relieve her acute pain. Before you administer the medication to Ms. Lipkin, which precaution should be your priority? Ask the health care provider about the prescription order Assess the client for headache Assess the client for dizziness Measure swelling of the client's feet and ankles
Ask the health care provider about the prescription order rational: Nitrates are the drugs of choice for relieving acute angina pain and treating an episode. Nevertheless, the nurse needs to be cautious about administering the sustained-release form of nitrates to a client for treatment of angina if the client also has glaucoma. It is important to remember that nitrates dilate the blood vessels which can increase the intraocular pressure. Therefore, the priority precaution should be talking to the health care provider about the prescription order for Ms. Lipkin. Although dizziness and headache are potential adverse effects of nitrates that should be monitored, the medication has not yet been administered, and the priority is talking with the health care provider first. Swelling of the feet and ankles is not typically associated with nitrates.
Both beta1-adrenergic antagonists and nonselective beta-adrenergic antagonists are used in the treatment of angina. Which are true statements about these medications? Select all that apply. Both nonselective and beta-adrenergic may worsen angina caused by vasospasm. Only beta-antagonists may decrease cerebral blood flow. Nonselective beta antagonists may cause bronchoconstriction. Nonselective beta antagonists are weaker than beta-antagonists. Both nonselective and beta-adrenergic antagonists may hide the symptoms of hypoglycemia.
Both nonselective and beta-adrenergic antagonists may hide the symptoms of hypoglycemia. Nonselective beta antagonists may cause bronchoconstriction. Both nonselective and beta-adrenergic may worsen angina caused by vasospasm Rational: Nonselective beta-adrenergic antagonists may cause bronchoconstriction, whereas beta1-adrenergic antagonists are less likely to do so. Both types may mask the symptoms of hypoglycemia because of the depression of tachycardia, which is a symptom of hypoglycemia. Both types can worsen vasospastic angina. Both types-not just beta1-antagonists-are contraindicated for clients with low cerebral blood flow, as they can decrease cerebral tissue perfusion. Nonselective beta-adrenergic antagonists are not weaker than beta1-adrenergic antagonists.
Which drugs are considered the drugs of choice for vasospastic angina? Beta blockers Calcium channel blockers Nitrates Beta-adrenergic antagonists
Calcium channel blockers Rational: Calcium channel antagonists, also called calcium channel blockers (CCBs), relax arterial smooth muscle, thereby lowering blood pressure. CCBs are considered the drugs of choice for vasospastic angina because they dilate the coronary arteries, bringing more oxygen to the heart muscle. For clients with persistent symptoms, CCBs may be used as adjunctive therapy with nitrates, but nitrates are not the first choice for vasospastic angina. Beta blockers (beta-adrenergic antagonists) are not effective for treating vasospastic angina, and may even worsen this condition.
The nurse is teaching a client who was recently diagnosed with chronic stable angina about the most common side effects (adverse reactions) of beta-adrenergic antagonists (beta blockers). Which instructions will the nurse integrate into the teaching plan? Beta blockers decrease myocardial workload by decreasing heart rate and blood pressure, which reduces the contractility of the heart muscle. Beta-adrenergic antagonists reduce blood pressure and block the effects of adrenaline, causing the heart to beat more slowly and with less force; with decreased blood pressure, blood vessels widen and cardiac blood flow is improved. Clients taking beta blockers may experience dizziness, lightheadedness, blurred vision, and nausea and vomiting as the body adjusts to the medication. Beta blockers are contraindicated in clients with a history of bradycardia, heart disease (e.g., heart block, heart failure, cardiogenic shock), stroke, lung disease (e.g., asthma, bronchitis, emphysema), or depression.
Clients taking beta blockers may experience dizziness, lightheadedness, blurred vision, and nausea and vomiting as the body adjusts to the medication. Rational: As with any medication, adverse effects are possible with beta-adrenergic antagonists (beta blockers). However, not all users of beta blockers will experience problems. In fact, most people tolerate beta blockers well. When side effects do occur, they are usually minor and require no treatment, or are easily treated. The most common side effects of taking beta-adrenergic antagonists include bradycardia, hypotension, fatigue, weakness, cold hands and feet, dizziness, and nausea and vomiting. This question asks about the adverse effects (side effects) of beta-adrenergic antagonists, not the mechanism of action or the contraindications for these types of medications.
