Question

1Mr M. is a 50 years old male patient who came in to the emergency department with complaint of chest paln while mowing his lawn. He is accompained by his lawn. He is accompained byhis 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.

1.Explain the nurse's role while in care of a patient undergoing PCL.

2. Describe how PCL would be used to manage this patient condition.

3.What informatiom\n wuld the nurse give to this patient that would best teach him about what to expect when receiving PCL

4.Explain the difference between a STEMI and a NSTEM and how these two condition would be treated.

5 How should the nurse explain the relationship between a patient's lack of history of angina and acute MI.

6. Describe the factors that would determine the severity of this patient's MI.

7.What nursing interventions would the nurse employ first after learning of the diagnosis of a STEMI?

8.Describe the changes in cardiac enzymes that would most likely develop because this patient is having an MI.

9.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?

Answer 1

Ans;

1. Nurses role while in care of patient will undergoing PCI is cleaning area of wrist or groin where a catheter insert in to the blood vessels

to identify the blockage a live x ray is needed. Block will removed with the help of catheter. After PCI catheter is removed. Bandage is applied to the opening area on wrist or groin.

2. PCI is helpful to open the coronary arteries that are narrowed or blocked by the atherosclerotic plaque. And it is useful to reduce further complications like atherosclerosis, ischemic disorders.

3. Nurse advises to the patient regarding PCI - it's safe method which is done under aseptic conditions and skilled health professionals.

- it remove or relieve symptoms of coronary heart disease and reduce the heart damage during or after heart attack.
4.the characteristic electrocardiography changes resulting from myocardial ischemia or necrosis in various distributions, a transmural infarcts is some time referred to as an ST ELEVATION MYOCARDIAL INFARCTS  and subendocardial infract as a Non ST ELEVATION INFARCTS. depending on the extent location of the vascular involvement..

5. Without history of angina there is a chances of occurrence of MI. The attack of MI is different from angina.
6. Chances of MI increase with age. The incidence of MI also strongly correlated with genetic and behavioural predisposition to atherosclerosis. And male gender increases the relative risk of MI.

7. Nursing intervention for STEMI patients:-

a) bed rest and back rest

b) change of positions to reduce the pooling of fluid.

c) administration of oxygen and medication like nitroglycerin, aspirin .

d) monitoring vital signs and oxygen saturation levels.
8. The most sensitive and specific bio markers of myocardial damage are cardiac specific proteins , particularly cTnT and cTnI.

following on MI level of Troponins I and T begin to rise at 3 to 12 hours.

cTnT levels peak somewhere between 12-48 hours, cTnI levels are maximal at 24 hours.

time to elevation of CKMB is 3to 12 hours

CK MB return to normal in 48 to 72 , cTnI in 5 to 10 days, and cTnT in 5 to 14 days

9. He don't have to wait for the results of enzymes as the ST SEGMENT ELEVATION is one of diagnostic criteria. Trigger of cardiac enzymes it takes some time before we receive them so it's better to start the treatment based on ECG