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Case Studies Acute Myocardial Infarction ( Stemi)

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Nursing Foundation (NURS 301)

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Technische Universiteit Delft

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CASE STUDIES

ACUTE MYOCARDIAL INFARCTION (STEMI)

DO NOT READ THE NAME OF THE DISEASE TO THE CLASS. BEGIN READING

PATIENT DATA FROM THE PARAGRAPH BELOW

Mr. M. is a 50-year-old male patient who came in to the emergency department with complaints of chest pain while mowing his lawn. He is accompanied by his wife, who says that he was working in the yard and had to call for help because of his discomfort. He complains of chest pain, rated at a “7” on a 0 to 10 scale and describes it as a feeling of pressure in the center of his chest. The pain does not radiate to any other location. He has nausea that developed 2 hours ago and he vomited once. Upon exam, he is breathing rapidly and is diaphoretic and he appears anxious. Mr. M tells the nurse, “I think I am having a heart attack.” The patient has a history of hyperlipidemia, in which he takes atorvastatin, and hypertension, in which he takes nifedipine. He does not have a history of angina and has never experienced chest pain; because of this, he is concerned that he has not had any warning signals prior to this event. He started smoking cigarettes in high school and smoked about 1 pack per day for 18 years before successfully quitting.

STOP. ANSWER THE FOLLOWING QUESTIONS

How should the nurse explain the relationship between a patient’s lack of history of angina and an acute MI? Describe the factors that would determine the severity of this patient’s MI.

  1. Angina is a condition marked by serve pain in the chest, and often spreads to the extremities. Sometimes people have silent heart attacks which is either no symptoms, minimal symptoms, or unrecognized symptoms.

The severity of an MI depends on the amount of occlusion in the artery, how long the occlusion has been present, and whether other vessels nearby are also occluded. Some factors increase the risk of a person having an MI, including a history of hyperlipidemia or diabetes, male gender, history of hypertension, family history of MI, and tobacco use. The patient in this example suffers from hyperlipidemia and he is a male; additionally, he has a smoking history even though he currently does not smoke tobacco.

RESUME READING CASE STUDY

Mr. M has an ECG and has several blood tests to check cardiac enzymes, including creatine kinase, troponin, and myoglobin levels. The ECG shows an anterior wall ST elevation myocardial infarction (STEMI).

STOP. ANSWER THE FOLLOWING QUESTIONS

Explain the difference between a STEMI and a NSTEMI and how these two conditions would be treated. What nursing interventions would the nurse employ first after learning of the diagnosis of a STEMI? Describe the changes in cardiac enzymes that would most likely develop because this patient is having an MI. Based on the fact that the patient has a STEMI as seen on ECG, would the physician wait to find out the cardiac enzyme results before providing treatment? Why or why not?

A STEMI (myocardial infarction marked by S-T elevation), complete block, will demonstrate changes in the S-T segment on the ECG; it typically occurs with a complete occlusion of a coronary artery after the rupture of plaque from atherosclerosis. Alternatively, a NSTEMI (partial block) may indicate an incomplete occlusion and there is still a small amount of blood flow through the artery.

A STEMI is a medical emergency, and the nurse must know how to rapidly respond in this situation. The main treatment of a STEMI is percutaneous coronary intervention (PCI), which should be performed within 90 minutes of arrival at the hospital.

RESUME READING CASE STUDY

The nurse gives Mr. M a dose of nitroglycerin and prepares him for PCI. After administration of the drug, Mr. M states that his pain level has dropped to a “3” on a 0 to 10 scale.

STOP. ANSWER THE FOLLOWING QUESTIONS

Describe how PCI would be used to manage this patient’s condition. What information would the nurse give to this patient that would best teach him about what to expect when receiving PCI? Explain the nurse’s role while in care of a patient undergoing PCI.

The goal of PCI is to restore blood flow to the heart. Following the procedure, the patient will need to remain on bedrest for a prescribed period. The nurse’s role is to monitor the patient’s hemodynamic status and ensure that his cardiac function is improving. The patient is at risk of bleeding from the catheter insertion site and the nurse must ensure that the patient does not move the affected leg, that he stays on bedrest, and that the site is intact.

