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Questions and Answers
What is an early sign of congestive heart failure (CHF) that a nurse should assess for during a cardiovascular assessment?
What is an early sign of congestive heart failure (CHF) that a nurse should assess for during a cardiovascular assessment?
- Chest pain
- Shortness of breath
- Peripheral edema (correct)
- Headache
Which intervention is aimed at relieving pain and symptoms of ischemia in a patient presenting with a myocardial infarction (MI)?
Which intervention is aimed at relieving pain and symptoms of ischemia in a patient presenting with a myocardial infarction (MI)?
- Administering antibiotics
- Elevating the head of the bed (correct)
- Encouraging vigorous exercise
- Placing ice packs on the chest
What does the acronym 'MONA' stand for in the context of initial treatment for myocardial infarction?
What does the acronym 'MONA' stand for in the context of initial treatment for myocardial infarction?
- Morphine, Oxygen, Nitroglycerin, Aspirin (correct)
- Midazolam, Opioids, Nifedipine, Atorvastatin
- Morphine, Oxygen, Naloxone, Aspirin
- Melatonin, Ondansetron, Nifedipine, Albuterol
What is the purpose of administering nitroglycerin to a patient experiencing a myocardial infarction?
What is the purpose of administering nitroglycerin to a patient experiencing a myocardial infarction?
Which symptom is more commonly associated with a female presentation of myocardial infarction?
Which symptom is more commonly associated with a female presentation of myocardial infarction?
Why is it important to monitor capillary refill in a patient with myocardial infarction?
Why is it important to monitor capillary refill in a patient with myocardial infarction?
What is the recommended interval for administering Epinephrine IV bolus during CPR?
What is the recommended interval for administering Epinephrine IV bolus during CPR?
When treating a patient with asystole, what is the final rhythm indicating?
When treating a patient with asystole, what is the final rhythm indicating?
What action should be taken if a heart rhythm is shockable during resuscitation?
What action should be taken if a heart rhythm is shockable during resuscitation?
Which electrolyte imbalance should be monitored closely when administering loop diuretics?
Which electrolyte imbalance should be monitored closely when administering loop diuretics?
In case of PEA, what is the potential outcome if not treated quickly?
In case of PEA, what is the potential outcome if not treated quickly?
What should a patient feel under their tongue when taking sublingual nitroglycerin?
What should a patient feel under their tongue when taking sublingual nitroglycerin?
Why should a patient replace their nitroglycerin after 6 months?
Why should a patient replace their nitroglycerin after 6 months?
What is the purpose of administering TPA in thrombolytic therapy for MI?
What is the purpose of administering TPA in thrombolytic therapy for MI?
When does ischemia occur in the context of cardiac death progression?
When does ischemia occur in the context of cardiac death progression?
Why is it important to assess the patient for signs of bleeding when administering TPA?
Why is it important to assess the patient for signs of bleeding when administering TPA?
What should a patient do if chest pain is unrelieved after taking nitroglycerin?
What should a patient do if chest pain is unrelieved after taking nitroglycerin?
What is the function of a Calcium Channel Blocker like Lopressor in the medical management of myocardial infarction?
What is the function of a Calcium Channel Blocker like Lopressor in the medical management of myocardial infarction?
What does a high PTT (Partial Thromboplastin Time) level indicate in a patient suspected of having a myocardial infarction?
What does a high PTT (Partial Thromboplastin Time) level indicate in a patient suspected of having a myocardial infarction?
What is the significance of abnormal troponin levels in the diagnosis of a myocardial infarction?
What is the significance of abnormal troponin levels in the diagnosis of a myocardial infarction?
What is the primary goal of thrombolytic therapy in a patient experiencing a myocardial infarction?
What is the primary goal of thrombolytic therapy in a patient experiencing a myocardial infarction?
In a patient with pulseless electrical activity (PEA), what is the most immediate concern?
In a patient with pulseless electrical activity (PEA), what is the most immediate concern?
What are the normal reference ranges for Potassium (K+) levels in the blood?
What are the normal reference ranges for Potassium (K+) levels in the blood?
What does the ST segment represent in an EKG?
What does the ST segment represent in an EKG?
What is the significance of the U wave in an EKG?
What is the significance of the U wave in an EKG?
