2. What other significant test are missing that would help establish the diagnosis of acute Myocardial Infaction?

Cardiac Enzyme test such as: 1. 2. 3. 4. Myoglobin LDH AST, SGOT Troponin I and T

Other test such as: 1. 2. 3. 4. Lactic Dehydrogenase test Exercise Stress Testing Radioisotope imaging with thallium Coronary angiography

3. Discuss the nursing responsibilities of giving aspirin and nitroglycerin? Aspirin: This drug may cause dyspepsia, nausea, vomiting, gastrointestinal ulcer, tinnitus, angioedema, or Reye's syndrome (persistent nausea/vomiting, somnolence, lethargy, confusion, combative behavior, decreased level of consciousness, seizure). Instruct patient to report signs/symptoms of bleeding or gastrointestinal distress. Patient should take drug with an 8-ounce glass of water. Patient may take with food or milk. Instruct patient to avoid alcohol during therapy. Patients who drink 3 or more alcoholic drinks daily should consult a healthcare professional prior to taking aspirin.

Nitroglycerin: Counsel patient to rise slowly from a sitting/supine position to prevent lightheadedness or syncope. Warn patient to avoid activities requiring mental alertness or coordination until drug effects are realized because drug may cause dizziness. Drug may cause severe hypotension, headaches, flushing, or rash. Advise patient using the extended-release tablet, ointment, or patch to allow for a drug-free interval of 10 to 12 hours each day to avoid nitrate tolerance. Instruct patient using sublingual tablet or spray to rest in a sitting position when using drug.

Counsel patient using sublingual spray not to exceed 3 metered sprays within a 15-minute period. Warn patient to avoid concurrent use of alcohol, CNS depressants, or antihypertensive due to additive hypotension. Advise patient using the patch to notify healthcare professional of patch use or remove patch before MRI procedure.

4. Discuss in writing the care of client receiving APSAC (Pre-Infusion Care, During Infusion, Post Infusion Care). Pre- Infusion Care: Check patient for: Hypersensitivity to anistreplase or streptokinase Active or recent internal bleeding Cerebrovascular accident within past 2 months Aneurysm Uncontrolled hypertension Severe hepatic disease Breastfeeding

Use cautiously in patients with: Hemorrhagic conditions, hepatic or renal disease Patients receiving warfarin concurrently Elderly patients Pregnant patients

During Infusion Care: Monitor patient for signs and symptoms of anaphylaxis. Watch for bleeding tendency and hemorrhaging. Assess neurologic status and vital signs regularly. Evaluate patient for arrhythmias, conduction disorders, and hypotension. Monitor CBC and blood coagulation studies.

Post Infusion Care: Tell patient to report signs and symptoms of allergic reaction. Instruct patient to report unusual bleeding or bruising. Caution patient to avoid activities that can cause injury. Advise him to use soft toothbrush and electric razor to avoid gum and skin injury.

Explain to patient that he will be on bed rest during entire course of treatment and will be monitored closely. Advise patient to minimize GI upset by eating small, frequent servings of food and drinking plenty of fluids. Caution patient not to use aspirin during therapy. Inform patient that he'll undergo regular blood testing during therapy As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests

Adverse effect Headache Fever Sweating Agitation Dizziness Paresthesia Tremor Vertigo Hypotension Conduction disorders Nausea Vomiting Decreased hematocrit Surface bleeding Rash Urticarial Phlebitis at the injection site Itching Flushing Low back pain Arthralgia Altered respirations Dyspnea

Life-threatening side effects include: Intracranial hemorrhage Dysrhythmias GI bleeding Genitourinary bleeding Intracranial bleeding Retroperitoneal bleeding Thrombocytopenia Bronchospasm Lung edema Anaphylaxis

5. Cardiac Rehabilitation is a long-term program. Prepare a Rehabilitation program for Ms. Mary during the in- phase (Phase 1), immediate out patient phase (Phase 2), and continuous program of cardiac Rehabilitation (Phase 3).

PHASE 1 Preventive measures 1. Level of activities (Walking) 2. Initial education of patient and family (For self care) 3. Quit Smoking! 4. DIET > NO FATTY FOODS PHASE 2 1. 2. 3. 4. Time the patient has been discharged from the hospital All activities are supervised; support from an outside person Based on the stress test of the client Dietitian would make a list of foods to be eaten and not eaten

PHASE 3 1. Maintain cardiovascular stability 2. Patient can still be on diet and exercise, but no longer supervised