Medsurg: Cardiovascular: Myocardial Infarction

Front 1

Risk factors of MI are the same as those for coronary artery disease, what are they? (10)

Back 1

1. Age
2. Gender
3. Heredity
4. Race
5. Smoking
6. Hyperlipidemia
7. Hypertension
8. Diabetes
9. Diet
10. Sedentary lifestyle

Front 2

MI Pathophysiology:
Atherosclerotic plaque may form two types of lesions, what are they?

Back 2

1. Stable lesion
2. Unstable (complicated) lesion

Front 3

MI Pathophysiology:
Describe stable lesions

Back 3

Stable lesions progress by gradually occluding the vessel lumen and often causes angina.

Front 4

MI Pathophysiology:
Describe unstable or complicated lesions

Back 4

Unstable or complicated lesions are prone to rupture and thrombus formation. Unstable lesions often lead to acute coronary syndrome or acute ischemic heart disease.

Front 5

MI Pathophysiology:
Acute coronary syndromes include: (3)

Back 5

1. Unstable angina
2. MI
3. Sudden Cardiac Death

Front 6

MI Pathophysiology:
How does MI occurs?

Back 6

MI occurs when blood flow to cardiac muscle is blocked, resulting in prolong tissue ischemia and irreversible cell damage.

Front 7

MI Pathophysiology:
Describe the cause of coronary occlusion.

Back 7

Coronary occlusion is usually caused by ulceration or rupture of a complicated atherosclerotic lesion.

Front 8

MI Pathophysiology:
Describe the chain reaction of a ruptured atherosclerotic lesion

Back 8

Rupture lesion  Platelet aggregation
 Thrombin generation
 Local vasomotor tone
As a result  Clot formation  Vessel occlusion  ischemia to distal muscles

Front 9

MI Pathophysiology:
How long will it takes for tissue ischemia becomes irreversible tissue damage?

Back 9

20 to 45 minutes

Front 10

MI Pathophysiology:
Which area of the heart is most susceptible to changes in coronary blood flow?

Back 10

Subendocardium

Front 11

MI Pathophysiology:
What is a Q wave MI?

Back 11

When all the layers of the myocardium are affected by occlusion of blood flow. With this a significant Q wave develops.

Front 12

MI Pathophysiology:
MI usually affects which portion of the heart and why?

Back 12

The Left ventricle because its muscle mass is greatest, as also its oxygen demand.

Front 13

MI Pathophysiology:
Occlusion of the lateral anterior descending (LAD) artery will damage which area(s) of the heart?

Back 13

1. Anterior wall of the left ventricle (an anterior MI)
2. Part of the interventricular septum

Front 14

MI Pathophysiology:
Occlusion of the left circumflex artery (LCA) will damage which area(s) of the heart?

Back 14

Lateral portion of the heart (lateral MI)

Front 15

MI Pathophysiology:
Occlusion of the right coronary artery (RCA) and posterior descending artery (PDA) will damage which area(s) of the heart?

Back 15

1. Right ventricle
2. Anterior portion of the heart (anterior infarct)
3. Posterior portion of the heart (posterior infarct)

Front 16

MI Pathophysiology:
Occlusion of the left main coronary artery will damage which area(s) of the heart?

Back 16

Entire left ventricle (grave prognosis)

Front 17

MI Pathophysiology:
Patent with cocaine induced MI may present with: (7)

Back 17

1. Altered LOC
2. Confusion and restlessness
3. Seizure activity
4. Tachycardia
5. Hypotension
6. Increase respiratory rate
7. Respiratory crackles

Front 18

Manifestation of MI:

Back 18

1. Chest pain
2. Tachycardia, tachypnea
3. Dyspnea, SOB
4. Nausea and vomiting
5. Anxiety, sense of impending doom
6. Diaphoresis
7. Cool, molted skin
8. Diminished peripheral pulse
9. Hypotension or hypertension
10. Palpitation, dysrhythmias
11. Signs of left heart failure
12. Decrease LOC

Front 19

How is MI chest pain distinguished from angina chest pain? (4)

Back 19

1. Longer duration, lasting for than 15 to 20 minutes
2. Pain is sudden and usually not associated with activity
3. Often occurs early in the morning
4. Pain not relieved by rest or nitroglycerine

Front 20

Describe atypical MI pain in women and older adult (4)

Back 20

1. Indigestion
2. Heart burn
3. Nausea
4. Vomiting

Front 21

List the complications associate with AMI (5)

Back 21

1. Dysrhythmias
2. Pump failure (Heart failure)
3. Infarct Extension
4. Structural defects
5. Pericarditis

Front 22

List manifestations of left-sided heart failure: (4)

Back 22

1. Dyspnea
2. Fatigue
3. Weakness
4. Respiratory crackles on auscultation

Front 23

List manifestations of right-sided heart failure (2)

Back 23

1. Peripheral edema
2. Neck vein distension

Front 24

List the manifestations of infarction extension: (3)

Back 24

1. Continuing chest pain
2. Hemodynamic compromise
3. Worsening heart failure

Front 25

When is infarction extension most likely to occur?

