Questions and Answers
Which of the following characteristics may indicate acute myocardial infarction (AMI) pain? (Select all that apply)
If a patient has chest pain for less than 6 hours, they may be a candidate for thrombolytic therapy.
True
What should be monitored in patients during pain episodes and medication administration?
Vital signs including heart rate and blood pressure.
What is the rationale for assessing for contraindications to thrombolytic agents?
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Why is bed rest recommended during periods of pain?
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What is the target oxygen saturation level when administering oxygen therapy?
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What is the purpose of administering IV nitrates?
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What does the administration of morphine sulfate aim to achieve?
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What should be assessed before administering thrombolytic agents?
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What should be monitored frequently to assess for complications of intracranial bleeding?
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What is the goal of administering IV heparin after thrombolysis?
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What are the possible interventions if signs of reperfusion are not evident?
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The nursing diagnosis for acute chest pain is _____
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Match the treatment with its purpose:
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Study Notes
Acute Myocardial Infarction (AMI) Pain Characteristics
- Crushing substernal pain is common in AMI; may feel like intense pressure.
- Pain can radiate to the jaw, back, and left arm indicating severity.
- Pain may occur unexpectedly, often in the early morning hours.
- Typically, pain is unrelieved by rest or nitroglycerin, requiring stronger analgesics like narcotics.
- Duration of pain lasts 30 minutes or longer, signaling a possible cardiac event.
Thrombolytic Therapy Consideration
- Assess the time since onset of chest pain; candidates for thrombolytics must present within 6 hours.
Prior Treatments Assessment
- Evaluate any prior pain management measures, such as sublingual nitroglycerin and aspirin, taken before hospital arrival.
Vital Signs Monitoring
- Closely monitor heart rate and blood pressure during episodes of chest pain and medication administration for nonverbal pain indications.
Diagnostic ECG Surveillance
- Baseline ECG should be reviewed for T- and ST-segment changes and the development of Q waves to identify ischemia or injury.
Cardiac Marker Monitoring
- Serial cardiac markers help in the diagnosis and confirmation of myocardial infarction.
Ongoing Pain Assessment
- Continuous evaluation of chest pain and the effectiveness of medications is critical; persistent pain necessitates immediate intervention.
Thrombolytic Agents Contraindications
- Identify absolute contraindications such as active internal bleeding, bleeding diathesis, or a history of hemorrhagic stroke to ensure safe medication administration.
Bed Rest Implementation
- Rest is crucial during pain episodes to lower the heart's oxygen demand.
Oxygen Therapy Administration
- Administer oxygen at 4-6 L/min to keep oxygen saturation above 90%, aiding in myocardial oxygenation.
IV Nitrates Use
- Initiate nitrates as they provide both coronary and peripheral vasodilation, managing blood flow and pressures.
Morphine Sulfate for Pain Relief
- Morphine reduces heart workload via venodilation and alleviates chest pain effectively.
Beta-Blockers Administration
- Beta-blockers help decrease heart rate, enhance myocardial perfusion, and lower myocardial contractility.
Aspirin Administration
- Aspirin limits platelet aggregation, lowering mortality rates in AMI patients.
ACE Inhibitors Role
- Administer ACE inhibitors to mitigate the risks of heart failure and mortality, especially in large transmural MIs or diabetic patients.
Thrombolytic Agents Timing
- These medications should be given within the first 6 hours of a coronary event for effective restoration of perfusion.
Monitoring for Bleeding
- Continuous assessment for signs of bleeding is essential to manage complications arising from thrombolytic therapy.
Intracranial Bleeding Vigilance
- Frequent neurological status checks are necessary to detect potential intracranial bleeding complications due to thrombolytic agents.
Heparin Administration Guidelines
- IV Heparin dosage must maintain aPTT levels at 1.5 to 2 times the normal range for optimal vessel patency post-thrombolysis.
Preparing for Advanced Interventions
- Be ready for possible cardiac catheterization, PTCA, or coronary bypass graft surgery if reperfusion signs are absent and infarction is progressing.
Blood Pressure Monitoring
- After administering medications, monitor blood pressure closely; intervene if systolic BP is below 100 mm Hg or drops significantly from previous readings.
Nursing Diagnosis for AMI
- Acute chest pain is the primary nursing diagnosis in cases of myocardial infarction.
Patient Outcomes for Pain Management
- Effective pain management is confirmed when the patient verbalizes pain relief and appears comfortable.
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Description
Test your knowledge on the nursing diagnosis and interventions related to acute chest pain, specifically focusing on the characteristics of acute myocardial infarction (AMI). This quiz will cover assessment criteria and rationale for early treatment options in nursing practice.