The nurse admits a new client to the nursing unit with a baseline medical diagnosis of stable angina. Which nursing actions occur during the assessment phase of the nursing process? Select all that apply. Teach the client about the medication (sublingual nitroglycerin): how to safely self-administer, side effects, precautions, and when to call for emergency medical help (9-1-1). Complete a health history and gather specific information regarding the signs and symptoms that brought the client to the emergency department and nursing unit. Determine if results of monitoring (for example, vital signs, electrocardiograms) and laboratory data (troponin and electrolyte levels, lipid studies, C-reactive protein tests) are in the client's medical chart (all tests ordered by the health care provider on admission). Give the client feedback as he/she self-administers the sublingual nitroglycerin medication. Complete a thorough pain assessment.
Complete a health history and gather specific information regarding the signs and symptoms that brought the client to the emergency department and nursing unit. Determine if results of monitoring (for example, vital signs, electrocardiograms) and laboratory data (troponin and electrolyte levels, lipid studies, C-reactive protein tests) are in the client's medical chart (all tests ordered by the health care provider on admission). Complete a thorough pain assessment. rational: During the assessment phase of the nursing process (in relation to medication administration for a new client admitted with stable angina), the nurse has many responsibilities, including obtaining a complete medical and social history, obtaining the client's medication history, and verifying that baseline laboratory and diagnostic tests are completed and that the results are in the client's medical chart. Other responsibilities include monitoring baseline vital signs, with continued and frequent monitoring thereafter; completing a pain assessment (onset, location, intensity, duration, character, precipitation, and alleviating factors); determining drug allergies; and having a thorough understanding of all prescribed medications and monitoring for therapeutic effect and for any contraindications. Teaching clients about their medication (in this example, sublingual nitroglycerin), including how to safely self-administer, side effects, precautions, and when to call for emergency medical help (9-1-1), is part of the nurse's role in the implementation phase of the nursing process. Giving clients feedback as they self-administer medication is part of the planning phase of the nursing process.
A client who experienced an MI is about to be discharged after one week in the hospital. What issues should you consider when evaluating the effectiveness of the medication(s) administered for MI? Select all that apply. Decrease in heart rate Clear breath sounds Decrease in blood pressure Relief of chest pain No further occurrence of MI
Decrease in blood pressure Relief of chest pain No further occurrence of MI Decrease in heart rate Rational: Your role in the evaluation phase of administering medications for MI involves assessing the effectiveness of medication(s) for relief of chest pain, decrease in heart rate and blood pressure, with no further myocardial infarction occurrence. Medications for MI do not affect breath sounds.
Why does rest often reduce angina pain? Decreases myocardial oxygen demand Increases myocardial oxygen demand Reverses tissue ischemia in the heart Opens narrowed arteries in the heart
Decreases myocardial oxygen demand rational: Angina pain is usually relieved by rest because relaxing reduces myocardial oxygen demand that was increased with physical exertion or stress. However, rest cannot reverse tissue ischemia or open narrowed arteries.
The health care provider prescribed nitrates for a client who is admitted with stable angina pectoris. Nitrates would be contraindicated if this client had which additional health conditions? Select all that apply. Head trauma Hypotension Hypertension Dehydration Diabetes mellitus
Dehydration Head trauma Hypotension Rational: Nitrates have been a preferred initial treatment for angina pectoris for many years. Nitrates are vasodilators that act upon vascular smooth muscle. They promote oxygenation to cardiac muscle by decreasing myocardial oxygen demand. This is achieved by decreasing the amount of blood returning to the heart (preload) and by increasing the flow of blood through the coronary arteries. The coronary vasodilatation is also effective in the treatment of angina caused by vasospasm. Contraindications and precautions for using nitrates include preexisting hypotension; head injury or head trauma; and dehydration, as well as shock, pericardial tamponade, and constrictive pericarditis. Caution should be used when administering the sustained-release form of nitrates to clients with glaucoma or to clients who use sildenafil (Viagra) or similar medications, because concurrent use may cause severe hypotension. Nitrates are not contraindicated for the client with diabetes or hypertension.
The nurse is providing care for a client who experienced a myocardial infarction (MI) 48 hours ago. This client reports occasional sharp chest pain that moved to his neck, shoulder, abdomen, and back after the MI. He is without dyspnea, and his oxygenation saturation level is 98% (normal: 95%-100%). Which nursing actions are consistent with the goals of treatment for this client? Select all that apply. Reduce the heart's oxygen demand. Turn and reposition the client every 1 to 2 hours. Administer high-flow oxygen. Discuss pain management strategies with the client and family members at the bedside. Administer prescribed medications to restore circulation and oxygen supply to the heart.
