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TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN

TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN. Acute Myocardial Infarction (AMI) is ischemia with death to the myocardium caused by lack of blood supply Can be classified as Q-wave or non-Q wave

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TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN

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  1. TREATMENT OF ACUTE MYOCARDIAL INFARCTION NUR 351/352 PROFESSOR DIANE E. WHITE RN MS CCRN

  2. Acute Myocardial Infarction (AMI) is ischemia with death to the myocardium caused by lack of blood supply • Can be classified as Q-wave or non-Q wave • Q-wave results from total occlusion of coronary artery represented by in elevated ST segment and cardiac enzymes • Non-Q wave results from partially occluded & associated with ST depression and increased cardiac enzymes • Dx: 12-lead ECG, Cardiac Enzymes • 12-lead vs 5-lead placement • CK, CK-MB, Troponin levels

  3. INTERVENTIONS • Pain Relief • Morphine – increases collateral circulation • NTG – vasodilates 5-200 mcg.min titrated • Oxygen • 4-6 L/min nasal cannula • Decrease Platelet Aggregation • Aspirin po • Repro ( gtt for 12 hours after bolus IV per kg) • Aggrestat (weight based continuous gtt)

  4. Thrombolytic Therapy • Criteria of Usage: patient symptomatic for less than 6 hour, 20 minutes of CP not relieved by NTG, & Q-wave AMI • Agents – • -- Streptokinase: increase risk of reactions in patient’s with recent strep infections, less expensive but less reperfusion • -- TPA: tissue plasminogen activator; caution with bleeding; bolus and gtt changes every hour for 3 then gtt runs at same rate for 3 hours • -- TNK: tenecteplase a newer agent; single dose, 30-50mg over 5 seconds based on patient’s weight

  5. ** Heparin is still used in conjunction with other medications and sometimes with thrombolytics. Usually seen in Non- Q wave AMI • Cardiology Interventions • PTCA – percutaneous transluminal coronary angioplasty; compresses intracoronary plaque • Coronary Rotational Atherectomy – compresses & shaves the plaque off the vessel wall & removes it with a rotablator • Intracoronary Shunt – tubes placed at site of stenosis • Nursing Care After Procedures

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