Medical-surgical Nursing Demystified

(^12) Medical-Surgical Nursing Demystified
There is a better outcome for patients who receive adequate medical attention
and make appropriate lifestyle changes post-myocardial infarction. Cardiac reha-
bilitation can help patients make these changes safely.
HALLMARK SIGNS AND SYMPTOMS

• Chest pain that is unrelieved by rest or nitroglycerin, unlike angina


• Pain that radiates to arms, jaw, back and/or neck


• Shortness of breath, especially in the elderly or women


• Nausea or vomiting possible


• Maybe asymptomatic, known as a silent MI, which is more common in dia-
  betic patients


• Heart rate >100 (tachycardia) because of sympathetic stimulation, pain, or
  low cardiac output


• Variable blood pressure


• Anxiety


• Restlessness


• Feeling of impending doom


• Pale, cool, clammy skin; sweating (diaphoresis)


• Sudden death due to arrhythmia usually occurs within first hour

INTERPRETING TEST RESULTS

• EKG.
  
  
  • T-wave inversion—sign of ischemia.
  
  
  • ST-segment elevated or depressed—sign of injury.
  
  
  • Significant Q-waves—sign of infarction.
  
  
  
  


• Decreased pulse pressure because of diminished cardiac output.


• Increased white blood count (WBC) due to inflammatory response to injury.


• Blood chemistry:
  
  
  • Elevated creatine kinase MB (CK-MB)—usually done serially, the num-
    bers will rise along a predetermined curve to signify myocardial damage
    and resolution.
  
  
  • Elevated troponin I- and troponin T-proteins elevated within one hour of
    myocardial damage.
  
  
  
  


• Less than 25 ml/hr of urine output due to lack of renal blood flow.