Discuss pain management strategies with the client and family members at the bedside. Administer prescribed medications to restore circulation and oxygen supply to the heart. Reduce the heart's oxygen demand. Rational: Goals of treatment after a client experiences myocardial infarction (MI) include restoring circulation and oxygen supply to the damaged portion of the heart, as quickly as possible; reducing myocardial oxygen demand with nitrates, beta blockers, and calcium channel blockers to decrease the risk of subsequent MIs or the risk of extending the current area of damage; managing MI pain and anxiety; controlling or preventing dysrhythmias or other post-MI complications; reducing post-MI mortality; and, after cardiac arrest has occurred, restarting the heart and restoring cardiac function to as near normal as possible. There is no evidence that this client is hypoxic and in need of oxygen; further assessment must be completed before initiating this nursing action. Also, repositioning and turning a client after myocardial infarction (MI) increases energy expenditure and may lead to dyspnea, so this nursing action is not warranted at this time.
The nurse is teaching the client about clinical manifestations of angina pectoris. Which signs and symptoms should be included in the teaching plan? Select all that apply. Feeling fear or anxiety Feeling changes in heart rhythm Shortness of breath Chest pain that is stabbing, crushing, or squeezing (tightness) Pain in the left shoulder, arm, jaw, neck, and epigastric and upper abdominal area, and between the shoulders
Feeling fear or anxiety Shortness of breath Chest pain that is stabbing, crushing, or squeezing (tightness) Pain in the left shoulder, arm, jaw, neck, and epigastric and upper abdominal area, and between the shoulders. Rational: Chest pain associated with angina pectoris is usually characterized as stabbing, crushing, or squeezing (tightness); some have described angina pain as "feeling like a vise is squeezing" the chest. Clients with angina pectoris often describe pain in the left shoulder or arm, jaw, neck, epigastric and upper abdominal area, and between the shoulders. When the angina occurs, clients report feelings of anxiety, fear, impending doom, and shortness of breath. Feeling changes in the heart rhythm is not associated with angina pectoris
Which laboratory data are helpful in your baseline assessment of angina and MI issues? Select all that apply. ESR sed rate Lipid studies Electrolytes CK Troponins
Lipid studies Electrolytes CK Troponins Rational: As a nurse, you may be responsible for obtaining a baseline assessment that includes lab data for lipids, creatine kinase (CK), electrolytes, and troponins. A sed rate or erythrocyte sedimentation rate (ESR) blood test reveals inflammatory activity in the body and would not be automatically ordered for an angina or MI client.
The client, recently diagnosed with myocardial infarction (MI), will be discharged in 48 hours. Which action is included in the planning phase of the nursing process in relation to medication administration? Make sure the client is able to describe the mechanism of action and list at least four of the most common adverse effects for all of the medications prescribed at discharge. Determine if the client is allergic to any medications. Determine what medications the client has taken for pain in the past. Teach the client about adverse effects of vasodilators; for example, teach about orthostatic hypotension and the importance of changing positions slowly (sitting to standing) to prevent dizziness, lightheadedness, and fainting.
Make sure the client is able to describe the mechanism of action and list at least four of the most common adverse effects for all of the medications prescribed at discharge. Rational: In the planning stage in relation to medication administration, the nurse is responsible for organizing (planning) nursing care to ensure that the client is able to verbalize an understanding of prescribed medications, including their use, action, adverse effects, and precautions. Determining what medications the client has taken for pain in the past, and obtaining baseline assessment data such as the client's medication allergies, are part of the assessment phase of the nursing process. Teaching a client about adverse effects of medications is part of the implementation phase of the nursing process in relation to medication administration.
What are common symptoms of myocardial infarction (MI)? Select all that apply. Nausea and vomiting Unusually pale skin Hyperventilation Chest pain or tightness Excessive sweating
Nausea and vomiting Unusually pale skin Chest pain or tightness Excessive sweating Rational: Clinical manifestations of MI include extreme chest pain or tightness, diaphoresis (sweating), nausea and vomiting, and pallor. Shortness of breath, not hyperventilation, is another common symptom of MI.
