Myocardial Infarction – Case StudyMr. Salazar, a 57-year old male, presents to the Emergency Departm

Myocardial Infarction – Case StudyMr. Salazar, a 57-year old male, presents to the Emergency Department (ED) with chest pain. He reports that the pain started about an hour after dinner, while he was working. He describes the pain as a “crushing pressure” located midsternally and radiating down his left arm and to his back. He rates the pain a 4/10. On assessment, Mr. Salazar is diaphoretic and pale and complains of shortness of breath (SOB).  What further nursing assessments need to be performed for Mr. Salazar?Full set of vital signsHeart soundsLung soundsPulsesEdemaSkin condition (temperature, color, etc.)What interventions do you anticipate being ordered by the provider?OxygenNitroglycerinAspirin12-Lead EKGCardiac EnzymesChest X-rayPossibly an EchocardiogramUpon further assessment, the patient has no jugular vein distention (JVD), and no edema. His heart sounds are normal S1 and S2 present and lungs are clear with scattered wheezes on auscultation.  His vital signs were as follows:BP  140/90 mmHg   SpO2 90% on Room AirHR 92 bpm and regular  Ht 173 cmRR 32 bpm   Wt 104 kgTemp 36.9°C His 12-lead EKG report reads: “Normal sinus rhythm (NSR) with frequent premature ventricular contractions (PVCs) and three- to four-beat runs of ventricular tachycardia (VT)”. ST-segment elevation in leads I, aVL, and V2 through V6 (3-4mm). ST-segment depression in leads III and aVF.”Cardiac enzymes were drawn, results are still pending. A chest x-ray was ordered as well.The provider orders the following: Aspirin 324 mg PO once, Nitroglycerin 0.4 mg SL q5min for up to 3 doses, Morphine 4 mg IVP PRN unrelieved chest pain, Oxygen to keep SpO2>92%.What intervention should you, as the nurse, perform right away? Why?Apply oxygen – this can be done quickly and easily and can help to prevent further complications from low oxygenation.Oxygen helps to improve oxygenation as well as to decrease the myocardial oxygen demands.Often it takes a few minutes or more for medications to be available from the pharmacy, so it makes sense to take care of this intervention first.ABC’s – breathing/O2.What medication should be the first one administered to this patient? Why? How often?Nitroglycerin 0.4mg SL – it is a vasodilator and works on the coronary arteries. The goal is to increase blood flow to the myocardium. If this is effective, the patient merely has angina. But if it is not effective, the patient may be having a myocardial infarction.Aspirin should also be given, but it is to decrease platelet aggregation and to reduce mortality. While it can somewhat help prevent worsening of the blockage, it does little for the current pain experienced by the patient.Morphine should only be given if the nitroglycerin and aspirin do not relieve the patient’s chest pain.What is the significance of the ST-segment changes on Mr. Salazar’s 12-lead EKG?ST-segment changes on a 12-lead EKG indicate ischemia (lack of oxygen/blood flow) or infarction (death of the muscle tissue) of the myocardium (heart muscle). This indicates an emergent situation. The patient’s coronary arteries are blocked and need to be reopened by pharmacological (thrombolytic) or surgical (PCI) intervention.Time is tissue – the longer the coronary arteries stay blocked, the more of the patient’s myocardium that will die. Dead heart tissue doesn’t beat.Mr. Salazar’s chest pain was unrelieved after three (3) doses of sublingual nitroglycerin (NTG). Morphine 5 mg intravenous push (IVP) was administered, as well as 324 mg chewable baby aspirin. His pain was still unrelieved at this pointMr. Salazar’s cardiac enzyme results were as follows:CK  254 U/LCK-MB 10%Troponin I 3.5 ng/mLBased on the results of Mr. Salazar’s labs and his response to medications, what is the next intervention you anticipate? Why? Health Science Science Nursing Share QuestionEmailCopy link Comments (0)

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