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Questions and Answers
What is an important early indicator of altered perfusion?
What role does auscultation of heart sounds play in assessing cardiac function?
Why is continuous ECG monitoring critical in patients with decreased cardiac output?
How do ABG levels correlate with tissue perfusion?
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What is the significance of monitoring CK isoenzymes and troponin levels in patients with potential myocardial damage?
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What is the primary reason for managing acute chest pain in a patient with myocardial ischemia?
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Which intervention should be performed first during the assessment of a patient experiencing chest pain?
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What is a critical factor to monitor when administering morphine for chest pain?
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Why is a pain scale an important tool in managing a patient's pain?
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Which outcome is improved by promoting physical and psychological rest for a patient experiencing acute pain?
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What effect do anterior wall infarcts have compared to right ventricular infarcts?
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What should be done if a patient is hypoxic and has chest pain?
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What is one of the primary nursing interventions for monitoring tissue perfusion after myocardial damage?
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Study Notes
Chest Pain Management
- Chest pain occurs when the heart muscle's oxygen supply doesn't meet demand. This can be caused by Myocardial Ischemia, Infarction, or Reperfusion of ischemic areas.
- Relieving pain is crucial to interrupt the Sympathetic Nervous System (SNS) stimulation, regardless of the pain's origin.
- Use pain scales for objective pain measurement and monitoring relief.
- If a patient is hypoxic, administer oxygen at 2 to 5 L/min via nasal cannula to increase myocardial oxygen supply, decreasing ischemia and pain.
- Promote physical and psychological rest to decrease cardiac workload and SNS stimulation.
- Titrate IV Nitroglycerin to relieve chest pain, maintaining a systolic BP of greater than 100 mmHg.
- Administer 2 to 4 mg of morphine by IV push for chest pain as needed. Morphine decreases pain and anxiety, acts as a vasodilator, and decreases the patient's respiratory rate.
Monitoring Tissue Perfusion
- Damage to cardiac muscle affects compliance, contractility, and Cardiac Output (CO), with the extent and location of injury impacting perfusion.
- Anterior wall infarcts have a greater impact on CO compared to right ventricular infarcts.
- Infarcted muscle increases the risk of cardiac dysrhythmias, which can further affect blood and oxygen delivery to tissues.
- Assess vital signs frequently to detect changes in heart rate, rhythm, BP, and respiratory rate. Decreased CO activates compensatory mechanisms that may lead to tachycardia and vasoconstriction, escalating cardiac work.
- Assess noncardiac systems. Key indicators of altered perfusion include altered Level of Consciousness (LOC), decreased urine output, changes in skin color, dusky mucous membranes, diminished peripheral pulses, and delayed capillary refill.
- Auscultate heart and breath sounds for abnormal heart sounds (e.g., gallop, murmur) or adventitious lung sounds to potentially identify issues with cardiac filling or output, increasing the risk of decreased tissue perfusion.
- Monitor ECG rhythms continuously as dysrhythmias can impair CO and tissue perfusion.
- Administer oxygen as ordered. Oxygen saturation levels provide early warning of tissue perfusion problems.
- Obtain and assess ABG levels. Oxygen saturation is an indicator of gas exchange, tissue perfusion, and the effectiveness of oxygen administration. ABG levels provide a more precise measurement of blood oxygen levels and acid–base balance.
- Administer antidysrhythmic medications as prescribed. Dysrhythmias affect tissue perfusion by altering CO.
- Obtain serial laboratory samplings for CK, isoenzyme, and troponin levels as ordered. Levels of various cardiac markers (CK isoenzymes in particular) correlate with the extent of myocardial damage.
- Anticipate invasive hemodynamic monitoring to facilitate AMI management and treatment evaluation. This provides a means of assessing pressures in the systemic and pulmonary arteries, the relationship between oxygen supply and demand, CO, and cardiac index.
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Description
This quiz focuses on the management of chest pain due to various cardiac conditions. It covers essential techniques for pain relief, the administration of oxygen and medications, and the importance of monitoring tissue perfusion. Test your knowledge on effective strategies to manage chest pain in patients.