Back 25

10 to 14 days after MI

Front 26

List possible structural defects as a result of AMI?

Back 26

1. Ventricular aneurysm
2. Rupture of ventricular septum
3. Rupture of papillary muscle
4. Myocardial rupture

Front 27

When is structural defects most likely to occurs in patient with AM I?

Back 27

4 to 7 days after MI

Front 28

What are the manifestations of Pericarditis? (3)

Back 28

1. Chest pain that maybe sharp or stabbing
2. Pain is aggravated by movement or breathing
3. Pericarditis maybe heard on auscultation of heart sounds

Front 29

When is Pericarditis most likely to occur?

Back 29

2 to 3 days after AMI

Front 30

What is Dressler’s syndrome and when is it likely to occur?

Back 30

A hypersensitivity response to necrotic tissue or an autoimmune disorder, may develop days to weeks after AMI.

Front 31

What are the symptoms of Dressler’s syndrome?

Back 31

1. Fever
2. Chest pain
3. Dyspnea

Front 32

What are the immediate goals for the MI client? (5)

Back 32

1. Relieve chest pain
2. Reduce the extent of myocardial damage
3. Maintain cardiovascular stability
4. Decrease cardiac workload
5. Prevent complications

Front 33

What are the 4 serum cardiac markers?

Back 33

1. Creatinine phosphokinase (CK or CPK)
2. CK-MB
3. Cardiac-specific troponin T (cTnT)
4. Cardiac-specific troponin I (cTnI)

Front 34

CK (CPK) normal level

Back 34

Male: 12 to 80 U/L
Female: 10 to 70 U/L

Front 35

CK (CPK) primary tissue location (3)

Back 35

1. Cardiac muscle
2. Skeletal muscle
3. Brain

Front 36

CK (CPK) significance of elevation
Injury to muscle cells

Back 36

CK (CPK) level changes occurring with MI
Appears 3 to 6 hours
Peaks 12 to 24 hours
Duration 24 to 48 hours

Front 37

CK-MB normal level

Back 37

0% to 3% of total CK

Front 38

CK-MB primary tissue location

Back 38

Cardiac muscle

Front 39

CK-MB significance of elevation (5)

Back 39

1. MI
2. Cardiac ischemia
3. Myocarditis
4. Cardiac contusion
5. Defibrillation

Front 40

CK-MB level changes occurring with MI

Back 40

Appears 4 to 8 hours
Peaks 18 to 24 hours
Duration 72 hours

Front 41

cTnT normal level

Back 41

< 0.2 mcg/L

Front 42

cTnT primary tissue location

Back 42

Cardiac muscle

Front 43

cTnT significance of elevation (2)

Back 43

1. Acute MI
2. Unstable angina

Front 44

cTnT level changes occurring with MI

Back 44

Appears 2 to 4 hours
Peaks 24 to 36 hours
Duration 10 to 14 days

Front 45

cTnI normal level

Back 45

< 3.1 mcg/L

Front 46

cTnI primary tissue location

Back 46

Cardiac muscle

Front 47

cTnI significance of elevation (2)

Back 47

1. Acute MI
2. Unstable angina

Front 48

cTnI level changes occurring with MI

Back 48

Appears 2 to 4 hours
Peaks 24 to 36 hours
Duration 7 to 10 days

Front 49

Aside from Serum Cardiac Markers what other laboratory tests maybe run for MI patient? (3)

Back 49

1. Myoglobin
2. CBC
3. ABGs

Front 50

What diagnostic tests are commonly performed when AMI is suspected?

Back 50

1. Electrocardiogram (ECG)
2. Echocardiography
3. Radionuclide imaging
4. Hemodynamic monitoring

Front 51

Medication management if AMI includes what class of drugs? (9)

Back 51

1. Thrombolytic
2. Analgesia
3. Antidysrhythmics
4. Beta blockers
5. ACE inhibitors
6. Nitroglycerins
7. Anticoagulants
8. Heparin
9. Stool softener

Front 52

What is the first line of drug used to treat AMI?

Back 52

Thrombolytic agents

Front 53

What are contraindications for Thrombolytic agents? (8)

Back 53

1. Bleeding disorders or active bleeding
2. History of cerebrovascular disease
3. Uncontrolled hypertension
4. Pregnancy
5. Recent trauma or surgery to the head or spine
6. Prolonged CPR
7. Gastrointestinal ulcers
8. Diabetic hemorrhagic retinopathy

Front 54

What are the four commonly used thrombolytic agents?

Back 54

1. Streptokinase
2. Anisoylated plasminogen streptokinase activator complex (APSAC)
3. Tissue plasminogen activator (t-PA)
4. Reteplase

Front 55

How would the nurse evaluate the effectiveness of thrombolytic therapy?

