Coronary Artery Disease

After discussing these test results with the healthcare provider (HCP) and the nurse, the client expresses interest in learning how to lower her cholesterol and lose weight. The HCP prescribes the antihyperlipidemic agent lovastatin 20 mg PO daily. Which intervention is most important for the nurse to include in the client's plan of care related to the use of an antihyperlipidemic?

Healthy lifestyle habits

A Complication Occurs On the client's second day post-MI, the nurse notes a change in the client's cardiac monitor. The client's rhythm strip changes from normal sinus rhythm to sinus rhythm with short runs of ventricular tachycardia (VT). The nurse assesses the client, whose blood pressure is now 100/54 mmHg. The client is lethargic, but she is able to be aroused. Which intervention should the nurse initiate first?

Administer amiodarone IV.

Therapeutic Communication: Noncompliance The client is post-menopausal and smokes two packs of cigarettes a day. Her hypertension is uncontrolled even with the prescribed ACE inhibitor. The client took the clinic's online learning course on reducing the risk for heart disease. At the conclusion of the course, the client tells the nurse that she does not need classes because she knows she is going to be healed. Which nursing intervention best promotes effective communication?

"Do you feel that you do not need to be involved in your health care?"

If a patient has more than one risk factor, they are at an increase risk for cardiovascular disease (CAD). These risk factors are classified in two categories: non-modifiable and modifiable. The non-modifiable factors include family history, age, gender, culture, and ethnicity. Modifiable factors include smoking, hyperlipidemia, hypertension, diabetes mellitus, obesity, sedentary lifestyle, stress, and psychosocial factors. Smoking cigarettes has a two to three times greater risk for developing cardiovascular disease. Which information in the client's history indicates an increased risk for coronary artery disease (CAD) and requires the nurse to provide disease management education? (Select all that apply. One, some, or all options may be correct.)

-Family history of hyperlipidemia. -Consumption of a high fat diet. -Smoking two packs of cigarettes per day

The client is started on a continuous IV infusion of lidocaine at 2 mg/min. The ventricular tachycardia is controlled, and her cardiac monitor strip shows a sinus rhythm with occasional PVCs. The nurse monitors the client for adverse effects of the infusion, including hypotension, drowsiness, seizures, bradycardia, and confusion. What steps should the nurse take to minimize the development of these adverse effects? (Select all that apply. One, some, or all options may be correct.)

-Monitor serum lidocaine levels -Monitor ECG, blood pressure, and respiratory status -Monitor the client's anxiety level

The client continues to recover in the intensive care unit. Which interventions should the nurse implement for the client? (Select all that apply. One, some, or all options may be correct.)

-Provide pain medication with onset of pain. -Administer anti-anxiety medication as needed -Assess the client's level of knowledge and ability to learn

Discharge Preparation The nurse determines that these individuals are beginning nursing students who are learning to interview clients and the nurse asks the group to leave the client's room. The nurse reviews the importance of promoting client rights and ways to achieve this. Upon learning the students' goals, the client welcomes the opportunity to visit with the nursing students. She talks with them at length about her impending discharge, the concerns she has, and her plans to engage in a healthier lifestyle. The nurse completes the client's discharge teaching and schedules the client to begin therapy at the cardiac rehabilitation unit the following week. Which expected outcomes indicate that the nurse's discharge teaching was effective? (Select all that apply. One, some, or all options may be correct.)

-The client chooses walking as her initial form of exercise -The client chooses a diet low in saturated fat and cholesterol

Percutaneous Transluminal Angioplasty The primary healthcare provider (HCP) prescribes a continuous IV infusion of amiodarone 1 mg/min for the client. The available drug is amiodarone 900 mg in 500 mL of D5W. The nurse should set the IV pump at how many mL/hr? (Enter numerical value only. If rounding is necessary, round to the whole number.)

33

Management Issues: Priorities The next day, the client is transferred to the Progressive Cardiac Unit. During report, the nurse is assigned four clients. Which client should the nurse assess first?

A client with unstable angina who is complaining of chest discomfort and who has been given one nitroglycerin tablet sublingually (SL)

While taking the prescribed antihyperlipidemic, which serum laboratory value requires intervention?

ALT 60 U/L (1.0 mckat/L).

ECG findings reveal ST segment elevation in leads II and III, and a VF indicating that the client is having an inferior acute myocardial infarction (AMI). Which intervention should the nurse implement first?

Have the client chew four 81 mg chewable acetylsalicylic acid.

Nursing Diagnoses and Interventions The nurse assesses the client for changes in vital signs and for dysrhythmias. Other assessment findings related to MI include: Dyspnea Pallor Diaphoresis Weakness Fatigue Nausea Vomiting Fever The client is transferred to the critical care unit for treatment and monitoring. She is still receiving oxygen at 2 L/min and IV nitroglycerin infusion. Her vital signs are stable. Her oxygen saturation is 94%, her breath sounds are clear, and she denies any pain at the present time. The client's nurse develops a plan of care based on the following nursing problems: Pain related to an imbalance between myocardial oxygen supply and demand. Alteration in tissue perfusion (cardiac) related to blood flow interruption. Activity intolerance related to imbalance between oxygen supply and demand. Anxiety related to pain and fear. Which intervention is most important for the nurse to include in the client's plan of care?

