When Mr. Thompson presents with mild ST-segment elevation on the ECG, which immediate nursing intervention is most important to perform first?

B) Place Mr. Thompson on continuous cardiac monitoring

A) Administer nitroglycerin for chest pain relief

B) Place Mr. Thompson on continuous cardiac monitoring

C) Initiate intravenous access for medication administration

D) Administer a stat dose of morphine if the pain persists

Which immediate nursing intervention is crucial in managing Mr. Thompson's chest pain and potential myocardial infarction?

A) Administer aspirin as per protocol

B) Encourage physical activity to reduce anxiety

C) Apply a cold compress to the chest

D) Position the patient in a Trendelenburg position

What is the primary reason for administering nitroglycerin to Mr. Thompson?

B) To reduce chest pain by dilating coronary arteries

C) To increase his oxygen saturation

D) To treat his premature ventricular contractions

What is the primary purpose of monitoring troponin levels in a patient with suspected myocardial infarction?

C) To confirm myocardial damage

D) To check for electrolyte imbalances

Which laboratory finding in Mr. Thompson's case is most indicative of myocardial damage?

C) Normal basic metabolic panel

Which vital sign is most indicative of adequate cardiac output in Mr. Thompson's case?

B) Blood pressure of 128/76 mmHg

A) Heart rate of 78 beats per minute

B) Blood pressure of 128/76 mmHg

C) Respiratory rate of 18 breaths per minute

D) Oxygen saturation of 98% on room air

Which assessment finding in Mr. Thompson indicates a potential complication that requires further intervention?

B) Mild swelling in the lower extremities

A) Oxygen saturation consistently at 98% on room air

B) Mild swelling in the lower extremities

C) Heart rate averaging 78 beats per minute

D) Pain level below 3 on a 0-10 scale

When assessing a patient on diuretic therapy for fluid retention, which laboratory value is most important for the nurse to monitor?

B) B-type Natriuretic Peptide (BNP)

Myocardial Infarction - Nursing Case Study

Pathophysiology

• Primary mechanism: Myocardial infarction, commonly known as a heart attack, primarily occurs due to the blockage of a coronary artery by a blood clot. This blockage prevents oxygen-rich blood from reaching a section of the heart muscle, leading to tissue damage or death.

• Secondary mechanism: Atherosclerosis plays a major role, where fatty deposits (plaques) build up on the artery walls. These plaques can rupture, triggering the formation of a blood clot and obstructing blood flow.

• Key complication: If not promptly treated, this can lead to heart muscle damage, impairing the heart's ability to pump effectively, potentially resulting in heart failure or life-threatening arrhythmias.

Patient Profile

Demographics:

57-year-old male, accountant

History:

• Key past medical history: Hypertension, hyperlipidemia

• Current medications: Lisinopril 10 mg daily, Atorvastatin 20 mg daily, Aspirin 81 mg daily

• Allergies: No known drug allergies

Current Presentation:

• Chief complaint: Mild chest discomfort

• Key symptoms: Mild chest pain, slight shortness of breath, lightheadedness

• Vital signs: Blood pressure 128/82 mmHg, heart rate 78 bpm, respiratory rate 18 breaths per minute, temperature 98.6°F, oxygen saturation 97% on room air

Section 1

Initial Assessment Findings:

Upon arrival at the emergency department, the patient, Mr. Thompson, is alert and oriented, but appears mildly anxious. He reports that the mild chest discomfort began approximately two hours ago while he was at rest. He describes the pain as a pressure-like sensation located in the center of his chest, radiating slightly to his left arm. Mr. Thompson denies any nausea, vomiting, or diaphoresis. His skin is warm and dry to the touch.

A focused cardiovascular assessment reveals regular heart sounds with no murmurs, rubs, or gallops detected. Peripheral pulses are palpable and equal bilaterally. Lung auscultation reveals clear breath sounds without any wheezing or crackles. An initial electrocardiogram (ECG) shows mild ST-segment elevation in the inferior leads, suggestive of an early-stage myocardial infarction. Laboratory tests are ordered, including cardiac biomarkers, to confirm the diagnosis and assess the extent of myocardial damage.

The immediate nursing interventions include placing Mr. Thompson on continuous cardiac monitoring, administering supplemental oxygen to maintain his oxygen saturation above 94%, and initiating intravenous access for medication administration. Aspirin is administered as per protocol to inhibit further platelet aggregation. Additional orders include nitroglycerin for chest pain relief and a stat dose of morphine if the pain persists. These interventions aim to alleviate symptoms and stabilize Mr. Thompson's condition while further diagnostics and treatment plans are developed.

Section 2

Response to Interventions:

Following the initial interventions, Mr. Thompson's condition is monitored closely. After receiving nitroglycerin sublingually, he reports a noticeable decrease in chest discomfort, with the pressure sensation subsiding from an initial intensity of 6 out of 10 to a more manageable 3 out of 10. His vital signs show a stable blood pressure of 128/78 mmHg, heart rate of 68 beats per minute, and respiratory rate of 16 breaths per minute. Oxygen saturation remains steady at 96% on supplemental oxygen delivered via nasal cannula at 2 liters per minute.