The nurse is teaching the client about his recently diagnosed angina pectoris. She tells him that his type of angina is not predictable and is associated with a higher risk for myocardial infarction (MI). What types of angina might this client have? Select all that apply. Silent angina Vasospastic angina Stable angina Prinzmetal's angina Unstable angina
Silent angina Unstable angina Rational: Two types of angina, unstable angina and silent angina, place a client at higher risk for myocardial infarction. In addition, clients with silent angina are at higher risk for sudden death. Unstable angina is characterized as "unstable" for two reasons. First, symptoms occur in a more random and unpredictable manner, often without any apparent trigger (often occurs at rest, or may awaken a person from a restful sleep). Secondly, unstable angina is most often caused by an actual rupture of a plaque, which often leads to the formation of a blood clot in the coronary artery that partially blocks the artery. If the clot causes complete obstruction of the artery, the heart muscle (supplied by that affected artery) is in grave danger of sustaining irreversible damage and the imminent risk of a complete myocardial infarction is very high. Unstable angina is considered a medical emergency. Cardiac ischemia (silent angina) refers to a decrease of oxygen-rich blood flowing to the heart muscle caused by a narrowed or blocked coronary artery. If ischemia is severe or lasts for an extended time, it can lead to myocardial infarction and heart tissue/muscle death. With silent angina, there is no pain. Silent angina (ischemia) may disturb the heart's normal rhythm (causing ventricular tachycardia or ventricular fibrillation) and may interfere with the heart's pumping ability and cause loss of consciousness. People who have diabetes or have had previous heart attacks are especially at risk for developing silent angina. Clients with silent angina are at higher risk for MI and sudden death.Stable angina is the most common type of chest pain and occurs most often during activity or stress. Stable angina is caused by diminished blood flow through the coronary arteries to the heart muscle (myocardium). A higher risk for myocardial infarction (MI) is not associated with this type of angina. Vasospastic angina, or coronary artery spasm, refers to a temporary and sudden narrowing (spasm) of one of the coronary arteries. This spasm slows or stops blood flow through the coronary artery and reduces the amount of oxygen-rich blood getting to the heart muscle. A higher risk for myocardial infarction (MI) is not associated with this type of angina. Prinzmetal's angina is another name for vasospastic angina. Prinzmetal's angina, also referred to as "variant" angina, is a temporary and sudden increase in coronary vascular tone (or vasospasm), causing a marked and transient reduction in arterial luminal diameter and leading to chest pain (angina). A higher risk for myocardial infarction (MI) is not associated with this type of angina.
Don Morey presents to the urgent care clinic with tightness in his chest, shortness of breath, and anxiety. He reports that he was rearranging rocks in his garden. Mr. Morey shares that he felt better after resting in his armchair, but his daughter insisted that he see a health care provider. As the nurse, you recognize that Mr. Morey's symptoms may be related to what? Stable angina Silent angina Unstable angina Vasospastic angina
Stable angina rational: Stable angina occurs with activity or stress, due to an increased myocardial oxygen demand. It is relieved by rest and nitrates. Vasospastic angina is not related to activity and often occurs at rest. Unstable angina may take place at rest, but it occurs with increasing frequency, severity, and duration. Silent angina occurs when the client has an episode of myocardial ischemia but does not experience pain or chest tightness.
The nurse is caring for a client who was recently diagnosed with vasospastic (Prinzmetal's) angina. Which nursing action is included in the implementation phase of the nursing process in relation to medication administration with this client? Review the client's medical chart to make sure the results of the angiogram (a diagnostic test that produces an x-ray of the heart's arteries on a monitor) are placed in the correct section of the client's chart. Determine if the client goal of listing two or three of the most common adverse effects of the medications he is taking was met. Teach the client about the medications he/she is taking (medication self-administration, mechanism of action, and adverse effects). Interview the client to determine when the angina occurs, if the pain occurs in clusters, and if there are any identifiable triggers that lead to the chest pain.
Teach the client about the medications he/she is taking (medication self-administration, mechanism of action, and adverse effects). Rational: The implementation phase of administering medications for the client with vasospastic (Prinzmetal's) angina includes teaching the client about medication use, mechanism of action, and adverse effects. During the assessment stage of the nursing process, the nurse is responsible for obtaining baseline assessment data, which includes interviewing the client to determine when the angina occurs, if the pain occurs in clusters, and if there are any identifiable triggers that lead to the chest pain. Reviewing the chart for proper placement of documentation is not part of the nursing process. Determining if the client goal of listing two or three of the most common adverse effects of the medications he/she is taking was met is a component of the evaluation phase of the nursing process.