Back 55

Look for signs that the clot has been dissolved and the myocardium is being reperfused
1. Normalization of ST segment
2. Relief of chest pain
3. Reperfusion dysrhythmias
4. Early peaking of the CK and CK-MB

Front 56

What are the manifestations of reocclusion?

Back 56

1. Changes in the ST segment
2. Chest pain
3. Dysrhythmias

Front 57

Thrombolytic therapy: Pre-infusion care (5)

Back 57

1. Obtain nursing history, and perform a physical assessment
2. Evaluate for contradictions to thrombolytic therapy
3. Inform client the purpose of therapy
4. Discuss the risk of bleeding
5. Tell client to keep extremity immobile during and after the infusion

Front 58

Thrombolytic therapy: During the infusion (6)

Back 58

1. Assess and record vital signs and the infusion site for hematoma or bleeding.
2. Assess pulses, color, sensation, and temperature of both extremities with each vital sign check.
3. Remind client to keep extremities still and straight.
4. Do not elevate the head of the bed above 15 degree.
5. Maintain continuous cardiac monitoring
6. Keep antidysrhythmic drugs and the emergency cart ready.

Front 59

Thrombolytic therapy: Post-infusion care (10)

Back 59

1. Assess vital signs, distal pulses, and infusion site frequently as needed.
2. Evaluate response to therapy
3. Maintain bed rest for 6 hours
4. Avoid injections for 24 hours after catheter removal
5. On catheter removal hold direct pressure for 30 minutes
6. Assess body fluids for evidence of bleeding
7. Assess for changes in LOC
8. Administered platelet-modifying drugs
9. Report manifestations of reocclusion
10. Monitor Hgb, Hct, PT, and PTT levels

Front 60

During the infusion of thrombolytic agent, how often are vital signs assess and record?

Back 60

Every 15 minutes for the first hour,
Every 30 minutes for the next two hours, then
Hourly until the IV catheter is discontinued.

Front 61

What analgesic medications are used for acute MI? (2)

Back 61

1. Sublingual Nitroglycerine
2. Morphine sulfate

Front 62

What is the dose of Sublingual Nitroglycerine given for Pt. with AMI?

Back 62

Up to three 0.4 mg doses at five minutes interval.

Front 63

What is the dose of Morphine Sulfate given for Pt. with AMI?

Back 63

Initial IV dose of 4 to 8 mg. Small doses of 2 to 4 mg may be repeated IV q 5 minutes until pain is relieved.

Front 64

What medication maybe given to Pt. with AMI for anxiety?

Back 64

diazepam (Valium)

Front 65

What antidysrhythmics medications are used in AMI? (3)

Back 65

1. Class I or class II
2. Verapamil
3. Short acting Beta-blockers

Front 66

What are medical managements for AMI patients? (6)

Back 66

1. Continuous monitoring
2. ICU for the first 24 to 48 hours
3. IV line established
4. Bed rest for 24 hours
5. Oxygen 2 to 5 L/min
6. Restricted diet

Front 67

What diet restrictions are imposed on AMI patients? (5)

Back 67

1. Liquid diet for the first 4 to 12 hours
2. Low fat, low-cholesterol, reduced-sodium diet for 2 to 3 days
3. Small, frequent feedings
4. No drinks containing caffeine
5. No very hot and cold foods

Front 68

What revascularization procedures may be performed for AMI patient?

Back 68

1. Percutaneous coronary revascularization (PCR)
angioplasty
stent placement
2. CABG surgery

Front 69

When AMI is large and Pt. shows evident of pump failure, what invasive devices may be used to temporary take over the function of the heart? (2)

Back 69

1. Intra-aortic balloon pump (IABP)
2. Ventricular assist devices (VADs)

Front 70

Nursing care:
What should the nurse discuss in regarding to health promotions for AMI patient? (3)

Back 70

1. Risk factor management
2. Use of prescribed medications
3. Cardiac Rehabilitation

Front 71

Nursing care:
What are nursing diagnoses for AMI patient? (3)

Back 71

1. Acute pain
2. Ineffective tissue perfusion
3. Ineffective coping

Front 72

Nursing care: What are the main nursing interventions for pain due to AMI? (5)

Back 72

1. Assess for pain
2. Administer oxygen 2 to 5 L/min per nasal cannula
3. Promote rest and provide support
4. Titrate IV nitroglycerine per order (systolic > 100)
5. Administer 2 to 4 mg morphine by IV push as ordered

Front 73

Nursing care: What are the main nursing interventions for ineffective tissue perfusion due to AMI?

Back 73

1. Assess and record vital signs, report changes
2. Assess for changes in LOC
3. Assess for signs of ineffective tissue perfusion
4. Auscultate heart and breath sounds
5. Monitor ECG continuously
6. Monitor oxygen saturation
7. Administer antiarrhythmic medications
8. Obtain serial CK, isoenzyme, and troponin level
9. Plan for invasive hemodynamic monitoring