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."
