Cardiovascular Disorders - Myocardial Infarction Flashcards Preview

NUR 102- Test 4 > Cardiovascular Disorders - Myocardial Infarction > Flashcards

Flashcards in Cardiovascular Disorders - Myocardial Infarction Deck (27):
1

Cardiovascular Disorders - Myocardial Infarction

What is a myocardial infarction?

It is when the myocardium is severely deprived of blood and oxygen. The muscle begins to infarct or necrose (die). This is a life-threatening event.

2

Cardiovascular Disorders - Myocardial Infarction

What happens if the circulation to the affected cardiac muscle is not rapidly restored? What can it lead to?

Functional muscle is lost and the heart may be unable to maintain an effective cardiac output. This can lead to cardiogenic shock and death

3

Cardiovascular Disorders - Myocardial Infarction

When does a MI occur (as related to the pathophysiology)?

Occurs when a coronary artery is totally occluded, blocking blood flow to a portion of cardiac muscle for a prolonged period of time.

4

Cardiovascular Disorders - Myocardial Infarction

What happens to the cells when they are deprived of oxygen and nutrients for more than 20 to 45 minutes?

The are irreversibly damaged leading to cellular death and tissue necrosis.

5

Cardiovascular Disorders - Myocardial Infarction

What part of the heart is usually affected by a MI? Why is this part affected?

The left ventricle because it has more muscle mass, therefore, there for the oxygen demands are greater.

6

Cardiovascular Disorders - Myocardial Infarction

What is the classic manifestation of MI?

Chest pain

7

Cardiovascular Disorders - Myocardial Infarction

How long does a chest pain last in the event of a MI?

It lasts more than 15 to 20 minutes.

8

Cardiovascular Disorders - Myocardial Infarction

Can MIs be relieved by rest or nitroglycerin?

No.

9

Cardiovascular Disorders - Myocardial Infarction

What are other manifestations of MIs?

Tachycardia
Cool, clammy skin
Diaphoresis
Feeling of impending doom
N&V
Possible dysrhythmias

10

Cardiovascular Disorders - Myocardial Infarction

What is most remarkable on an ECG during a MI?

Depression or elevation of the ST segment
Formation of a Q wave

11

Cardiovascular Disorders - Myocardial Infarction

What is the most common complication of MIs

Dysrhythmias. Sinus tachycardia (HR > 100 bpm)

12

Cardiovascular Disorders - Myocardial Infarction

What other complications can occur with MIs?

Pump Failure (Cardiogenic shock)
Pericarditis (inflammation of the pericardium)
Left ventricular aneurysm
Myocardial rupture
CHF

13

Cardiovascular Disorders - Myocardial Infarction

What is cardiogenic shock?

It is impaired tissue perfusion due to pump failure.

14

Cardiovascular Disorders - Myocardial Infarction

What is the most important thing to remember when providing interdisciplinary care in the event of a MI?

Rapid assessment, early diagnosis, and treatment are vital!
Remember: "Time is muscle". The quicker the artery is reopened and blood flow restored, the more myocardium can be saved and fewer complications.

15

Cardiovascular Disorders - Myocardial Infarction

When does the creatine kinase (CK) level appear in MIs?

within 3-6 hours

16

Cardiovascular Disorders - Myocardial Infarction

When is the creatine kinase (CK) peak level in MIs

12-24 hours

17

Cardiovascular Disorders - Myocardial Infarction

When does the CK level begin to decline?

24-72

18

Cardiovascular Disorders - Myocardial Infarction

What does the CK peak level indicate?

The size of the MI. The greater the amount of infarcted tissue the higher the CK level.

19

Cardiovascular Disorders - Myocardial Infarction

What are the principle laboratory tests ordered when an MI is suspected? What do these tests determine?

Serum Cardiac Markers: Serum Creatine Kinase,Cardiac-Specific Troponins.

They are used to establish the diagnosis and to evaluate the extent of myocardial damage.

20

Cardiovascular Disorders - Myocardial Infarction

How long does troponins remain in the blood?

10-14 days

21

Cardiovascular Disorders - Myocardial Infarction (Chapter 16 - Burke Textbook)

A client asks the nurse how he can distinguish between angina and chest pain associated with a myocardial infarction. An accurate response by the nurse would be:

A. "Chest pain associated with a MI is relieved by nitroglycerin."
B. "Chest pain associated with angina is unrelieved by nitroglycerin."
C. "Chest pain associated with angina is relieved by rest."
D. "Chest pain associated with a MI is relieved by rest."

