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Care of Patient with an Acute Myocardial Infarction MI

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She was experiencing vague heaviness for about 3 hours after a dinner party with ... The site is soft and flat without hematoma or ecchymosis. ... – PowerPoint PPT presentation

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Title: Care of Patient with an Acute Myocardial Infarction MI


1
Care of Patient with an Acute Myocardial
Infarction (MI)
  • Tiffany Boyd BSN, RN, PCCN
  • Staff Development Instructor
  • Pinnacle Health

2
Case Study
  • Mrs. Rogers is a 63 year old Hispanic Female that
    was admitted to the ED with an Acute MI. She was
    experiencing vague heaviness for about 3 hours
    after a dinner party with co-workers. She really
    ate too much and the Mylanta helped a lot. She
    went to bed and was awakened feeling short of
    breath and noticed that her heart felt fluttery.
    The same chest heaviness returned. Mr. Rogers
    called 911.

3
Case Study Cont.
  • Past Medical History
  • Anterior MI with stent in 2005
  • EF 45
  • Type 2 Diabetes
  • High Cholesterol
  • HTN
  • Some wine on weekends
  • BGMs 170s-190s

4
Case Study Cont.
  • Its 430pm and the charge nurse calls that you
    are receiving a 63 year old female patient from
    the Cath lab, Mrs. Rogers
  • Next, you get report from the Cath lab

5
Case Study Cont.
  • Hi. I am calling report from the cath lab. You
    are receiving Mrs. Rogers. She is a 63 year old
    Hispanic female who came directly to us from the
    ED as a CODE STEMI. She was at a party felt
    indigestion like symptoms. She was diagnosed
    with an AWMI. We angioplastied stented the
    proximal LAD with 2 DES. She was angiosealed in
    the right groin. The site is soft and flat
    without hematoma or ecchymosis. Her pedal pulse
    is strong on the right. Her PMH includes
    previous MI with stent, DM, High Cholesterol,
    HTN. We gave her 25 of Fentanyl. Her sheath was
    removed at 1500 and she can get out of bed at
    2100. She has NSS infusing at 100ml/hr into a RFA
    peripheral IV. She had 600 mg of Plavix in the
    lab and still needs education on her MI. She
    will be arriving shortly. Any questions?

6
Case Study Report
  • S-
  • B-
  • A-
  • R-

7
Case Study Report
  • S- Hi, I am calling report on Mrs. Rogers who is
    63 years old and came to us as a CODE STEMI,
    AWMI, from the ED. We angioplastied stented the
    proximal LAD x2 DES. Her previous stent was
    patent. Her right groin was angiosealed.
  • B-
  • A-
  • R-

8
Case Study Report
  • S-
  • B- She was at a party and felt indigestion-like
    symptoms. Her right groin is soft and flat
    without hematoma or ecchymosis. Her pedal pulse
    is strong on the right. Her PMH includes previous
    MI with stent, DM, High cholesterol, HTN. Her
    sheath was removed at 1500. She received 600mg of
    Plavix in the lab
  • A-
  • R-

9
Case Study Report
  • S-
  • B-
  • A- She can get out of bed at 2100. She has NSS
    infusing at 100ml/hr into a RFA IPID. She needs
    teaching about her MI.
  • R-

10
Case Study Report
  • S-
  • B-
  • A-
  • R- She will be arriving shortly. Any questions?

11
Admission to Telemetry Unit
  • Frequent Vitals
  • Telemetry Monitoring
  • Frequent Groin Checks
  • Frequent Neurovascular Checks (pedal pulses)
  • EKGs

12
(No Transcript)
13
Lead Changes Wall Injury
septal
(LAD)
ANT
LAT
(CIRC)
(LAD)
ANT
septal
LAT
LAT
INF
(RCA)
(CIRC)
(CIRC)
(LAD)
ANT
INF
INF
(RCA)
(RCA)
LAT
(CIRC)
(LAD)
ANT
14
(No Transcript)
15
EKG Changes
  • ST elevation in V1-V4
  • V1-V4 changes ?????
  • ST elevation hyperacute T waves in V2-V4
    Acute MI (determining age of MI)

16
EKG Changes
  • ST elevation in V1-V4
  • V1-V4 changes Anterior Wall MI
  • ST elevation hyperacute T waves in V2-V4
    Acute MI (determining age of MI)

17
(No Transcript)
18
PHS Algorithm for Code STEMI
19
(No Transcript)
20
Symptom Differences
  • Male vs. Female
  • Diabetics

21
Male vs Female
22
Male vs Female
  • 10 years older
  • Less likely to have to typical angina
  • Describes CP as sharp burning
  • Pain in throat, neck, jaw, back area
  • Other symptoms include nausea, GI symptoms, SOB,
    weakness, fatigue, sleep disturbance,
    palpitations
  • Usually underestimates importance of CP
  • Have CP at younger ages
  • Typical angina symptoms
  • Crushing pain, elephant sitting on chest
  • Seeks help sooner
  • More likely to have ST elevated MIs

23
Diabetics
  • Due to the automatic denervation of the heart
    with diabetes, most diabetics suffer from silent
    ischemia
  • Some diabetics have blunted appreciation of
    ischemic pain, which may result in atypical
    anginal symptoms
  • They wont have chest pain
  • Symptoms more like SOB

24
Diabetics
  • During stress testing they wont have angina, but
    might have ischemia related to their prolongation
    of the anginal perceptual threshold

25
Case Study
  • Our patients symptoms
  • vague heaviness
  • Indigestion like symptoms
  • SOB
  • Fluttery heart (a-fib)
  • Are these typical symptoms?
  • Are these symptoms likely for a female?
  • Are these symptoms likely for a diabetic?

26
Case Study
  • Would you have thought an Acute MI with this
    patient?
  • What would you have treated her as?
  • MI
  • Indigestion
  • A-fib
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