The nurse is teaching the client about stable angina, which she describes as "predictable." The client asks what predictable means. The nurse explains that "predictable" means that the same amount of exercise or activity may cause the angina to occur. What should the client be told to expect when the exercise is stopped or slowed down? The client will require emergency medical treatment. The client's symptoms will occur even at rest and may recur at night. The client's symptoms should improve or go away. The angina will recur with increasing frequency, severity, and duration.
The client's symptoms should improve or go away. Rational: Stable angina is chest pain or discomfort that often occurs with activity or stress. Symptoms of stable angina are often predictable, which means that the same amount of exercise or activity may cause the angina to occur. Pain from stable angina should improve or go away when the exercise or activity is stopped or slowed down. In contrast, myocardial infarction (MI), commonly referred to as a heart attack, results in myocardial cellular necrosis (heart-muscle cell death) and is a life-threatening event that requires emergency medical treatment. Vasospastic angina or Prinzmetal's angina, caused by coronary artery spasm with or without the presence of atherosclerosis, is unpredictable and not related to activity; it often occurs at rest and may occur at night. Unstable angina occurs with increasing frequency, severity, and duration, and may occur at rest. Clients with unstable angina are at higher risk for MI.
The client, who recently suffered a myocardial infarction, tells the nurse he has never heard of glycoprotein IIb/IIIa inhibitors and asks what this medication does and why it has been prescribed for him. Which response by the nurse answers the client's questions? This medication prevents blood clots from developing. They are often given to clients who are undergoing angioplasty. This medication decreases the size of blood clots. That improves the blood flow to the heart. This medication is given only to selected clients at high risk for serious blood clot formation. This particular medication (glycoprotein IIb/IIIa inhibitors) is not recommended for clients who have low platelet counts.
This medication prevents blood clots from developing. They are often given to clients who are undergoing angioplasty. rational: Glydoprotein IIb/IIIa inhibitors prevent blood clots from developing. They are often given routinely to clients who are undergoing angioplasty. That medication does not decrease the size of blood clots, and is not given only to selected clients at high risk for serious blood clot formation. While that medication is not given to clients with low platelet counts, that fact does not answer the client's question about its indication and use in this client.
Your 38-year-old client, Jack Hageman, is undergoing angioplasty in your hospital. Mr. Hageman is prescribed tirofiban (Aggrastat) via IV. What is one of the potential adverse effects of this drug? Paresthesia Thrombocytopenia Hypokalemia Muscle tremors
Thrombocytopenia Rational: Tirofiban hydrochloride (Aggrastat) is in the class of antiplatelet drugs called glycoprotein IIb/IIIa inhibitors. Adverse effects of drugs in this class include hypotension secondary to blood loss, abnormal bleeding, and thrombocytopenia. Muscle tremors, hypokalemia, and paresthesia are not adverse effects associated with tirofiban.
Yvette Robles is a 65-year-old angioplasty client with coronary artery disease (CAD). Before being discharged from the hospital, she is prescribed clopidogrel (Plavix). Mrs. Robles also takes ibuprofen (Advil) on occasion for headaches. During the discharge teaching, what should you verify that Mrs. Robles understands? How to use sublingual nitroglycerin (Nitrostat) When to contact her health care provider When to adjust her two medications How to practice healthy heart living
When to contact her health care provider Rational: When clopidogrel (Plavix), an antiplatelet drug, is taken with ibuprofen (Advil), the risk for bleeding events increases. Thus, Mrs. Robles needs to know when to contact her health care provider to report adverse effects, such as any signs or symptoms of GI bleeding. Mrs. Robles does not have a need for sublingual nitroglycerin (Nitrostat). A health care provider-not Mrs. Robles-should determine when to adjust any medications. Although lifestyle changes for healthy heart living should be discussed, this education does not have as high a priority.
The nurse has provided teaching to a client who recently experienced a myocardial infarction (MI) about the use of aspirin (Bayer). Which client response indicates that the teaching has been successful? Select all that apply. "The doctor ordered aspirin to relieve my chest pain." "I may bleed longer than usual if I accidently cut myself or if I have a nosebleed." "I don't need to worry about having any side effects with aspirin because side effects with aspirin are pretty rare." "Being on this medication, I need to watch out for any stomach problems like heartburn or upset stomach." "Taking aspirin will help to prevent another heart attack."
