MEDSURG II: MI

A client comes to the emergency department with symptoms of chest pain radiating down the left arm, dyspnea, and diaphoresis. An electrocardiogram (EKG) shows ST segment elevation and the client is diagnosed with an ST segment-elevation myocardial infarction (STEMI). In order to determine if the client is a candidate for thrombolytic therapy, which question should the nurse ask?

"What time did your chest pain start?"!! "Did you take any nitroglycerine before coming to the emergency department?" "Do you have any allergies?" "Is this the first time you experienced this type of pain?"

collab care for MI

2 IV sites 12 lead ECG PQRST assessment admin O2 medicate serum markers ASA continuous telemetry

drug therapy

IV nitro (BP, change ECG, get ECG first) IV morphine (BP) BB (drop HR/BP) ACE (bP) anti-dysrhythmics anti platelets statins

The client has had a myocardial infarction, and the nurse has instructed the client to prevent Valsalva's maneuver. The nurse determines the client is following the instructions when the client:

Assumes a side-lying position. Clenches his teeth while moving in bed. Drinks fluids through a straw. Avoids holding his breath during activity.!!

A client with severe angina pectoris and electrocardiogram changes is seen in the emergency department. What laboratory studies would the nurse most likely anticipate?

Creatine kinase Lactate dehydrogenase Myoglobin Troponin !!

The nurse is reviewing the electrocardiogram of a client who has elevated ST segments visible in leads II, III, and aVf. Which is the nurse's best action?

Document the finding in the medical record Determine whether the rhythm is irregular, coinciding with inspiration and expiration Teach the client about risks for coronary artery disease Notify the healthcare provider!!

diagnostics for MI

ECG (ischemia) serum cardiac markers (troponin for cardiac cell death) coronary angiography (catheter thru femoral, inject dye, see the narrowing in heart)

angina assessment

PQRST

When administering a thrombolytic drug to the client experiencing a myocardial infarction (MI), and who has premature ventricular contractions, the expected outcome of the drug is to:

Promote hydration. Dissolve clots.!! Prevent kidney failure. Treat dysrhythmias.

Before discharge from the hospital after a myocardial infarction, a client is taught to exercise by gradually increasing the distance walked. Which vital sign should the nurse teach the client to monitor to determine whether to increase or decrease the exercise level?

Pulse rate.!! Blood pressure. Body temperature. Respiratory rate

A nurse is caring for a client with type 2 diabetes who has had a myocardial infarction (MI) and is reporting nausea, vomiting, dyspnea, and substernal chest pain. Which of the following is the priority intervention?

Reduce the nausea and vomiting and stabilize the blood glucose. Control the pain and support breathing and oxygenation.!! Decrease the anxiety and reduce the workload on the heart. Monitor and manage potential complications.

myocardial ischemia

ST segment depressed=ischemia T wave inversion

myocardial injury

ST segment elevation=cell death physiologic q wave

high risk px prevention meds

aspirin ACE inhibitors statins nitroglycerin put in a stent (reperfusion therapy)

20 minutes

cardiac cell death w/ decreased O2 will become necrotic

ongoing care

chronic disease regimen cardiac rehab teaching

antithrombotic therapy

clot buster drugs "TPA" within time frame d/t bleeding risk

fibrinolytic/thrombolytic therapy

clots in heart must be given within 6 hours of onset high risk of bleeding contra: previous cerebral hemorrhage, stroke, active bleeding, head trauma

A client with severe angina pectoris and ST-segment elevation on an electrocardiogram is being seen in the emergency department. In terms of diagnostic laboratory testing, it's most important for the nurse to advocate ordering a:

creatine kinase (CK) level. hemoglobin (Hb) level. troponin level.!! liver panel.

acute coronary syndrome

deterioration of once stable plaque essentially a MI thrombus is partially/fully occluding artery prolonged ischemia

coronary artery bypass graft

open heart sx bypass the blockage to re-perfuse the heart common think: infection and bleeding

complications with MI/HX of MI

dysrhythmias heart failure cardiogenic shock

cardiovascular manifestations MI

increased BP impaired left ventricular function

nrs considerations for ACS

iv access 12 lead ecg o2 drug therapy (nitro, morphine, aspirin, BB, ACE) emergent surgery (anti-platelet therapy)

serum cardiac markers

myoglobin (all muscle) troponin (heart specific) CK-MB (all muscle) all indicate cell death

coronary artery disease

narrowing and hardening or coronary arteries primary cause: atherosclerosis

NSTEMI

non-ST segment elevation MI no necrosis MI

MI clinical manifestations

pain, nitro doesn't help rest doesn't help happens in the morning N/V, SOB, epigastric pain, anxiety, diaphoresis, anxiety longer than 30minutes opioids help (morphine!)

SNS MI clini mani

pallor, cool, clammy, look grey, tachycardia

angina assessment P

provocation/palliation

ang assess Q

qual/quant

ang assess R

region/radiate

ang assess S

severity scale

risk factors for ACS

shitty lifestyle history of CAD, obesity, genetics

myocardial infarction

st elevated pathologic Q wave t wave inversion

nursing considerations-stable angina

stability: -drug therapy -surgery

ang assess T

timing extremely important!!

immediate care for ACS

transport to hospital immediately medical emergency

unstable angina

unpredictable chest pain occurs at rest, is new onset emergent situation

complications of cad

unstable angina ST segment elevation MI

percutaneous coronary intervention

with or wi/o stent balloon placed and expanded to compress plaque and allow improved blood flow, then removed can cut off vessel, can produce clots bleeding and infection

A nurse is caring for a client who is recovering from a myocardial infarction (MI). The cardiologist refers him to cardiac rehabilitation. Which statement by the client indicates an understanding of cardiac rehabilitation?

"When I finish the rehabilitation program I'll never have to worry about heart trouble again." "I won't be able to jog again even with rehabilitation." "Rehabilitation will help me function as well as I physically can."!! "I'll get rest during these rehabilitation classes. All I have to do is sit and listen to the instructor."