Critical Care Nurs Theo for the Expd Nurse

NUR440 Case Study 3 plasminogen to plasmin, which is responsible for degradation of fibrin. This lysis of the clot re-opens the obstructed artery. Early intervention is the key to restore oxygen supply to the myocardium. Candidates for fibrinolytic therapy must have onset of chest pain within 12 hours. An increased risk for bleeding would obviously exclude a patient due to the nature of the medication. Dobutamine is an inotropic agent; inotropic agents increase the strength and force of contractility, therefore, increasing cardiac output and increasing oxygen supply to the coronary arteries. Inotropic agents, such as dobutamine, also avoid damage to the recently infracted area. 6. Two hours after admission to the CCU, Mr. Jones develops a Wenchebach rhythm. What are the distinguishing features of this dysrhythmia? Wenchebach is a second degree AV block type I or Mobitz Type I. The AV conduction time progressively lengthens until a P is not conducted resulting in a dropped QRS. This results in a progressively longer PRI and the QRS is usually of normal width. The P to P interval is regular, the R to R usually becomes shorter with each beat, the PRI is shortest in the first beat and the final P wave of the group is not conducted. Ultimately the P wave is not followed by a QRS. 7. When would thrombolytic therapy not be initiated? What are the risks and benefits of thrombolytic therapy following myocardial infarction? Given the information in the scenario, would there be anything that might have excluded Mr. Jones from receiving the thrombolytic? Thrombolytic therapy would not be administered to patients who have a stable clot (such as recent surgery, trauma or CVA) - this may be disrupt the clot. Thrombolytic therapy is also not indicated for patients with unstable angina or NSTEMI. These conditions result from plaque rupture with formation of partially occluded thrombi. The thrombolytic could break up the clot and cause an increase in thrombi and occlude other vessels. Thrombolytic therapy administered within 12 hours after the onset of Q-wave acute MI reduces the infarct and mortality in patients. Patients with acute MI and an increased risk for hemorrhagic stroke, history of stroke, severe uncontrolled hypertension, active bleeding or a known bleeding disorder, dementia or those receiving oral anticoagulants should not be administered thrombolytic therapy. Benefits from thrombolytic therapy correlates with the degree of restoration of blood flow in the infarcted artery. Allergic reactions, bleeding and stroke are also associated risks when using thrombolytics. 8. Which common complications of acute myocardial infarction did Mr. Jones experience? Identify supporting data from the case to support your conclusions. What treatment was initiated for these complications? Most likely due to the inferior wall MI, the PRI = 0.24 is indicative of AV Heart Block. AV block most often occurs in patients with an inferior wall MI. Symptomatic hypotension, weak, thready pulse and low cardiac output – Mr. Jones blood pressure and heart rate was low in the CCU; he was then started on a dobutamine drip to increase the contractility of the heart.

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