STEMI

For all patients undergoing percutaneous coronary intervention (PCI), which drug is recommended to be combined with clopidogrel [Plavix]?

Aspirin In patients undergoing percutaneous coronary intervention (PCI), clopidogrel [Plavix] is used in combination with aspirin. Aspirin suppresses platelet aggregation, thereby reducing mortality by reducing the likelihood of reinfarction or stroke. p. 629

A patient is admitted to the emergency department complaining of chest pain, and the electrocardiogram (ECG) shows an evolving ST-segment elevation myocardial infarction (STEMI). Which intervention should the nurse anticipate?

Administer nitroglycerin In patients with ST-segment elevation myocardial infarction ( STEMI), nitroglycerin can (1) reduce preload, and thereby reduce oxygen demand; (2) increase collateral blood flow in the ischemic region of the heart; (3) control hypertension caused by STEMI-associated anxiety; and (4) limit infarct size and improve left ventricular (LV) function. Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are avoided, because they increase the risk of mortality, reinfarction, hypertension, heart failure, and myocardial rupture. Current guidelines recommend administration of oxygen by nasal cannula only if the arterial oxygen saturation is below 90%. Treatment with angiotensin-converting enzyme (ACE) inhibitors should begin within 24 hours of symptom onset.

Which adverse effect is the greatest concern with thrombolytic therapy?

Intracranial hemorrhage The major complication of thrombolytic therapy is bleeding. Intracranial hemorrhage (ICH) is the greatest concern. p. 628

The nurse is teaching a patient who has had an ST-segment elevation myocardial infarction (STEMI) about home medications. Which agent represents a drug category that should be taken by all post-myocardial infarction (post-MI) patients unless contraindicated?

Metoprolol All post-myocardial infarction (post-MI) patients should take a beta blocker, such as metoprolol [Lopressor]; an angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB); and an antiplatelet or anticoagulant agent. Although the other agents may be warranted, these three categories are universally indicated after MI