HEART
Amylase- pancreatic function.
ALT is 7 to 56 U/L (0.12 to 0.94 mckat/L). Antihyperlipidemics can cause increased liver
enzymes and should be monitored periodically during treatment. (Note: normal value ranges
can vary by laboratory.)
HDL is considered the "good" cholesterol, which reduces the risk of heart disease. Current
guidelines state that an HDL of less than 50 mg/dL (1.29 mmol/L) for women is too low to
safeguard the arteries.
LDL is the "bad" cholesterol that can accumulate in the arteries, eventually leading to angina,
infarction, or cerebrovascular accident. Less than 100 mg/dL (2.59 mmol/L) is considered the
optimal level, with readings above 190 (4.92 mmol/L) considered very high.
Serum cholesterol less than 200 mg/dL (5.18 mmol/L) is the desired level.
Serum cholesterol- While 200 mg/dL (5.18 mmol/L) or less is considered desirable,
medical intervention is not generally initiated for levels under 240 mg/dL (6.22 mmol/L).
Clients with cholesterol levels between 200 to 240 mg/dl (5.18 to 6.22 mmol/L) should
be advised to begin lifestyle modifications.
Nitroglycerin is a nitrate, causing systemic vasodilation. This often leads to hypotension, which
can cause the client to feel dizzy. She should be instructed to change positions slowly and to
avoid prolonged standing. If the dizziness is persistent when standing, the client's blood
pressure may be too low, requiring the HCP to adjust the dosage or change the medication.
Echocardiogram- Since the client smokes, she should be instructed not to smoke prior to the
test. Nicotine can interfere with heart rate.
Acute Myocardial Infarction (AMI)
The client's angina remains stable. She undergoes a hysterectomy for
dysmenorrhea related to uterine fibroids. The day after being
discharged from the hospital, the client comes to the ED with crushing
substernal chest pain radiating down her left arm. She is dyspneic,
pale, and diaphoretic.
,Correct answer:
Initiative IV access and administer morphine sulfate prescribed by the HCP.
Acute chest pain related to myocardial infarction, ischemia, or reduced coronary artery
blood flow is the most important nursing problem for the client with acute coronary
syndrome (ACS). Treating pain is critical, as pain activates the sympathetic nervous
system and aggravates diaphoresis, weakness, light-headedness, and palpitations,
which increases cardiac workload.
Incorrect answer:
Administer oxygen.
Oxygenation to the myocardial tissue is important for pumping activity and tissue
damage repair. Rest also helps to improve oxygenation. However, recent guidelines
suggest that routine use of supplemental oxygen may not be necessary in clients with
uncomplicated ACS without signs of heart failure, hypoxemia, respiratory distress, or for
an oxyhemoglobin saturation rate of 94% or greater.
ECG findings reveal ST segment elevation in leads II and III, and a VF indicating that the client
is having an inferior AMI. Which intervention should the nurse implement first?
Have the client chew four 81 mg chewable acetylsalicylic acid tablets.
The first intervention according to the American Heart Association standard is to administer
acetylsalicylic acid 160 to 325 mg PO that acts on the platelets, keeping them from clumping
together at the site of the coronary blockage.
Apply oxygen 2 L/nasal cannula.
Oxygen is the second intervention according to the American Heart Association standard if the
client's oxygen saturation level is less than 94%.
Give the client one nitroglycerin tablet to dissolve under the tongue.
Nitroglycerin is the third intervention according to the American Heart Association standard and
is given to vasodilate the coronary arteries and relieve pain.
Administer morphine sulfate 4 mg IV.
Morphine is given if pain is unrelieved by nitroglycerin, according to the American Heart
Association standard.
Nitrates cause the coronary blood vessels to dilate, allowing improved oxygen delivery to
cardiac muscle. In addition, nitrates cause systemic vasodilation, reducing the workload on the
heart, which reduces the myocardium's need for oxygen.
Prolongation of the PR interval is typical of a first-degree AV block, an electrical conduction
disturbance within the heart. While development of a conduction block may occur as a result of
myocardial injury, the presence of a prolonged PR interval is not itself indicative of myocardial
injury.
,Peaked T waves may indicate an elevated potassium level and should be further evaluated, but
is not priority over the myocardial injury that is occurring.