"I may bleed longer than usual if I accidently cut myself or if I have a nosebleed." "Being on this medication, I need to watch out for any stomach problems like heartburn or upset stomach." "Taking aspirin will help to prevent another heart attack." Rational: Aspirin (Bayer) can reduce mortality in the weeks following acute myocardial infarction (MI). Aspirin is used not only to treat MI, but also to prevent it. Aspirin has antiplatelet aggregation effects that prevent thrombus formation, and also an anti-inflammatory action that decreases the formation of C-reactive protein (the formation of C-reactive protein is associated with an increased risk for MI). All medications have adverse effects (side effects). The most common side effects of aspirin include stomach problems (irritation, heartburn, stomach pain, and upset stomach) and bleeding problems (gastrointestinal bleeding, prolonged bleeding). Other side effects include allergic reaction, tinnitus and hearing loss (with high doses), and hepatotoxicity/nephrotoxicity (with long-term use).
The nurse in the emergency department begins intravenous administration of a thrombolytic medication, streptokinase (Streptase), to a newly admitted client who had a myocardial infarction (MI). Which instructions should the nurse provide to the client (and family) related to this medication's mechanism of action and adverse effects? Select all that apply. "I will be checking your blood pressure often after you receive this medication to make sure you don't experience complications." "Let me know if you have any allergic reactions such as fever, chills, itching, or problems breathing after you receive this medication." "Clients receiving this medication sometimes experience bleeding. If you notice any bleeding, use the nurse call button immediately so that we can control the bleeding." "This medication works to break up and dissolve blood clots that can block arteries. It is often used as early treatment for heart attack." "You will be receiving this medication for the next three to four days. Be sure to let the nursing staff know if you experience any bleeding, fever, or chills."
"I will be checking your blood pressure often after you receive this medication to make sure you don't experience complications." "Let me know if you have any allergic reactions such as fever, chills, itching, or problems breathing after you receive this medication." "Clients receiving this medication sometimes experience bleeding. If you notice any bleeding, use the nurse call button immediately so that we can control the bleeding." "This medication works to break up and dissolve blood clots that can block arteries. It is often used as early treatment for heart attack." Rational: Clients have a better chance of surviving and recovering from myocardial infarction if they receive a thrombolytic drug, such as streptokinase (Streptase), within 12 hours after the heart attack occurs. Thrombolytics are most effective when administered between 20 minutes and 12 hours after the onset of MI symptoms. Ideally, the client presents to the emergency department and has the drug administered within 30 minutes or less. Thrombolytics work by dissolving major clots quickly, which helps restore some blood flow to the heart muscle and prevent damage to heart muscle. However, the blood flow may not return completely to normal, and some muscle damage may occur. Additional therapy, such as cardiac catheterization or angioplasty, may be needed. The most commonly reported adverse reactions to streptokinase treatment include unusual bleeding; severe/uncontrolled hypertension, internal hemorrhage, and allergic reactions (e.g., fever, chills, itching, and problems breathing, which are the most commonly reported allergic reactions to intravenous use of streptokinase after MI). Research has shown that thrombolytic therapy is of no value if administered more than 24 hours after the onset of MI. Thus, it would be incorrect for the nurse to teach the client that thrombolytics will be given for four days.
The nurse is teaching a 68-year-old woman, who was admitted with angina pectoris and a history of type 2 diabetes, why taking her medications as prescribed and making diet and exercise lifestyle changes will be important in treating her angina. Which response indicates that further teaching is needed? "I can lower my risk for heart attack if I keep active, eat right, and take my medications as they are prescribed." "If I exercise and watch my diet, my chest pain can be cured." "If I follow the treatment plan, which includes exercise and diet, my chances of having a heart attack are reduced." "If I follow the treatment plan, I will probably have fewer episodes of chest pain."
"If I exercise and watch my diet, my chest pain can be cured." Rational: The chest pain of angina is a symptom, not a disease to be cured. It alerts both clients and caregivers of a possible life-threatening situation. The client has three ways to reduce the risk of heart attacks: exercise, nutrition, and medication compliance. That same treatment plan supports a decrease in the probability of future angina.