The nursing team continues to observe Mr. Thompson for any adverse reactions to the medications, such as hypotension or a headache from the nitroglycerin. Encouragingly, he remains hemodynamically stable and has not required additional doses of morphine for pain control. The cardiac monitor displays a consistent sinus rhythm with only occasional premature ventricular contractions, which are deemed minor and non-threatening at this stage.

As the initial phase of treatment progresses, Mr. Thompson is prepared for transfer to the cardiac care unit for continued monitoring and management. The nursing staff ensures his comfort and safety during the transition, providing reassurance and education about the upcoming procedures. The team is prepared to address any questions he may have and reinforce the importance of adhering to the prescribed treatment plan to prevent further cardiac events. Looking ahead, the focus will shift to evaluating the results of the cardiac biomarkers and any necessary adjustments to his care plan based on these findings.

Section 3

New Diagnostic Results:

As Mr. Thompson settles into the cardiac care unit, the nursing team closely monitors the results of his cardiac biomarkers and other diagnostic tests to further assess his condition. The initial lab results reveal a modest elevation in troponin levels, confirming the presence of myocardial damage but suggesting a non-ST elevation myocardial infarction (NSTEMI). This finding aligns with his clinical presentation and the stability he has shown following initial treatment. Additionally, his complete blood count and basic metabolic panel return within normal limits, indicating no significant electrolyte imbalances or additional systemic concerns at this time.

An echocardiogram is performed to evaluate Mr. Thompson's cardiac function and assess any potential structural changes. The echocardiogram reveals preserved left ventricular function with an ejection fraction of 55%, indicating that his heart is pumping adequately despite the recent cardiac event. The absence of significant wall motion abnormalities provides reassurance that the myocardial infarction was relatively contained.

With these diagnostic results in hand, the healthcare team refines Mr. Thompson's care plan. The focus remains on maintaining cardiac stability, preventing further ischemic episodes, and optimizing his recovery. The nursing staff continues to monitor vital signs and cardiac rhythm closely, while also educating Mr. Thompson on lifestyle modifications and medication adherence to support long-term heart health. This diagnostic clarity allows the team to plan for gradual mobilization and rehabilitation, setting the stage for Mr. Thompson's eventual transition to a less intensive care setting.

Section 4

As Mr. Thompson progresses through his care in the cardiac unit, the nursing team keeps a vigilant eye on his response to the prescribed interventions. Over the next 24 hours, Mr. Thompson demonstrates positive trends in his recovery. His vital signs remain stable, with a heart rate averaging 78 beats per minute, blood pressure at 128/76 mmHg, and a respiratory rate of 18 breaths per minute. Oxygen saturation is consistently at 98% on room air, indicating adequate oxygenation and perfusion. Mr. Thompson reports only mild chest discomfort, which is effectively managed with sublingual nitroglycerin as needed, and his pain level remains below a 3 on a 0-10 scale.

The nursing staff notes Mr. Thompson's compliance with the prescribed medication regimen, which includes aspirin, beta-blockers, and a statin. His understanding of these medications is evident as he articulates their purpose in preventing further cardiac events and promoting heart health. During patient education sessions, Mr. Thompson expresses a positive attitude towards adopting lifestyle changes, such as a heart-healthy diet and increased physical activity in line with the cardiac rehabilitation plan. His readiness to engage in these modifications is a crucial step in reducing risk factors and preventing future complications.

However, during a routine assessment, the nurse identifies mild swelling in Mr. Thompson's lower extremities, raising a potential concern for early-stage fluid retention. The nurse carefully documents this finding and relays it to the attending physician. In response, a low-dose diuretic is added to Mr. Thompson's treatment plan to address this minor complication and prevent any escalation that could impact his recovery. The team continues to monitor Mr. Thompson closely, emphasizing the importance of early detection and intervention in maintaining his stability and facilitating a smooth transition to the next phase of his care.

Section 5

As Mr. Thompson continues his recovery, the nursing team remains alert to any changes in his condition. During a routine morning assessment, the nurse notes that Mr. Thompson's vital signs are stable, with a heart rate of 76 beats per minute, blood pressure of 126/74 mmHg, and respiratory rate holding steady at 18 breaths per minute. His oxygen saturation remains at 98% on room air, suggesting sustained adequate oxygenation. However, upon further examination, the nurse observes that the mild swelling in Mr. Thompson's lower extremities has not decreased, despite the initiation of a low-dose diuretic.

In light of these findings, the nurse decides to review recent lab results for any insights into Mr. Thompson's fluid status. The laboratory reports indicate a slight increase in his B-type Natriuretic Peptide (BNP) levels, which, while still within the upper limits of normal, suggest early indications of fluid overload. Electrolyte levels, including potassium and sodium, are within normal ranges but will require ongoing monitoring due to the introduction of the diuretic therapy.

The nursing team discusses these findings with the attending physician, who reassures them that while the swelling is a minor complication, the patient's overall stability is encouraging. Adjustments to the diuretic dosage are considered, and the care plan emphasizes continued monitoring of Mr. Thompson's fluid balance and electrolyte levels. The team also reinforces the importance of Mr. Thompson maintaining an appropriate fluid intake, as well as adhering to his medication regimen, to optimize his recovery. These steps are crucial in managing the fluid retention effectively and ensuring a smooth progression to the next stage of his rehabilitation.