To detect and treat the most common complication of MI, what should the nurse do Quizlet

CASE STUDY: Coronary Artery Disease
Patient Profile: H.C., a 67-year-old Navajo woman, comes to the emergency department with a burning sensation in her epigastric area extending into her sternum.
Subjective Data
• Has had unexplained fatigue
• Has had chest pain with activity that is relieved with rest for the past 3 months
• Has had type 2 diabetes since she was age 35 years
• Has a smoking history of 1 pack a day for 27 years
• Has no regular exercise program
• Expresses frustration with physical problems
• Is reluctant to get medical therapy because it will interfere with her life
• Has no health insurance
Objective Data
Physical Examination
• Anxious, clenching fists
• Appears overweight and withdrawn
Diagnostic Studies
• 12-lead ECG
• Cholesterol: 248 mg/dL (6.41 mmol/L)
• LDL: 160 mg/dL (4.14 mmol/L)
• Glucose: 210 mg/dL (11.7 mmol/L)
Interprofessional Care
• Metoprolol (Toprol) XL 100 mg PO daily
• Nifedipine (Procardia) 10 mg tid
• Nitroglycerin 0.4 mg sublingual PRN for chest pain
• Exercise stress test

Discussion Questions
1. What are H.C.'s risk factors for CAD?
2. What symptoms should lead the nurse to suspect the pain may be angina?
3. Patient-Centered Care: What nursing actions should be taken for H.C.'s discomfort?
4. What ECG changes would indicate myocardial ischemia?
5. What information should the nurse provide for H.C. before the exercise stress test?
6. Priority Decision: What are the priority nursing measures that should be instituted to help H.C. decrease her risk factors?
7. Should H.C.'s angina become chronic stable angina, explain the treatment that would be used using the mnemonic A, B, C, D, E, and F. 8. Priority Decision: Based on the assessment data presented, what are the priority nursing diagnoses? Are there any collaborative problems?

1. Diabetes, smoking history, physical inactivity, and stress response.
2. Unexplained fatigue; radiation of the burning from epigastric area into the sternum; and prior episodes of chest pain with activity, relieved by rest; anxiety with fist clenching.
3. Provide emotional support and explain all interventions and procedures. Position her in an upright position, apply oxygen per nasal cannula, obtain vital signs, start continuous ECG monitoring, auscultate heart and breath sounds, assess pain using PQRST, medicate as ordered, and obtain baseline laboratory values and a chest x-ray.
4. Depressed ST-segment and/or T wave inversion would show myocardial ischemia.
5. The nurse should inform H.C. that she will have continuous cardiac monitoring while she walks on a treadmill with increasing speed and elevation to evaluate the effects of exercise on the blood supply to her heart. Her pulse, respiration, BP, and heart rhythm will be measured while she walks and after the test until they return to normal, and the cardiac monitor will be used after the test until any changes return to normal.
6. This patient does not seem motivated to assume responsibility for her health and, in the absence of symptoms, has not had a desire to make lifestyle changes. First, the nurse should assist her to clarify her personal values and goals. Then, by explaining the symptoms related to her risk factors and having her identify her personal vulnerability to various risks, the nurse may help her recognize her susceptibility to CAD. Help the patient set realistic goals and allow her to choose which risk factor (smoking, activity level, diabetes management, or stress response) to address first.
7. Treatment for chronic stable angina
A: Antianginal, ACE inhibitor or ARB therapy, antiplatelet
B: BP control, β-adrenergic blocker
C: Cigarette smoking cessation, cholesterol management, calcium channel blockers, and cardiac rehabilitation
D: Diet for weight management, diabetes management, and depression screening
E: Education and exercise
F: Flu vaccination
- Many of these measures can be used now to help the patient better manage her current health if she is motivated to do so.
8. Nursing diagnoses
• Acute pain; Etiology: imbalance between myocardial oxygen supply and demand
• Anxiety; Etiology: diagnosis and uncertain future
• Overweight; Etiology: lack of physical activity
• Difficulty coping; Etiology: lack of effective coping skills
• Hyperglycemia; Etiology: history of Type 2 diabetes, increased glucose level
• Substance abuse; Etiology: history of smoking 1 pack per day, 27 years
• Lack of knowledge: Etiology: management of coronary artery disease
Collaborative problems
Potential complications: myocardial infarction, dysrhythmias

The laboratory tests for 4 patients show the following results. Which patient should the nurse teach first about preventing CAD because the patient is at the greatest risk for CAD even without other risk factors?

a. Total cholesterol: 152 mg/dL, triglycerides: 148 mg/dL, LDL: 148 mg/dL, HDL: 52 mg/dL
b. Total cholesterol: 160 mg/dL, triglycerides: 102 mg/dL, LDL: 138 mg/dL, HDL: 56 mg/dL
c. Total cholesterol: 200 mg/dL, triglycerides: 150 mg/dL, LDL: 160 mg/dL, HDL: 48 mg/dL
d. Total cholesterol: 250 mg/dL, triglycerides: 164 mg/dL, LDL: 172 mg/dL, HDL: 32 mg/dL

b. Heart failure

Left-sided HF, which can escalate to cardiogenic shock, initially occurs and manifests as mild dyspnea, restlessness, agitation, pulmonary congestion with crackles, and/or S3 or S4 heart sounds. Right-sided HF includes jugular vein distention, hepatic congestion, or lower extremity edema. Pericarditis is a common complication identified with chest pain that is aggravated by inspiration, coughing, and moving the upper body. Ventricular aneurysm is manifested with HF, dysrhythmias, and angina. Papillary muscle dysfunction is suspected with a new systolic apical murmur.

Which complication should the nurse monitor for MI?

Which treatment is used first for the patient with a confirm MI to open the blocked artery within 90 minutes of arrival to the facility?

Which is the priority management of a patient with MI?

Which test is most commonly used to determine the area of myocardial damage during or after a myocardial infarction MI )?