Question

M.D. is admitted to cardiac care unit with an acute ST segment elevation myocardial infarction (MI) involving his left main coronary artery supplying blood to his left ventricle. He began to have crushing chest pain about 3 hours ago. He is being prepared to receive alteplase (Activase) 100 mg intravenously over 90 minutes, then 50 mg over 30 minutes, then 35 mg over 60 minutes.

1. M.D.’s wife is asking the nurse how this drug works and if it will save her husband’s life. What’s the nurse’s best response?
2. What nursing care will be a priority for M.D. after thrombolytic therapy?

Answer 1

1. Nurses reply to the patient's wife -- Myocardial Infarction is known as heart attack . It occurs due to complete blockage of blood supply to the heart due to any clot , plague etc . The ECG changes in myocardial infarction is ST wave elevation ,T wave depression and pathological Q wave . Thrombolytic in myocardial infarction should be given within 6 hours of chest pain to dissolve the clot present in the coronary artery which is blocking the supply of blood to the heart and allows the tabloid to flow to the heart . Hence, recovery of the myocardial cell by oxygenation occur and patient get hemodynamically stable as heart starts to pump out blood to all the parts of the body by the difference in action potential.

2. The priority nursing care for M.D.after thrombolytic therapy is to monitor for bleeding and hypersensitivity.

Which include :-

- advice bed rest , monitor vital signs 2 hourly and limit invasive procedures.

- measure INR and PTT every 3-4 hours after thrombolytic infusion to confirm the activation of fibrinolytic systems

- perform only essential ABG on upper extremity with manual pressure for atleast 30 mins .

- assess for contraindications like active bleeding ,history of stroke ,peptic ulcer ,recent trauma etc .