Perfusion 1

Question 1

What are the medications for Acute MI?

Answer 1

Aspirin, Fibrinolytic therapy, Nitroglycerin, Morphine, Heparin

Question 2

What is Fibrinolytic therapy ?

Answer 2

Used if PCI is unavailable, before fibrinolytic therapy rule out neurological contraindications. Ex: tPA, Reteplase, Tenecteplase

Question 3

How to administer nitroglycerin ?

Answer 3

Sublingual: give Q 5 min as needed up to total of 3 doses, IV or transdermal: change Q 6 hrs

Question 4

How to administer Morphine ?

Answer 4

Typically 2-4 Mg IV, May repeat if need Q 5-15 min

Question 5

How to administer heparin ?

Answer 5

Runs for 24 hrs until pt can go to Cath lab

Question 6

What are the medications for Long term ?

Answer 6

Long-actting nitroglycerin, Dual antiplatlet therapy(DAPT), Beta blockers, ACE Inhibitors or ARBS, Statins

Question 7

What are contraindications for Thrombolytic Therapy?

Answer 7

Any prior intracranial hemorrhage, Known structural cerebral vascular lesion, Known malignant intracranial neoplasm, Ischemic stroke within 3 months except acute Ischemic stroke within 3 hrs, Suspected Aortic dissection, Active bleeding, Bleeding diathesis( a condition that causes an abnormal tendency to bleed or bruise easily), Significant closed head or facial trauma within 3 months

Question 8

What are some nursing interventions for MI ?

Answer 8

Obtain description of chest discomfort, Assess all Vital signs and cardiac monitoring( watch for arrythmias), Administer oxygen, Administer pain relief(nitroglycerin, morphine), ECG within 10 mins of arrival( or CP onset if already admitted), Administer 325 Mg aspirin (chewable or suppository), Obtain labs( Troponin), Prep for Cath Lab, pt education and emotional support

Question 9

Nursing considerations Pre-procedure for Percutaneous coronary Interventions

Answer 9

Signed informed consent, Assess allergies( Iodines, Dyes), NPO status 6-8 hrs, Weight, Height, vital signs, Shave Cath sites, Education on procedure, Insert peripheral IV( 20 G or larger), Administer any pre procedure meds(hold nitroglycerin for SBP <90), Hold metformin

Question 10

Nursing considerations Post- procedure for Percutaneous coronary interventions

Answer 10

Monitor vital signs and cardiac rhythm, Assess for chest pain, Peripheral pulses, color, warmth, sensation of affected extremity, Notify provider immediately of numbness/ tingling and extremities become cool, Pale, or cyanotic, Monitor for bleeding or hematoma from Cath sites, Monitor for signs of retroperitoneal bleed, Postion pt lying flat for 4-6 hrs depending on physician order, IV fluids to flush dye unless contraindicated, Monitor for reaction to dye(N/V, Rash)

Question 11

What are some complications of a MI ?

Answer 11

Arrythmias (Bradycardia, Tachycardia, A- flutter, A- fib, PVCs, V tach, V-fib, Third degree heart block), Cardiac arrest

Question 13

Anterior Wall

Answer 13

Leads: V2, V3, V4
Artery : Left Anterior Descending Artery (LAD)
ECG Changes: Poor R wave progression, ST segment, T wave inversion

Question 14

Septal wall

Answer 14

Leads: V1, V2
Artery: Left Anterior Descending artery (LAD)
ECG Changes: R wave disappear, S T segment elevation, T wave inverts

Question 15

Lateral Wall

Answer 15

Leads: 1, aVL, V5, V6
Artery: Left circumflex artery
ECG Changes: ST segment elevation

Question 16

Inferior Wall

Answer 16

Leads: ll, lll, aVF
Artery: Right Coronary Artery
ECG Changes: T wave inversion, ST segment elevation

Question 17

Posterior Wall

Answer 17

Leads: V1, V4
Artery: Left circumflex Artery, or Right Coronary Artery
ECG Changes: Tall R waves, ST segment depression, Upright T waves