Lipp Vis Nursing ChaptLWBK1630_C02_p013-068

34  Chapter 2 • Cardiovascular Care

Treatment of Myocardial Infarction • Pain relief • Stabilization of heart rhythm • Revascularization of the coronary artery • Preservation of myocardial tissue • Reduction of cardiac workload • Thrombolytic therapy • PCI such as coronary angioplasty with stenting opens the narrowed or blocked segments of a coronary artery • PCI. Pharmacologic Therapy for Myocardial Infarction: MONA 1.  M (morphine)—Relieves chest pain. 2.  O (oxygen)—Increases oxygenation to ischemic heart muscle. 3.  N (nitrates)—Vasodilator reduces preload by decreasing blood return to the heart and decreasing oxygen demand. 4.  A (aspirin)—Immediate dosing by mouth (chewed) is recommended to halt platelet aggregation. Nursing Assessment for Patients with Chest Pain • Determine intensity of patient’s pain by asking the patient to describe pain intensity on a scale of 0 (no pain) to 10 (worst pain). • Access precipitating causes of pain and pain quality. • After eating? After certain physical activities? After emotional stress? • Where is the pain located? Does it radiate? • Is the onset sudden? Gradual? • How long did the pain last? • Is the pain steady? Consistent in quality? • Is the pain associated with other symptoms? Sweating? Light-headedness? Nausea? Palpitations? Shortness of breath? • Is there anything that makes it worse? • How is the pain relieved?

• Obtain a 12-lead ECG • Observe patient for signs and symptoms, including diaphoresis, shortness of breath, protective body posture, dusky facial color, and/or changes in level of consciousness (LOC). • Position patient in a comfortable position such as Fowler position which promotes ventilation. • Administer oxygen, if indicated. • Obtain BP, apical heart rate, and respiratory rate. • Administer antiangina drug(s), as prescribed. • Monitor for relief of pain and the duration of the angina episode. • Monitor vital sights every 5 to 20 minutes until angina pain subsides. Nursing Considerations • Monitor blood pressure, heart rate, and breath sounds. • Observe for associated symptoms: dyspnea, nausea and vomiting, dizziness, palpitations. • Assess pain and treat appropriately as ordered. • Record the severity, location, type, duration, and relief of pain. • Continuously monitor ECG rhythm strips to detect rate TIP: Remember the acronym: MONA.

• Analyze rhythm strips, and place a representative strip in the patient’s chart if any new arrhythmias are identified, if chest pain occurs, or at least every shift or according to facility protocol. • Assess for crackles, cough, tachypnea, and edema, which may indicate impending left-sided HF. Carefully monitor daily weight, intake and output, respiratory rate, serum enzyme levels, ECG readings, and blood pressure. Auscultate for adventitious breath sounds periodically (patients on bed rest typically have atelectatic crackles, which may disappear after coughing) and for S 3 or S 4 gallops. • Provide a stool softener to prevent straining during defecation, which causes vagal stimulation and may slow heart rate. • After thrombolytic therapy, administer continuous heparin as ordered. Monitor the partial thromboplastin time every 6 hours and monitor the patient for evidence of bleeding. • Place patient at complete rest during anginal episodes. • Stay with patient who is experiencing pain or appears anxious. • Provide emotional support to help reduce stress and anxiety. • Maintain quiet, comfortable environment. • Administer oxygen as ordered.

changes and arrhythmias; treat according to facility protocol.

Teaching About Acute Coronary Syndrome • Explain dosages and

• Counsel the patient to resume sexual activity progressively. • Advise the patient about appropriate responses to new or recurrent symptoms. • Advise the patient to report typical or atypical chest pain. • Stress the need to stop smoking. If necessary, refer the patient to a support group.

therapy to promote compliance with the prescribed medication

regimen and other treatment measures. • Review dietary restrictions with patient and family. • Encourage the patient to participate in a cardiac rehabilitation exercise program. LESSON PLANS