Notched P waves may be evidence of atrial enlargement and should be further evaluated, but is
not priority over the myocardial injury that is occurring.
ST segment elevation is indicative of an acute myocardial injury leading to infarction and
requires immediate intervention.
Myoglobin 60 mcg/L (3.49 nmol/L).
Normal myoglobin for a female: 10 to 65 mcg/L (0.58 to 3.78 nmol/L).
Onset: 1 to 3 hr.
Peak: 6 to 10 hr.
Return to normal: 12 to 24 hr.
Creatine kinase-MB (CK-MB) 3.0 ng/mL (3.0 mcg/L).
Normal CK-MB <5.0 ng/mL (5.0 ug/L). This is the most sensitive creatine kinase to the
cardiac muscle, but is also found in skeletal muscle.
Lactate dehydrogenase (LDH) 200 U/L (3.34 mckat/L).
Normal LDH is 140 U/L (0.67 ukat/L) to 280 U/L (4.68 ukat/L). LDH, like creatine
phosphokinase (CPK), is an enzyme that is nonspecific to cardiac muscle injury.
However, LDH1 is a sensitive cardiac isoenzyme, which is often compared with LDH2
as a ratio during the diagnosis of MI.
Troponin T 0.4 ng/mL (0.4 mcg/L).
Normal troponin T is 0 to 0.2 ng/mL (0.2 ug/L).
Onset: 3-4 hr.
Peak: 10-24 hr.
Return to normal: 10 to 14 days.
This indicates acute myocardial injury and requires immediate intervention.
The most common complication after an MI is dysrhythmias. Lethal dysrhythmias often occur
within 4 hours from the onset of chest pain. Premature ventricular contractions may precede the
lethal dysrhythmias ventricular tachycardia and fibrillation.
Which intervention is most important for the nurse to include in the client’s plan of care?
Continuous cardiac monitoring of heart rate and rhythm.
The heart rate and rhythm should be continuously monitored. Lethal arrhythmias are the most
common immediate complication following an acute myocardial infarction that are life-
threatening.
Auscultate lungs for adventitious sounds such as crackles.
, Auscultating the lungs for crackles or other adventitious sounds can reveal pulmonary edema,
which is a possible complication following an acute MI. Pulmonary edema is often gradual and
not immediately life-threatening.
Titrate oxygen to keep oxygen saturation greater than 93%.
Monitoring and titrating oxygen will help provide the myocardial tissue the oxygen it needs to
prevent further injury. A gradual drop in oxygen can be managed and is not immediately life-
threatening.
Obtain blood to evaluate scheduled serum cardiac markers.
Monitoring serum cardiac markers will determine if the myocardial tissue injury is resolving.
Knowing the cardiac marker levels will aid in prompt intervention, but is a scheduled
intervention.
Dopamine is a vasopressor and inotropic agent that is used to treat severe hypotension and
shock. This intervention may be required if the client's dysrhythmia is not controlled and
cardiogenic shock develops.
The treatment of choice for frequent premature ventricular contractions (PVCs) and ventricular
tachycardia is an immediate IV bolus of amiodarone.
The client is started on a continuous IV infusion of lidocaine at 2
mg/min. The ventricular tachycardia is controlled, and the cardiac
monitor strip shows a sinus rhythm with occasional PVCs. The nurse
monitors the client for adverse effects of the infusion, including
hypotension, drowsiness, seizures, bradycardia, and confusion.
The client is started on a continuous IV infusion of lidocaine at 2 mg/min. The ventricular
tachycardia is controlled, and the cardiac monitor strip shows a sinus rhythm with
occasional PVCs. The nurse monitors the client for adverse effects of the infusion,
including hypotension, drowsiness, seizures, bradycardia, and confusion.
What step should the nurse take to minimize the development of these adverse effects?
Answer:
Monitor serum lidocaine levels.
Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/mL (6.4 to 21.34 mcmol/L).
The scheduled PTCA will be performed via femoral insertion. The
procedure involves the insertion of a balloon-tipped catheter into the
diseased coronary artery. When the balloon is inflated, it compresses
the plaque against the vessel wall, resulting in expansion of the inner
diameter of the blood vessel to allow blood to flow more easily.
