Myocardial Infarction
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| 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.
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| What causes MI? | Thrombus or clotting, shock or hemorrhage.
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| Discuss nursing assessments for pain with MI. | SUDDEN onset of pain in lower sternal region (substernal):severity increases till nearly unbearable.
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| 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.
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| Discuss nursing assessments for MI. | Rapid, irregular, feeble pulse;decreased LOC(indicating decreased cerebral perfusion).
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| 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.
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| 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.
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| What occurs in about 90% of MI pts? | Dysrhythmias.
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| What other assessments should an RN make concerning MI other than previously mentioned? | Cardogenic shock or fluid retention.
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| 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.
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| 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.
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| What type of pulse pressure will RN likely see with MI? | Narrowed pulse pressure e.g., 90/80
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| What bowel sounds may be assessed with MI pt? | Absent or high-pitched,indicating possible mesenteric artery thrombosis, which acts as an intestinal obstruction.
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| What lung sounds may be expected with MI pt? | HF indicated by wet lungs.
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| When can ECG changes be expected to occur post MI? As early as 2 hrs or as late as 72 hrs post-MI. |
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| 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
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| What may be used to increase O2 perfusion with MI and why? | IV morphine sulfate (acts as a peripheral vasodilatroe and decreases venous return).
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| 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,
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| What pt teaching should RN include for pt with MI? | Resume activity gradually,verbalize fears,disease process and cardiac rehab.
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| What medical interventions may be done with MI? | Thrombolytic agents, WITHIN 1-4 HRS of MI, intraaortic balloon pump (IABP) to improve myocardial perfusion.
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| What meds are often prescribed for MI? | Nitrates, Beta-blockers, CCB,Aspirin, and Antiplatelet aggregates.
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| Name 4 types of Antilipemic drugs. | Bile Sequestrants;HMG-CoA Reductase Inhibitors (statins);Fibric Acid Derivatives;water-soluble vitamins.
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| Name 4 Bile Sequestrants. | Colestipol HCL (Colestid);Colesevelam (Welchol);Cholestyramine (Questran).
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| What are the actions/indications for Bile Sequestrants? | Treat type IIA hyperlipidemia (hyper-cholesterolemia) when dietary changes fail.
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| 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.
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| 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
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| Name HMG-CoA Reductase Inhibitors (statins). | Atorvastatin (Lipitor),Fluvastatin (Lescol),Pravastatin (Pravachol),Simvastatin (Zocor),Lovastatin (Mevacor)
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| What does HMG-CoA Reductase do? | Basically controls the rate of cholesterol produced.
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| What do HMG-CoA Reductase Inhibitors (statins) do? | Used to lower cholesterol levels.
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| 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.
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| 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.
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