Continuous cardiac monitoring of heart rate and rhythm

Clinical Manifestations The nurse reviews the client's symptoms during the myocardial infarction. Her pain was first noted as a discomfort during the first presentation. She was weak and short of breath. The ECG revealed ST elevation. Later her chest pain increased and the ECG revealed ST elevation in the lower lateral leads which indicated a STEMI. Elevated cardiac specific laboratory findings, ECG findings, and physical assessment confirmed that the client was having an acute myocardial infarction. After 2 doses of sublingual nitroglycerin and 4 mg IV morphine sulfate, the client's pain is 1 out of 10. The nurse is monitoring the client for complications that are common after a myocardial infarction. Which focused assessment finding warrants immediate intervention by the nurse?

Dysrhythmias

Client Teaching: Hyperlipidemia The client's lab results include: Serum cholesterol 280 mg/dL (7.25 mmol/L). Low-density lipoproteins (LDL) 180 mg/dL (4.66. mmol/L). High-density lipoproteins (HDL) 32 mg/dL (0.83 mmol/L). The client asks the nurse if these results are bad. Which nursing intervention best promotes effective communication?

HDL less than 50 mg/dL (1.29 mmol/L) for women indicates an increased risk.

Acute Myocardial Infarction (AMI) The client's angina remains stable, and she undergoes a hysterectomy for dysmenorrhea related to uterine fibroids. The day after being discharged from the hospital, the client comes to the ED with crushing substernal chest pain radiating down her left arm. She is dyspneic, pale, and diaphoretic. Which nursing intervention should be implemented first?

IV access and administer morphine sulfate as ordered by the HCP

The client is scheduled for percutaneous transluminal coronary angioplasty (PTCA) via femoral insertion. PTCA involves the insertion of a balloon-tipped catheter into the diseased coronary artery. When the balloon is inflated, it compresses the plaque against the vessel wall, resulting in an increase in the inner diameter of the blood vessel so blood can flow more easily. Click for Image Which nursing intervention should be implemented first when the client returns to her room?

Immobilize the affected leg.

The healthcare provider (HCP) orders IV nitroglycerin for the client. What changes in the client's cardiac function should the nurse tell the client to expect?

Improved perfusion of oxygenated blood to the heart muscle.

The HCP prescribes a stress echocardiogram. When preparing the client for the test, which instruction is most important for the nurse to provide?

Instruct the client not to smoke on the day of the test.

Which intervention is most important for the nurse to reinforce when assisting the client in achieving their goal to quit smoking?

Provide the client with a list of local smoking cessation programs.

Angina Several months later, the client visits the clinic for routine lab work. After walking into the clinic on a very hot day, she reports to the nurse that she is experiencing chest pain. After resting for five minutes, the pain is relieved. Following assessment and ECG evaluation, the client is diagnosed with stable angina and receives two prescriptions:Nitroglycerin 0.2 mg/hour transdermal patch. Apply every morning and remove at bedtime daily.Nitroglycerin 0.3 mg SL as needed for chest pain. Which intervention is most important for the nurse to include in the client's plan of care for the self-administration of sublingual nitroglycerin?

Put one tablet every 5 minutes under tongue up to 3 tablets

In addition to nitroglycerin, the HCP orders morphine sulfate 4mg IV. Which reaction requires immediate intervention by the nurse?

Respiratory rate slowing to 10 breaths/min.

Diagnostic Tests With the client's presenting symptoms, physical examination, electrocardiogram (ECG) findings, and elevated cardiac markers, the healthcare provider (HCP) confirms the diagnosis of myocardial infarction (MI). The client reports an increase in her chest pain as 8 out of 10. The nurse immediately obtains another ECG. Which ECG assessment finding warrants immediate intervention by the nurse?

ST segment elevation and the development of Q waves.

When providing education for the prescribed transdermal nitroglycerin, which intervention is most important for the nurse to include?

Tell the healthcare provider (HCP) of persistent dizziness when standing

Ethical-Legal Considerations: Client Rights While the nurse is assessing the client, a group of people dressed in street clothes and lab coats enters the client's room. They are carrying clipboards and pens, and they begin to ask the client questions related to her hospitalization. The client seems unsure how to respond. The nurse should immediately intervene to prevent violation of which client right?

The right to have information about the qualifications of caregivers

In addition to the ECG, the nurse sent blood to the laboratory to evaluate the client's cardiac isoenzyme. Which serum laboratory values requires intervention by the nurse?

Troponin T 0.4 ng/mL (0.4 mcg/L)