Amylase- pancreatic function.
ALT is 7 to 56 U/L (0.12 to 0.94 mckat/L). Antihyperlipidemics can cause increased liver
enzymes and should be monitored periodically during treatment. (Note: normal value ranges
can vary by laboratory.)
HDL is considered the "good" cholesterol, which reduces the risk of heart disease. Current
guidelines state that an HDL of less than 50 mg/dL (1.29 mmol/L) for women is too low to
safeguard the arteries.
LDL is the "bad" cholesterol that can accumulate in the arteries, eventually leading to angina,
infarction, or cerebrovascular accident. Less than 100 mg/dL (2.59 mmol/L) is considered the
optimal level, with readings above 190 (4.92 mmol/L) considered very high.
Serum cholesterol less than 200 mg/dL (5.18 mmol/L) is the desired level.
Serum cholesterol- While 200 mg/dL (5.18 mmol/L) or less is considered desirable,
medical intervention is not generally initiated for levels under 240 mg/dL (6.22 mmol/L).
Clients with cholesterol levels between 200 to 240 mg/dl (5.18 to 6.22 mmol/L) should
be advised to begin lifestyle modifications.
Nitroglycerin is a nitrate, causing systemic vasodilation. This often leads to hypotension, which
can cause the client to feel dizzy. She should be instructed to change positions slowly and to
avoid prolonged standing. If the dizziness is persistent when standing, the client's blood
pressure may be too low, requiring the HCP to adjust the dosage or change the medication.
Echocardiogram- Since the client smokes, she should be instructed not to smoke prior to the
test. Nicotine can interfere with heart rate.
Acute Myocardial Infarction (AMI)
The client's angina remains stable. She undergoes a hysterectomy for
dysmenorrhea related to uterine fibroids. The day after being
discharged from the hospital, the client comes to the ED with crushing
substernal chest pain radiating down her left arm. She is dyspneic,
pale, and diaphoretic.
,Correct answer:
Initiative IV access and administer morphine sulfate prescribed by the HCP.
Acute chest pain related to myocardial infarction, ischemia, or reduced coronary artery
blood flow is the most important nursing problem for the client with acute coronary
syndrome (ACS). Treating pain is critical, as pain activates the sympathetic nervous
system and aggravates diaphoresis, weakness, light-headedness, and palpitations,
which increases cardiac workload.
Incorrect answer:
Administer oxygen.
Oxygenation to the myocardial tissue is important for pumping activity and tissue
damage repair. Rest also helps to improve oxygenation. However, recent guidelines
suggest that routine use of supplemental oxygen may not be necessary in clients with
uncomplicated ACS without signs of heart failure, hypoxemia, respiratory distress, or for
an oxyhemoglobin saturation rate of 94% or greater.
ECG findings reveal ST segment elevation in leads II and III, and a VF indicating that the client
is having an inferior AMI. Which intervention should the nurse implement first?
Have the client chew four 81 mg chewable acetylsalicylic acid tablets.
The first intervention according to the American Heart Association standard is to administer
acetylsalicylic acid 160 to 325 mg PO that acts on the platelets, keeping them from clumping
together at the site of the coronary blockage.
Apply oxygen 2 L/nasal cannula.
Oxygen is the second intervention according to the American Heart Association standard if the
client's oxygen saturation level is less than 94%.
Give the client one nitroglycerin tablet to dissolve under the tongue.
Nitroglycerin is the third intervention according to the American Heart Association standard and
is given to vasodilate the coronary arteries and relieve pain.
Administer morphine sulfate 4 mg IV.
Morphine is given if pain is unrelieved by nitroglycerin, according to the American Heart
Association standard.
Nitrates cause the coronary blood vessels to dilate, allowing improved oxygen delivery to
cardiac muscle. In addition, nitrates cause systemic vasodilation, reducing the workload on the
heart, which reduces the myocardium's need for oxygen.
Prolongation of the PR interval is typical of a first-degree AV block, an electrical conduction
disturbance within the heart. While development of a conduction block may occur as a result of
myocardial injury, the presence of a prolonged PR interval is not itself indicative of myocardial
injury.
,Peaked T waves may indicate an elevated potassium level and should be further evaluated, but
is not priority over the myocardial injury that is occurring.
