1a. What first actions should the nurse take after the patient has arrived in the emergency department?
The patient manifests signs and symptoms of a heart attack. The first action the nurse should take is to provide oxygen to the patient through prongs or a mask. Medication is administered to the patient through intravenous methods. Drugs like morphine and aspirin are administered to the patient according to instructions from the physician. Aspirin helps reduce mortality in case of myocardial infarctions.
1b. The emergency physician has contacted a cardiologist and the patient is scheduled for a percutaneous coronary intervention (PCI) in less than 60 minutes from the door-to-balloon time. Explain the reasoning for this action based on evidence-based guidelines and considering the clinical manifestations and the pathophysiology of the STEMI
Heart attacks appear when part of the muscles in the heart doesn’t get enough oxygen, mostly due to Coronary Artery Disease (CAD). Percutaneous coronary intervention is one of the methods used by physicians to help in unclogging coronary arteries. This procedure works by opening up the blocked arteries through non-surgical methods like using a thin, flexible tube known as a catheter.
2a. What are the rationales for the prescribed medications?
Nitroglycerine is a drug that helps relieve pain for patients with angina. The pain is mostly due to pressure or inadequate blood flow to the heart. Diltiazem works by relaxing blood vessels to lower the heart rate, thereby decreasing the rate of heart attacks. The Clopidogrel drug works by widening the blood vessels hence reducing occurrences of blockage from blood clots. This drug works best together with aspirin.
2b. Mr. Simpson continues to smoke despite his disease process. How does smoking increase Mr. Simpson’s chances of angina episodes?
Smoking increases the risk of angina. Cigarette smoke leads to free radical-mediated stress. This condition, in turn, raises the heart rate, causes damage to blood vessels, and a high probability of aggregation of platelets.
2c. The nurse reviews the correct procedure for taking nitroglycerin for chest pain, and includes what information?
The tablet should be taken preferably 5 to 10 minutes before any physical activity. The patient is advised to take the drug at the first sign of an angina attack and place the tablet in a moist part of the mouth, like between the cheek and gum. The patient should not exceed more than three tablets in fifteen minutes.
d. The nurse uses the PQRST acr
PQRST is an acronym used by physicians to assess the level of chest pain. Assessments include palliative actors, the quality of pain, the region, severity, and time the pain occurs.
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