Nursing Care Management 112: Myocardial Infarction

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Questions and Answers

What is the correct rate calculation for a patient weighing 50kg starting with dopamine at 5mcg/kg?

22.5 cc/h

25.0 cc/h

15.3 cc/h

18.79 cc/h (correct)

Which medication serves as a sodium channel blocker in maintaining electrophysiologic stability?

Lidocaine (correct)

Amiodarone

Beta-adrenergic blocking agents

Calcium channel blockers

What would be classified as a renal dose of dopaminergic medication for a patient?

11-20 mcg/kg

6-10 mcg/kg

Greater than 20 mcg/kg

1-5 mcg/kg (correct)

Which of the following is NOT a priority nursing diagnosis for a patient with decreased cardiac output?

Unstable blood pressure Signup and view all the answers

Which nursing intervention is essential for a patient experiencing acute pain due to decreased cardiac output?

Provide pain relief; morphine sulfate IV Signup and view all the answers

What is the primary cause of cell death in acute myocardial infarction?

Inadequate oxygenation Signup and view all the answers

Which condition is associated with a total occlusion of a coronary artery?

STEMI Signup and view all the answers

Which of the following is not a risk factor for acute myocardial infarction?

High carbohydrate diet Signup and view all the answers

What initial vital sign changes are commonly observed in acute myocardial infarction?

Increase in blood pressure and pulse Signup and view all the answers

What symptom differentiates chest pain in myocardial infarction from angina?

Sudden onset and unrelieved by rest Signup and view all the answers

Which of these diagnostic tests is most specific for myocardial injury?

Troponin I Signup and view all the answers

What type of ECG change is commonly seen in the early phase of a myocardial infarction?

ST elevation Signup and view all the answers

What is a typical skin condition observed in someone suffering from acute myocardial infarction?

Cool, clammy, and ashen Signup and view all the answers

What is the primary purpose of thrombolytic therapy in acute care management?

To dissolve or break up blood clots Signup and view all the answers

Which medication is used to prevent platelet adherence on the coronary artery?

Aspirin Signup and view all the answers

What is the main effect of beta-adrenergic blocking agents?

Decrease myocardial oxygen demand Signup and view all the answers

What role does morphine sulfate play in cardiac care?

It aids in pain relief and decreases preload Signup and view all the answers

What is the function of an intra-aortic balloon pump?

To increase myocardial oxygen perfusion Signup and view all the answers

What is the effect of diuretic agents in cardiac management?

Decrease left ventricular end-diastolic pressure (LVEDP) Signup and view all the answers

Which agent is classified as a positive inotropic medication?

Dopamine Signup and view all the answers

What is the primary goal of stenting in cardiac care?

To prevent the vessel from collapsing Signup and view all the answers

Study Notes

Acute Myocardial Infarction (AMI)

Characterized by death of myocardial cells due to lack of oxygen.
Often results from sudden complete blockage of a coronary artery.

ACS and MI Spectrum

Unstable Angina: Precedes heart attack, indicating severe cardiac distress.
NSTEMI: Partial occlusion, caused by increased metabolic demand or conditions like severe aortic valve stenosis.
STEMI: Total artery occlusion, presenting a significant risk of death and disability.

Causes of AMI

Coronary artery spasm.
Atherosclerosis.
Increased demand for oxygen due to rapid heart rate or stressors.

Risk Factors

Cigarette smoking increases risk.
Hyperlipidemia and diabetes are significant contributors.
Obesity and a sedentary lifestyle elevate chances.
Stress levels and family history also play a crucial role.
Men aged over 50 and postmenopausal women are at higher risk.

Assessment Findings

Severe, crushing chest pain unrelieved by rest or nitrates, akin to angina.
Symptoms may include nausea, vomiting, and dyspnea.
Skin may appear cool, clammy, and ashen.
Initially elevated blood pressure and heart rate may later decrease.
Restlessness and occasional respiratory findings, such as rales or crackles.

Diagnostic Tests

12-lead ECG to assess heart activity.
Creatine kinase levels (CK and CKMB) for muscle damage.
Troponin tests (T and I) for cardiac-specific injury markers.
Elevated WBC count indicates inflammation.
Echocardiogram for visual assessment of heart function.

Pathophysiology

Atherosclerotic plaques and thrombi obstruct blood flow.
Results in anaerobic metabolism, decreased ATP, and increased lactic acid.
Leads to myocardial contractility issues and potential dysrhythmias.

Acute Care Management

Goal is to salvage myocardium and limit infarction size.
Thrombolytic therapy helps dissolve clots; intra-aortic balloon pump improves O2 perfusion.
PTCA (angioplasty and stenting) opens narrowed arteries.
CABG provides alternate routes for blood flow.

Improving Myocardial Oxygen Supply

Administer supplemental oxygen.
Medications like aspirin and heparin prevent clotting.

Decreasing Myocardial Oxygen Demand

Implement mechanical assist devices and ensure bedrest.
Use beta-adrenergic blockers to minimize stress hormone effects.

Managing Preload and Afterload

Morphine sulfate alleviates pain and anxiety.
Nitroglycerin dilates arteries to improve blood flow.
Diuretic agents reduce fluid volume.
Calcium channel blockers and ACE inhibitors relax blood vessels and lower blood volume.

Enhancing Myocardial Contractility

Positive inotropics like dobutamine and dopamine enhance contractility and cardiac output.

Electrolyte and Hemodynamic Stability

Maintain electrolyte balance with medications like magnesium sulfate.
Administer IV fluid for volume loading and maintain blood pressure.

Nursing Diagnoses

Address acute pain, decreased cardiac output, and inadequate tissue perfusion.

Nursing Interventions

Establish IV access for medication administration.
Prioritize pain relief with morphine.
Monitor vital signs, ECG, and fluid outputs carefully to prevent complications.

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Description

This quiz focuses on the critical aspects of oxygenation and perfusion concerning Acute Myocardial Infarction (AMI). It covers the spectrum of conditions including unstable angina and NSTEMI, emphasizing the significance of proper oxygenation in myocardial health. Test your understanding of the respiratory system's role in managing these cardiac conditions.