Question

You are in the middle of your shift in the emergency department (ED) of a large urban medical center. C.B., a 47-year-old woman, was just brought in by her husband with chest pain. C.B. is a full-time homemaker with four children. She has had episodes of 'chest tightness' with exertion for the past year. The pain has become more intense in the last few hours. She initially thought it was severe indigestion and began taking Maalox with no relief. C.B. states she is experiencing severe substernal chest pain radiating to neck and down both arms. She rates the pain as 9 or 10 on a 0-to-10 scale. She has a history of hyperlipidemia and has smoked one pack of cigarettes daily for 30 years. Surgical history consists of total abdominal hysterectomy 10 years ago after the birth of her last child. She has no other known medical problems. What are your priority interventions (include pain management)? What are the best practices for patients with chest pain? The provider indicates the patient is having an MI. What would you expect to see for a cardiac rhythm with a patient experiencing an MI? tPA (tissue plasminogen activator) is ordered. What are the contraindications for this drug? It is determined the patient is a candidate for tPA. What will you monitor for after this medication is administered? Math practice question: A client is prescribed amiodarone 1mg/min IV. You have on hand 900mg of amiodarone in 500cc D5W. The patient’s weight is 165 pounds. What would you set the mL/hr on an infusion pump? Show your calculation and round to the nearest tenth mL.

Answer 1

Priority management for Patient with MI(Myocardial Infarction):
? The immediate concern for this patient with suspected MI make them comfort and safety.Transfer the patient to High supervision area connect the patient with cardiac monitor...Elevate his head upto his chest level to reduce dyspnea..check the vitals continuously..Check the oxygen saturation and connect the patient with oxygen therapy..
Pain Management:-
?    The initial pain mangement we can give Glycerly trinitrate(GTN) for pain and dyspnea.. According to clinical practice guidelines morphine can be given with doctors supervision..
?Cardiac rhythm changes in ECG:
?    --ST segment elevation with Q wave formation in the precordial leads(v1-6)_+ the high lateral leads(I and aVL)
      --Reciprocal ST depression in the inferior leads (mainly III and aVF)
?Contra indication(TPA)
? --this is a Thrombolytic agent..Bleeding is the major complication of this therapy
? --Dissecting aortic aneurysm,pericarditis,stroke,severe uncontrolled hypertension
?Monitor during administration:-
-- Hourly blood pressure should be monitor..Every 15 minutes for 1 hour for 24hours..
?    -- Monitor urine output,closely monitor fluid calculation
   -- Observe the patient chest pain
-- check EcG every 4th hourly
?    -- Monitor the breath sounds
?Fluid calculation:-
? 1mg/minx900mg/500ml=1.8ml/hr

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