C. "Chest pain associated with angina is relieved by rest."

Rationale:
Anginal chest pain usually is relieved by rest and sublingual nitroglycerin (or other rapid acting nitroglycerin preparations), whereas the chest pain associated with a MI usually continues despite rest or administration of sublingual nitroglycerin

22

Cardiovascular Disorders - Myocardial Infarction (Chapter 16 - Burke Textbook)

A male client has experienced a MI. The nurse assesses him for signs of complications. Which of the following would concert the nurse MOST?

A. BP 138/84, P 72
B. BP 90/50, urinary output 20 mL/hr
C. P 92, urinary output 50 mL/hr
D. BP 150/70, P 100

B. BP 90/50, urinary output 20 mL/hr

Rationale:
Hypotension and a urine output of less than 30 mL/hr are indicative of a fall in cardiac output and may indicate inadequate tissue perfusion.

23

Cardiovascular Disorders - Myocardial Infarction (Chapter 16 - Burke Textbook)

Which of the following would the nurse identify as an expected finding in a client who was admitted for an acute MI 24 hours ago?

A. CK 240 U/L
B. Hct 30%
C. blood glucose 210 mg/dL
D. BUN 45 mg/dL

A. CK 240 U/L

Rationale:
Creatinine kinase (CK) is an enzyme released from necrotic cardiac muscle cells. The blood level of CK rises within hours after an acute MI and remains elevated for up to 48 hours. The hematocrit and BUN should remain within normal limits after an MI. Blood glucose levels may increase slightly due to the stress response.

24

Cardiovascular Disorders - Myocardial Infarction (Chapter 16 - Burke Textbook)

Teaching for a client with a diagnosis of acute myocardial infarction should include which of the following?

A. Take nitroglycerin sublingually q5 minutes until chest pain disappears.
B. Call 911 immediately if chest pain occurs.
C. Avoid all stress.
D. Adjust diet to low cholesterol, low fat, low sodium.

D. Adjust diet to low cholesterol, low fat, low sodium.

Rationale:
Lifestyle modifications, include dietary changes, can reduce the risk for MIs in the future.

25

Cardiovascular Disorders - Myocardial Infarction (ATI/Med Surge - Chapter 28)

A nurse is caring for a client who has been prescribed aspirin (Ecotrin) 325 mg PO daily. Which of the following should the nurse recognize as possible side effects related to this medications? (Select all that apply)

A. Constipation
B. Tinnitus
C. Increased appetite
D. Gastric ulcers
E. Light-headedness

B. Tinnitus
D. Gastric ulcers

26

Cardiovascular Disorders - Myocardial Infarction (ATI/Med Surge - Chapter 28)

A nurse is reinforcing teaching about a client who has had an MI. The client asks why one aspirin per day has been prescribed. Which of the following responses should the nurses give?

A. "Aspirin reduce the formation of blood clots that could cause a heart attack."
B. "Aspirin decreases pain due to myocardial ischemia."
C. "Aspirin dissolves clots that are forming in your coronary arteries."
D. "Aspirin relieves headaches that are caused by your other medications."

A. "Aspirin reduce the formation of blood clots that could cause a heart attack."

Rationale:
Aspirin decreases platelet aggregation. One aspirin a day is not sufficient to alleviate ischemic pain. Aspirin does not dissolve clots. Other medications can cause headaches but one aspirin per day is not administered as an analgesics.

27

Cardiovascular Disorders - Myocardial Infarction (ATI/Med Surge - Chapter 28)

A nurse is caring for a client diagnosed for a client diagnosed with an MI who reports having SOB beginning 2 weeks ago. Which of the following cardiac enzymes should the nurse recognize as the laboratory value to determine if the infarction occurred 14 days ago?

A. CK-MB
B. Troponin I
C. Troponin T
D. Myoglobin

C. Troponin T

Rationale:
The Troponin T level still be evident 14 to 21 days after the MI. Troponin I levels are no longer evident after 7 days, myoglobin levels are not longer evident after 24 hr, and creatine kinase-MB levels are not longer evident after 3 days.