Which zone of infarction is associated with Q waves on an EKG?
Which zone of infarction is associated with Q waves on an EKG?
What is the underlying cause of cardiogenic shock?
What is the underlying cause of cardiogenic shock?
How can cardiogenic shock caused by myocardial infarction be managed?
How can cardiogenic shock caused by myocardial infarction be managed?
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Study Notes
Cardiovascular Assessment
- Cardiovascular assessment includes physical examination, skin color, peripheral edema, and capillary refill
- 1L H2O = 1kg, so if a patient retains 1L of fluid, they will gain 1kg (2.2lb)
Signs and Symptoms of Myocardial Infarction (MI)
- Male presentation: chest pain, radiating pain to left arm, and jaw pain
- Female presentation: shortness of breath, nausea, and vague epigastric symptoms
- Other symptoms: dizziness, syncope, changes in level of consciousness, palpitations
Interventions for Myocardial Infarction (MI)
- Relieve pain and symptoms of ischemia
- Elevate head of bed (HOB) to improve respiratory function
- Treat anxiety with a calm voice
- Administer MONA+ (Morphine, Oxygen, Nitroglycerin, Aspirin, and Calcium Channel Blocker)
- Monitor intake and output (I&O) and tissue perfusion
- Educate patient and family on MI
MONA+ Initial Treatment
- Morphine: reduces anxiety and vasodilation, increasing oxygen supply
- Oxygen: provides supplemental oxygen to increase oxygen supply
- Nitroglycerin: vasodilation increases oxygen supply, may cause headache
- Aspirin: anticoagulant and platelet inhibitor, increases oxygen supply
- Calcium Channel Blocker: slows down heart rate, reducing heart workload and oxygen demand
Medical Management of MI
- Thrombolytic therapy: destroys thrombus and restores blood flow to myocardium
- Emergent PCI (Percutaneous Coronary Intervention): catheterization
- Goals of treatment: limit infarct size, pain relief, prevent and manage complications, preserve myocardial function
Lab Values
- Troponin: gold standard test for MI, normal value is 0-0.04 ng/mL, repeat every 6-8 hours x3
- Potassium: normal value is 3.5-5.2 mEq/L
- PTT: normal value is 25-35 seconds, may be affected by blood thinners
Treatment of Pulseless Cardiac Arrest
- Interventions: CPR for 2 minutes, administer Epinephrine 1mg IV bolus, identify and treat the cause
- Analyze heart rhythm, determine need to deliver shock, and administer amiodarone or lidocaine
Med Calc Conversions
- 1kg = 1000g, 1g = 1000mg, 1mg = 1000mcg, 1kg = 2.2lb, 1oz = 30ml, 1 cup = 8oz, 1 tsp = 5ml, 1 tbsp = 15ml, 1 tbsp = 3 tsp, 1L = 1000ml, 1 gallon = 4qt
Electrolyte Imbalances and Diuretic Administration
- Diuretics decrease fluid volume, monitor serum electrolytes
- Loop diuretics increase excretion of Na, Cl, and K, ensure patient receives K+ supplements
EKG Changes in MI
- 12-lead EKG changes: Q waves, ST elevation or depression, diagnose NSTEMI or STEMI
- Normal EKG: P wave, QRS complex, ST segment, U wave
- Pathophysiology: ischemia occurs within 20 minutes, necrosis occurs within 6 hours
Cardiogenic Shock
- Failure of the heart to pump enough blood, resulting in shock
- Caused by: MI, CHF, arrhythmias, pulmonary embolism
- Nursing assessment: low tissue perfusion, restlessness, agitation, confusion, low BP, tachypnea, oliguria/anuria, dysrhythmias
Patient Education for Sublingual Nitroglycerin
- Take prophylactic NTG prior to exertion
- Replace NTG every 6 months
- Keep in the original bottle
- Should feel tingling under the tongue
- If chest pain is unrelieved, repeat NTG every 5 minutes and call 911
Thrombolytic Therapy
- Goal: destroy thrombus and restore blood flow to the myocardium
- Nursing care: administer ASAP, assess for signs of bleeding, minimize punctures and invasive procedures
- Steps involved in cardiac death: ischemia, infarction, troponin release, and cardiac death
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