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Myocardial Infarction

What is a MI? Disruption in or deficiency of coronary artery blood supply resulting in necrosis of myocardial tissue. Disruption or deficiency in the coronary blood supply resulting in death of cardiac tissue.
What causes MI? Thrombus or clotting, shock or hemorrhage.
Discuss nursing assessments for pain with MI. SUDDEN onset of pain in lower sternal region (substernal):severity increases till nearly unbearable.
What type of pain is likely with MI? Heavy,viselike,often radiates to shoulders,downarmsand/or to neck and jaw.Substernal,retrosternal, epigastric commonWomen may present w/SOB,fatigue.SUDDENONSET.NOTRELIEVEDBYRESTORNITRO.Maypersist hrs/daysMAY NOT HAVE PAIN!ESPECIALLY W/DIABETIC NEUROPATHY.
Discuss nursing assessments for MI. Rapid, irregular, feeble pulse;decreased LOC(indicating decreased cerebral perfusion).
What may occur post MI and what does it mean? Left heart shift- refers to the relative increase in immature forms of blood cells. If you go back to a patho book and look at the entire cascade diagram of how blood cells mature, the immature cells are on the left side of the old, standard diagram.
Discuss what left shift means. Mmore band cells(% bands)inCBC withdifferential.bands =babyWC's If the body is producing and mobilizing a large#of new wc's,tofightoffveryactiveinfection.Norm2-6%WBC'sbands. %increasesinfectionsuchneed tokickbabyWC'soutof nestbefore theirtimetojoinfight.
What occurs in about 90% of MI pts? Dysrhythmias.
What other assessments should an RN make concerning MI other than previously mentioned? Cardogenic shock or fluid retention.
Name serum cardiac markers,their andnormal values and times they are released into circulation post MI. Creatine Kinase (CK) 26-174 units/L, rise 3-12 hours post MI,peak in 24 hrs,return to normal in 2-3 days;CK_MB band is specific to myocardial cells 0-5% of total;cardiac specific troponin,increase 3-12 hrs post MI,peak24-48hrs,return to normal5-14days.
Name times cardiac markers are released post MI. Creatine kinase (Ck) 3-12hrs,peakin24,normal2-3days;CK-MB2-4hrs,peak12-20hrs,norm48-72,cardiac troponins as early as 1 hr,peak10-24,norm5-14days.
What type of pulse pressure will RN likely see with MI? Narrowed pulse pressure e.g., 90/80
What bowel sounds may be assessed with MI pt? Absent or high-pitched,indicating possible mesenteric artery thrombosis, which acts as an intestinal obstruction.
What lung sounds may be expected with MI pt? HF indicated by wet lungs.
When can ECG changes be expected to occur post MI? As early as 2 hrs or as late as 72 hrs post-MI.
Name nursing diagnoses for MI. Ineffective tissue perfusion (specify type) R/t;Decreased cardiac output r/t;activity intolerance r/t;Acute pain r/t
What may be used to increase O2 perfusion with MI and why? IV morphine sulfate (acts as a peripheral vasodilatroe and decreases venous return).
Discuss nursing plans/interventions for the pt with MI. Admin meds,O2, V/S, breath sounds(for rales), ECG regularly(per policy),O2 at 2-6Lper nasal cannula,patent IV line for ER meds,monitor fluid balance,semi-Fowler,rest 24 hrs,quiet,
What pt teaching should RN include for pt with MI? Resume activity gradually,verbalize fears,disease process and cardiac rehab.
What medical interventions may be done with MI? Thrombolytic agents, WITHIN 1-4 HRS of MI, intraaortic balloon pump (IABP) to improve myocardial perfusion.
What meds are often prescribed for MI? Nitrates, Beta-blockers, CCB,Aspirin, and Antiplatelet aggregates.
Name 4 types of Antilipemic drugs. Bile Sequestrants;HMG-CoA Reductase Inhibitors (statins);Fibric Acid Derivatives;water-soluble vitamins.
Name 4 Bile Sequestrants. Colestipol HCL (Colestid);Colesevelam (Welchol);Cholestyramine (Questran).
What are the actions/indications for Bile Sequestrants? Treat type IIA hyperlipidemia (hyper-cholesterolemia) when dietary changes fail.
What are possible side effects for Bile Sequestrants? Ab pain, N/V,distention, flatulence,belching,N/V,constipation, reduced absorption of lipid-soluble vits:ADEK, ALTERATION IN ABSORPTION OF OTHER ORAL MEDS.
Discuss nursing implications for bile sequestrants. Teach pt to mix powder forms w/adequate liquid or fruits high in moistur to prevent accidental inhalation or esophageal distress, MONITOR PT TIMES, assess for visual changes&rickets,ADMIN OTHER ORAL MEDS 1 HR BEFORE OR 6 HOURS AFTER
Name HMG-CoA Reductase Inhibitors (statins). Atorvastatin (Lipitor),Fluvastatin (Lescol),Pravastatin (Pravachol),Simvastatin (Zocor),Lovastatin (Mevacor)
What does HMG-CoA Reductase do? Basically controls the rate of cholesterol produced.
What do HMG-CoA Reductase Inhibitors (statins) do? Used to lower cholesterol levels.
Discuss possible side effects of HMG-CoA Reductase Inhibitors. Similar to bile sequestrants, May elevate liver enzymes, may elevate liver enzymes,hepatitis or pancreatitis, rhabdomyolysis.
Discuss nursing implications for HMG-CoA Reductase Inhibitors (statins). Obtain liver enzymes baseline and monitorQ6mos,monitor CPK levels,teachavoid grapefruit,INSTRUCT PT TO REPORT ANY MUSCLE TENDERNESS,timing with/without food varies with drug.
Created by: 100000255019352