MYOCARDIAL INFARCTION D.M., a 51-year-old, successful executive, is rushed to th

Question

MYOCARDIAL INFARCTION D.M., a 51-year-old, successful executive, is rushed to the hospital by ambulance after experiencing crushing substernal chest pain that radiates down his left arm. He also complains of dizziness and nausea Subjective Data Has a history of chronic stable angina and hypertension . States he is "borderline diabetic Overweight but recently lost 10 pounds Rarely exercises Has three teenage children who are causing "problems Recently experienced loss of best friend and business partner, who died from cancer Objective Data Physical Examination Diaphoretic, short of breath, nauseous BP 165/100 mm Hg, pulse rate 120/min, respiratory rate 26/min Diagnostic Studies 12-lead ECG shows sinus tachycardia with ST elevation in leads II, IlI, aVF, V5, V6 with occasional premature ventricular contractions Cardiac-specific troponin I level elevated Cholesterol 350 mg/dL (9.1 mmol/L) Hb A1C 9.0% . Inferolateral wall MI Collaborative Care Oxygen 2 L/min via nasal cannula, titrate to keep O2 saturation above 93% Continuous ECG monitoring Aspirin 325 mg (chewable) Eptifibatide (Integrilin) IV Weight-based heparin IV Nitroglycerin IV, titrate to relieve chest pain; hold for systolic BP below 100 mm Hg Morphine 2 to 4 mg IV q5min PRN for chest pain unrelieved by nitroglycerin Vital signs, pulse oximetry every 10 minutes Preparation of patient for transfer to cardiac catheterization laboratory for possible PCI Discussion Questions 1. Which coronary artery(ies) is (are) most likely occluded in D.M.'s coronary circulation? Explain the pathogenesis of CAD. What risk factors contribute to its development? What risk factors were present in D.M.'s life? What is angina? How does chronic stable angina differ from angina associated with acute coronary syndrome? 2. 3. . Explain the pathophysiologic basis for the clinical manifestations that D.M. exhibited. 5. Explain the significance of the results of the laboratory tests and the 12-lead ECG findings 6. Provide a rationale for each treatment measure ordered for D.M. 7. Based on the assessment data presented, what are the priority nursing diagnoses? Identify any 8. 9. What are the priority nursing interventions for D.M. immediately after his Mi? Immediately after his PCI? Two days after an uncomplicated PCI and the placement of two stents, D.M. wants to know what the most effective strategies are to prevent another MI. Based on his clinical situation, what would you tell him?

Explanation / Answer

In above question D.M.suffered from myocardial infaraction in the inferolateral wall of heart which caused by blockage in right posterior coronary artery and circumflex artery.

The risk factor of CAD is heredity,smoking,lack of exercise ,high fatty diet,stress ,over weight and diabetes mellitus

D.M. have hypertension, d.m.,sedantary life style, stress and over weight resulting increase LDL and cholesterol and decrease HDLlevel cause reduce the the diameter and plaque formation in artery resultin increase blood pressure and heart rate

Angina is warning sign of weak arterial blood supply to cardiac muscles by squeezing chest pain radiating jaw, neck and left arm

Stable angina is most common and caused by physical activity or stress and releived by rest or NTG

angina associated with acute coronary syndrome is chest pain which occur in resting condition and not releived by NTG

In the management of MI is administration of oxygen by nasal prong and place the pulse oximetry

Administration of sublingual NTG which is vasodilator increase blood supply

Intravenous heparine also administer for prevention further clotting

Antilipid for maintain lipid concentration in blood

Rest to decrease work load on heart

Advise for PTCA and provide health eduction regarding reduce lipid level and mediction side effect

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