Diagnostics
non-invasive test to determine MI
What is ECG/ EKG
Prompt pain management with myocardial infarction is essential for which reason?
a) The discomfort will increase client anxiety and reduce coping.
b)Pain relief improves oxygen supply and decreases oxygen demand.
c) Relief of pain indicates that the MI is resolving.
D) Pain medication should not be used until a definitive diagnosis has been established.
B.
The focus of pain relief is on reducing myocardial oxygen demand. Chest discomfort will increase anxiety, but it may not affect coping. Relief of pain is secondary to the use of opiates or indicates that the tissue infarction is complete.
ACUTE PAIN related to tissue perfusion, if you improve pain tissue perfusion will improve and increase o2
The MONA regimen stands for
What is morphine, oxygen, nitrates, aspirin- if not already taken?
Older adults and patients with this disorder may never complain of chest pain when having an MI.
What is diabetes (due to diabetic neuropathy)
Daily weights and I&Os should be watched closely for what reason after an MI?
ECG/ EKG indication for MI
What is ST-Elevation
Along with persistent, crushing chest pain, which signs/symptoms would make the nurse suspect that the client is experiencing a myocardial infarction?
A) Midepigastric pain and heartburn
B) Diaphoresis and cool clammy skin
C) Intermittent claudication and palor
D) Jugular vein distention and dependent edema
What is
B) Diaphoresis and cool clammy skin
Rationale: Diaphoresis is a systemic reaction to the MI. The body vasoconstricts to shunt blood from the periphery to the trunk of the body; this in turn, leads to cold, clammy skin
First line drugs used to treat acute myocardial infarction?
What are thrombolytics? (tenectaplase, tissue plasminogen activator)...started within 6 hrs
What are clinical features of a patient presenting with STEMI?
What are:
Angina at rest or with minimal exertion
New-onset angina
Severe, persistent, and/or worsening angina
Autonomic symptoms may be present: diaphoresis, syncope, palpitations, nausea, and/or vomiting
The appropriate nursing action to take for a patient that does not comply with his medication regimen would be...
What is to collect more information to identify his reason for noncompliance?
A 56 year old patient was admitted to the ED with a myocardial infarction. Cardiac enzymes were drawn. In a patient with a myocardial infarction, which enzymes would be elevated?
What are elevated CK, CK-MB, and troponin I.
The nurse in the coronary care unit is caring for a group of clients who have had myocardial infarction. Which client does the nurse see first?
A) Client with dyspnea on exertion when ambulating to the bathroom
B)Client with third-degree heart block on the monitor
C) Client with normal sinus rhythm and PR interval of 0.28 second
D) Client who refuses to take heparin or nitroglycerin
B.
Third-degree heart block is a serious complication that indicates that a large portion of the left ventricle and conduction system are involved, so the client with the third-degree heart block should be seen first. Third-degree heart block usually requires pacemaker insertion. A normal rhythm with prolonged PR interval indicates first-degree heart block, which usually does not require treatment. The client with dyspnea on exertion when ambulating to the bathroom is not at immediate risk. The client's uncooperative behavior when refusing to take heparin or nitroglycerin may indicate fear or denial; he should be seen after emergency situations have been handled.
What is door to balloon time? What is its time threshold?
What is
Door-to-balloon time refers to the time from presentation at a percutaneous coronary intervention (PCI) center to first balloon inflation.
90 minutes
Literature demonstrates woman have decreased reporting of MI because
What is women are more likely to experience secondary symptoms in MI like SOB, nausea, vomiting, jaw pain. Because these symptoms are less specific for an MI, woman are less likely to seek treatment with these symptoms presenting.
Exercise that supports the cardiovascular system several times per week, dietary consult that facilitate and promote lifestyle changes, medications to improve and sustain heart tissues, and follow-up Drs. visits.
What is post cardiac care?
ST-depression classically suggests
What is myocardial ischemia?
A patient is admitted with chest pain to the ER. The patient has been in the ER for 5 hours and is being admitted to your unit for overnight observation. From the options below, what is the most IMPORTANT information to know about this patient at this time?
A. The key words in this question are "chest pain" and "been in the ER for 5 hours". The patient should have already had one troponin level drawn since it starts to elevate 1-3 hours after injury and has been in the ER for 5 hours. Therefore, it is essential you know what the level is and when the next level is due. If the patient's chest pain is caused by a myocardial event the troponin levels will trend upward. Troponin levels are usually ordered every 8 hours x 3. CK results are not as specific as a troponin levels. This question wanted to know the MOST important, and the troponin level for this patient/when it is drawn next is MOST important. Diet status and last consumption of caffeine are things the nurse needs to know but not the MOST important
Reroute your vein and arteries so the blood can flow around the blockage.
What is CABG (coronary artery bypass graft)?
A patient was admitted to the emergency department (ED) 24 hours earlier with complaints of chest pain that were subsequently attributed to ST-segment-elevation myocardial infarction (STEMI). What complication of MI should the nurse anticipate?
What are cardiac dysrhythmias?
As electrical impulses learn to travel new pathways created by tissue death and recovery of tissue pathway of ischemic tissue, dysrhythmias may occur.
A patient who has recently had an acute myocardial infarction (AMI) ambulates in the hospital hallway. Which data would indicate to the nurse that the patient should stop and rest? Respirs go from 14 to 20, O2% drops from 99 to 95%, HR increases 66 to 98, or BP changes from 118/60 to 126/68
What is HR
A change in heart rate of more than 20 beats over the resting heart rate indicates that the patient should stop and rest. The increases in BP and respiratory rate, and the slight decrease in O2 saturation, are normal responses to exercise.
Troponin I levels may elevate within how many hours after MI, and return to normal levels within how many days?
What is elevation within 12–16 h after MI and return to normal levels within 5-9 days.
The client diagnosed with a myocardial infarction asks the nurse, "why do I have to rest and take it easy? My chest doesn't hurt anymore." Which statement would be the nurse's best response?
A) "Your heart is damaged and needs about 4 to 6 weeks to heal"
B) "There is necrotic myocardial tissue that puts you at risk for dysrhythmias"
C) "Your doctor has ordered bedrest. Therefore, you must stay in bed."
D) "Just because your chest doesn't hurt anymore doesn't mean you are out of danger"
A) "Your heart is damaged and needs about 4 to 6 weeks to heal"
Rationale: The heart tissue is dead, stress or activity may cause heart failure, and it does take about 6-8 weeks for scar tissue to form
This class of drugs decrease myocardial oxygen demand and have been shown to reduce morbidity and mortality in patients with myocardial infarction
What are beta blockers?
Severe chest pain not relieved by rest, position change, or nitrate administration is the hallmark of an __
What is myocardial infarction?
The overall goals for a patient with ACS (6) of them
What is: (1) relief of pain, (2) preservation of heart muscle, (3) immediate and appropriate treatment, (4) effective coping with illness-associated anxiety, (5) participation in a rehabilitation plan, and (6) reduction of risk factors.
This is overall care if MI patients in a nutshell, start to finish