Question

A 68-year-old woman arrives in the emergency department and tells the nurse, “I think I had a heart attack.” She states that earlier that day while on her daily 3-mile walk, she had an episode of chest pain that lasted a couple of minutes but was resolved with rest. The pain returned shortly after arriving home. Again the pain was relieved with rest. On admission to the ED, her ECG rhythm is normal sinus rhythm. She has no abnormal heart sounds or abnormal laboratory values. VS are stable. SaO2 by pulse oximetry is 97% on room air. She is diagnosed with angina. The patient is seen by a cardiologist who prescribes nitroglycerin tablets and one aspirin per day.

1. What differences in assessment/clinical data would the nurse expect if the patient was experiencing a myocardial infarction?

2. What would the nurse explain to the patient about the diagnosis of angina?

3. What diagnostic test will be ordered for this patient and give rationale?

4. Which goods of medication this patient will receive and give rationale?

5. Provide two nursing diagnoses for this patient and give the rationale for your nursing diagnoses.

Answer 1

1.Angina is the medical term for chest pain. The heart is not only the pump for the blood of our body but it is also a muscle. Just like all muscles in the body it requires blood to provide oxygen and nutrients to maintain the health and function of the muscle.

The coronary arteries are the arteries that provide blood to the heart muscle. If the arteries are narrowed, the heart muscle is at risk for not receiving enough blood. Atherosclerosis is a plaque build-up that causes narrowing in the arteries.

At rest, the heart muscle requires less oxygen and nutrients than with activity. Think of your car. When driving at a slow rate, it requires less gas to fuel it. But when the car is performing at high speeds, it requires increased gas to fuel it. The same applies to your heart.

Myocardial Infarction

If the narrowed arteries that feed the heart muscle become blocked or severely narrowed, it is called a myocardial infarction, commonly known as a heart attack. The blockage is often due to a blood clot. When the heart muscle doesn't receive oxygen and nutrient-rich blood, it results in cell damage and death in the heart. This results in permanent damage to the heart muscle.

Time is important when experiencing a heart attack. The longer the blockage occurs, the more damage that can be done.

It is recommended to take aspirin if experiencing signs and symptoms of a heart attack. The aspirin works to prevent any further clotting. In the emergency room, they will administer oxygen. They may also administer nitroglycerin, which dilates the blood vessels and allows increased blood flow to the heart. Morphine is used for pain. It may be necessary to have a stent placed to open up the artery and resume normal blood perfusion.

A diagnosis of myocardial infarction is created by integrating the history of the presenting illness and physical examination with electrocardiogram findings and cardiac markers (blood tests for heart muscle celldamage).^[1][2] A coronary angiogram allows visualization of narrowings or obstructions on the heart vessels, and therapeutic measures can follow immediately. At autopsy, a pathologist can diagnose a myocardial infarction based on anatomopathologicalfindings.

2.Electrocardiogram (ECG or EKG). Each beat of your heart is triggered by an electrical impulse generated from special cells in your heart.

Stress test. Sometimes angina is easier to diagnose when your heart is working harder. During a stress test, you exercise by walking on a treadmill or pedaling a stationary bicycle.

Echocardiogram. An echocardiogram uses sound waves to produce images of the heart.

Nuclear stress test. A nuclear stress test helps measure blood flow to your heart muscle at rest and during stress. It is similar to a routine stress test, but during a nuclear stress test, a radioactive substance is injected into your bloodstream.

• Chest X-ray. This test takes images of your heart and lungs. This is to look for other conditions that might explain your symptoms and to see if you have an enlarged heart.
• Blood tests. Certain heart enzymes slowly leak out into your blood if your heart has been damaged by a heart attack. Samples of your blood can be tested for the presence of these enzymes.

• Coronary angiography. Coronary angiography uses X-ray imaging to examine the inside of your heart's blood vessels.

• Cardiac computerized tomography (CT) scan. In a cardiac CT scan, you lie on a table inside a doughnut-shaped machine. An X-ray tube inside the machine rotates around your body and collects images of your heart and chest, which can show if any of your heart's arteries are narrowed or if your heart is enlarged.
• Cardiac MRI. In a cardiac MRI, you lie on a table inside a long tube-like machine that produces detailed images of your heart's structure and its blood vessels.

treatmrnt:

• Aspirin. Aspirin and other anti-platelet medications reduce the ability of your blood to clot, making it easier for blood to flow through narrowed heart arteries.
• Nitrates. Often used to treat angina, nitrates relax and widen your blood vessels, allowing more blood to flow to your heart muscle. Nitrates in pills or sprays act quickly to relieve pain during an event. There are also long-acting nitrate pills and skin patches.

anuraing diagnosis:

• Ineffective cardiac tissue perfusionsecondary to CAD as evidenced by chest pain or other prodromal symptoms.
• Death anxiety related to cardiac symptoms.
• Deficient knowledge about the underlying disease and methods for avoiding complication
• Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes.