Myocardial Infarction Essay
DECISION-MAKING CASE SUMMARIES
|PHARMACOLOGY #2: MYOCARDIAL INFARCTION|
|CASE NAME||OVERVIEW||MAJOR CASE DECISIONS|
|Derreck Bryant||Derreck Bryant is a 58-year-old male who was brought to the ED by ambulance after he collapsed and was unconscious and not breathing. After CPR and defibrillation, Mr. Bryant regained consciousness but was disoriented. He complained of severe chest and left arm pain. Mr. Bryant was given aspirin and nitroglycerin. He was also administered oxygen and morphine. A 12-lead EKG indicated ST segment elevation. He was diagnosed with lateral myocardial infarction with ST segment elevation (STEMI).||1. Selecting priority interventions
2. Identifying contraindications for medication use
3. Following protocols for ongoing medication administration
4. Monitoring for side effects of medications
5. Choosing the correct method of administration for medications
6. Recommending appropriate treatments for clients
7. Assessing clients before medication administration
|Estimated Case Length:
Difficulty Level: Medium
· Advocate for effective care of clients with myocardial infarction.
|1. After a brief assessment and client history, you consult with the physician. What is the priority intervention for Mr. Bryant right now?||Administer tenecteplase, 50 mg IV bolus to break up the clot. The medication is a fibrinolytic agent that will help liquify the clot and result to reperfusion.|
|2. Which of the following medical conditions would be a contraindication for fibrinolytic therapy?||Von Willebrand disease. This is because fibrinolytic treatment will elevate bleeding risk by liquifying the clot. The disease is a clotting disorder and hence administering fibrinolytic therapy in patients with clotting disorder elevates the risk of bleeding.|
|3. Which of the following medications that the EMTs administered should be administered again or continued to be administered in the emergency department? Select all that apply.||3.5 L/min oxygen through nasal cannula to help SpO2 above 94%
0.8 mg/h morphine to reduce pain level
|4. What side effect of morphine do you need to monitor for closely while Mr. Bryant is in the ED?||Respiratory depression|
|5. The physician orders administration of anticoagulants for Mr. Bryant, including unfractionated heparin and clopidogrel. Which methods of administration will you need to prepare for?||IV for heparin and PO for clopidogre|
|6. Mr. Bryant is now on IV heparin. What test needs to be performed regularly to monitor heparin effectiveness?||aPTT every 4-6 h to achieve 1.5-2 times baseline|
|7. Throughout treatment, you have been monitoring Mr. Bryant’s heart rhythm. One hour after Mr. Bryant arrives, he develops a dysrhythmia. What is your priority nursing intervention in this situation? Assume the physician has given contingent orders for any medications.||Administration of lidocaine, 100 mg IV bolus at 25 mg/min, followed by 2 mg/min infusion in D5W.
Lidocaine is an antiarrhythmic utilized in the treatment of dysrhythmias allied to myocardial infarction.
|8. You have been monitoring Mr. Bryant’s vital signs since he arrived at the ED. His latest vital signs are T 100.3°F, P 62, R 5, and BP 102/68. Mr. Bryant appears lethargic and does not respond to commands. What is your priority nursing intervention?||2 mg naloxone, IV as needed|
|9. What is the mechanism of action of naloxone?||Opioid antagonist|
|10. Ninety minutes after initiation of fibrinolytic therapy, Mr. Bryant’s ST segment resolution is <50%. What should be the priority recommendation?||Mr. Bryant should be recommended for percutaneous transluminal coronary angioplasty (PTCA).|
|11. Upon recovery from angioplasty, Mr. Bryant’s physician orders administration of metoprolol, 50 mg PO bid. What assessments do you need to perform before administering this medication to Mr. Bryant? Select all that apply.||Apical pulse
|12. What comorbidity would be a contraindication for beta blocker use?||Asthma|
|13. It is currently 2330, and Mr. Bryant is very restless. He states that he feels tired but his anxiety about the day and his medical condition isn’t allowing him to sleep. He denies the presence of chest pain, rating his pain on a 0 on a scale of 0 to 10, even though morphine has been discontinued. Which of the following medications may benefit Mr. Bryant?||Diazepam|
Use your soap note template and fill in the responses as indicated. Use the HPI to start your Soap Note for an MI patient. Medications have already been provided.
HISTORY OF PRESENT ILLNESS: The patient is a 68-year-old man who returns for recheck. He has a history of ischemic cardiac disease; he did see Dr. XYZ in February 2004 and had a thallium treadmill test. He did walk for 8 minutes. The scan showed some mild inferior wall scar and ejection fraction was well preserved. He has not had difficulty with chest pain, palpitations, orthopnea, nocturnal dyspnea, or edema.
MEDS: MEDICATIONS: Losartan 50 mg daily, gemfibrozil 600 mg twice daily, Crestor 80 mg 1/2 pill daily, aspirin 325 mg daily, vitamin E 400 units daily, and Citrucel one daily.
SOAP with Problem list 6609
|SOAP with Problem list 6609|
|This criterion is linked to a Learning OutcomeH&P||
|This criterion is linked to a Learning OutcomeProblem List||
|This criterion is linked to a Learning OutcomeManagement and Evaluation||
|This criterion is linked to a Learning OutcomeOrganization||
|Total Points: 100|
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