RATIONALE

An acute myocardial infarction (MI), also known as a heart attack, occurs when the heart muscle experiences ischemia and eventual necrosis of tissue as a result of lack of blood flow. This usually occurs because of some form of occlusion in the coronary blood vessels that supply blood to the heart muscle. The severity of an MI depends on the amount of occlusion in the artery, how long the occlusion has been present, and whether other vessels nearby are also occluded. Some factors increase the risk of a person having an MI, including a history of hyperlipidemia or diabetes, male gender, history of hypertension, family history of MI, and tobacco use. The patient in this example suffers from hyperlipidemia and he is a male; additionally, he has a smoking history even though he currently does not smoke tobacco. Angina may occur in some cases before an MI; angina is chest pain and pressure that may feel like a heart attack and it develops because of decreased oxygen reaching the heart muscle. Approximately 50 percent of people who suffer an MI will have a history of angina. An MI may be classified as a STEMI or an NSTEMI, depending on the outcome of the ECG. A STEMI (myocardial infarction marked by S-T elevation) will demonstrate changes in the S-T segment on the ECG; it typically occurs with a complete occlusion of a coronary artery after the rupture of

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Case Studies Acute Myocardial Infarction ( Stemi)

Course: Nursing Foundation (NURS 301)

21 Documents
Students shared 21 documents in this course
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CASE STUDIES
ACUTE MYOCARDIAL INFARCTION (STEMI)
DO NOT READ THE NAME OF THE DISEASE TO THE CLASS. BEGIN READING
PATIENT DATA FROM THE PARAGRAPH BELOW
Mr. M. is a 50-year-old male patient who came in to the emergency department with
complaints of chest pain while mowing his lawn. He is accompanied by his wife, who says that
he was working in the yard and had to call for help because of his discomfort. He complains of
chest pain, rated at a “7” on a 0 to 10 scale and describes it as a feeling of pressure in the center
of his chest. The pain does not radiate to any other location. He has nausea that developed 2
hours ago and he vomited once. Upon exam, he is breathing rapidly and is diaphoretic and he
appears anxious. Mr. M tells the nurse, “I think I am having a heart attack.The patient has a
history of hyperlipidemia, in which he takes atorvastatin, and hypertension, in which he takes
nifedipine. He does not have a history of angina and has never experienced chest pain; because
of this, he is concerned that he has not had any warning signals prior to this event. He started
smoking cigarettes in high school and smoked about 1 pack per day for 18 years before
successfully quitting.
STOP. ANSWER THE FOLLOWING QUESTIONS
How should the nurse explain the relationship between a patients lack of history of angina and
an acute MI? Describe the factors that would determine the severity of this patients MI.
1. Angina is a condition marked by serve pain in the chest, and often spreads to the extremities.
Sometimes people have silent heart attacks which is either no symptoms, minimal symptoms, or
unrecognized symptoms.
The severity of an MI depends on the amount of occlusion in the artery, how long the occlusion
has been present, and whether other vessels nearby are also occluded. Some factors increase
the risk of a person having an MI, including a history of hyperlipidemia or diabetes, male
gender, history of hypertension, family history of MI, and tobacco use. The patient in this
example suffers from hyperlipidemia and he is a male; additionally, he has a smoking history
even though he currently does not smoke tobacco.
RESUME READING CASE STUDY
Mr. M has an ECG and has several blood tests to check cardiac enzymes, including creatine
kinase, troponin, and myoglobin levels. The ECG shows an anterior wall ST elevation myocardial
infarction (STEMI).
STOP. ANSWER THE FOLLOWING QUESTIONS
Explain the difference between a STEMI and a NSTEMI and how these two conditions would be
treated. What nursing interventions would the nurse employ first after learning of the
diagnosis of a STEMI? Describe the changes in cardiac enzymes that would most likely
develop because this patient is having an MI. Based on the fact that the patient has a
STEMI as seen on ECG, would the physician wait to find out the cardiac enzyme results before
providing treatment? Why or why not?

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