Patient take vital signs take pain assessment get

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Unformatted text preview: . What antiplatelet might help? Why? Why? 39 Critical Thinking Question Critical A patient has had an acute myocardial patient infarction and has received alteplase (Activase) to lyse the clot. What nursing action should have been taken prior to the patient receiving the medication? patient Take vital signs. Take pain assessment. Get Take CBC. Alteplase could cause your patient to bleed. 40 40 Management of ST-Elevation Myocardial Infarction 41 ST-Elevation Myocardial Infarction (STEMI) (STEMI) MI – necrosis of the myocardium resulting MI from ischemia from STEMI – an acute MI caused by complete STEMI interruption of regional myocardial blood flow flow – Causes elevation of the ST segment on the Causes ECG ECG 42 Pathophysiology of STEMI Pathophysiology Blood flow to a region of myocardium is Blood stopped (platelet plugging and thrombus formation) formation) Local metabolic changes occur Myocardial injury Degree of residual cardiac impairment Degree depends on amount/location of damage depends 43 Diagnosis of STEMI Diagnosis Chest pain – Severe substernal, crushing/constricting, Severe down arm and jaw down Characteristic ECG changes Elevated serum levels of myocardial Elevated cellular components (troponin, creatine kinase) kinase) Sweating, weakness, sense of impending Sweating, doom doom – 20% of patients with STEMI experience no 20% symptoms symptoms 44 Fig. 52-1. ECG changes associated with ST-elevation myocardial infarction. 45 Management of STEMI Management Routine drug therapy – Oxygen- don’t need an order for need – Aspirin (not NSAIDs) – Morphine – Beta blockers – Nitroglycerin 46 Management of STEMI Management Reperfusion therapy – Fibrinolytic (thrombolytic) therapy Fibrinolytic – Action – to dissolve clots; converts Action plasminogen into plasmin plasminogen 47 Management of STEMI Management Thrombolytic drugs – Alteplase, a tissue plasminogen activator – Reteplase – Streptokinase – Tenecteplase – Urokinase Percutaneous coronary intervention (PCI) – Catheterization Catheterization – Try to get out clot Try 48 48 Primary Percutaneous Coronary Intervention Intervention Primary refers to the use of angioplasty rather than fibrinolytic therapy rather Stents may be placed (plavix) Goal – primary PCI within 90 minutes of Goal rimary patient contact patient Success rate with PCI somewhat higher Success than with thrombolytics than 49 Fibrinolytic (Thrombolytic) Therapy Fibrinolytic Dissolve clots Convert plasminogen into plasmin Convert (proteolytic enzyme) (proteolytic 1. Alteplase, a tissue plasminogen activator 2. Reteplase 3. Streptokinase 4. Tenecteplase 5. Urokinase 50 Fibrinolytic (Thrombolytic) Therapy Fibrinolytic Most effective when patient presents early; Most early not given if pain has been present more than 12 hours (best if given during first 4-6 hours) hours) Goal: to improve ventricular function, limit Goal: size of infarct, and reduce mortality size Timely administration = opening of Timely occluded artery in 80% of patients occluded Guidelines suggest 30-minute target time Best for patients younger than 75 years 51 Adjuncts to Reperfusion Therapy – Management of STEMI Management Unfractionated heparin used for treatment lasting less Unfractionated than 48 hours than LMW heparin used for treatment lasting longer than 48 LMW hours hours Antiplatelet drugs – Clopidogrel (Plavix) Clopidogrel – Glycoprotein (GP) IIb/IIIa inhibitors Low-dose aspirin...
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