Notched P waves may be evidence of atrial enlargement and should be further evaluated, but is
not priority over the myocardial injury that is occurring.
ST segment elevation is indicative of an acute myocardial injury leading to infarction and
requires immediate intervention.
Myoglobin 60 mcg/L (3.49 nmol/L).
Normal myoglobin for a female: 10 to 65 mcg/L (0.58 to 3.78 nmol/L).
Onset: 1 to 3 hr.
Peak: 6 to 10 hr.
Return to normal: 12 to 24 hr.
Creatine kinase-MB (CK-MB) 3.0 ng/mL (3.0 mcg/L).
Normal CK-MB <5.0 ng/mL (5.0 ug/L). This is the most sensitive creatine kinase to the
cardiac muscle, but is also found in skeletal muscle.
Lactate dehydrogenase (LDH) 200 U/L (3.34 mckat/L).
Normal LDH is 140 U/L (0.67 ukat/L) to 280 U/L (4.68 ukat/L). LDH, like creatine
phosphokinase (CPK), is an enzyme that is nonspecific to cardiac muscle injury.
However, LDH1 is a sensitive cardiac isoenzyme, which is often compared with LDH2
as a ratio during the diagnosis of MI.
Troponin T 0.4 ng/mL (0.4 mcg/L).
Normal troponin T is 0 to 0.2 ng/mL (0.2 ug/L).
Onset: 3-4 hr.
Peak: 10-24 hr.
Return to normal: 10 to 14 days.
This indicates acute myocardial injury and requires immediate intervention.
The most common complication after an MI is dysrhythmias. Lethal dysrhythmias often occur
within 4 hours from the onset of chest pain. Premature ventricular contractions may precede the
lethal dysrhythmias ventricular tachycardia and fibrillation.
Which intervention is most important for the nurse to include in the client’s plan of care?
Continuous cardiac monitoring of heart rate and rhythm.
The heart rate and rhythm should be continuously monitored. Lethal arrhythmias are the most
common immediate complication following an acute myocardial infarction that are life-
threatening.
Auscultate lungs for adventitious sounds such as crackles.
, Auscultating the lungs for crackles or other adventitious sounds can reveal pulmonary edema,
which is a possible complication following an acute MI. Pulmonary edema is often gradual and
not immediately life-threatening.
Titrate oxygen to keep oxygen saturation greater than 93%.
Monitoring and titrating oxygen will help provide the myocardial tissue the oxygen it needs to
prevent further injury. A gradual drop in oxygen can be managed and is not immediately life-
threatening.
Obtain blood to evaluate scheduled serum cardiac markers.
Monitoring serum cardiac markers will determine if the myocardial tissue injury is resolving.
Knowing the cardiac marker levels will aid in prompt intervention, but is a scheduled
intervention.
Dopamine is a vasopressor and inotropic agent that is used to treat severe hypotension and
shock. This intervention may be required if the client's dysrhythmia is not controlled and
cardiogenic shock develops.
The treatment of choice for frequent premature ventricular contractions (PVCs) and ventricular
tachycardia is an immediate IV bolus of amiodarone.
The client is started on a continuous IV infusion of lidocaine at 2
mg/min. The ventricular tachycardia is controlled, and the cardiac
monitor strip shows a sinus rhythm with occasional PVCs. The nurse
monitors the client for adverse effects of the infusion, including
hypotension, drowsiness, seizures, bradycardia, and confusion.
The client is started on a continuous IV infusion of lidocaine at 2 mg/min. The ventricular
tachycardia is controlled, and the cardiac monitor strip shows a sinus rhythm with
occasional PVCs. The nurse monitors the client for adverse effects of the infusion,
including hypotension, drowsiness, seizures, bradycardia, and confusion.
What step should the nurse take to minimize the development of these adverse effects?
Answer:
Monitor serum lidocaine levels.
Therapeutic serum lidocaine levels range from 1.5 to 5 mcg/mL (6.4 to 21.34 mcmol/L).
The scheduled PTCA will be performed via femoral insertion. The
procedure involves the insertion of a balloon-tipped catheter into the
diseased coronary artery. When the balloon is inflated, it compresses
the plaque against the vessel wall, resulting in expansion of the inner
diameter of the blood vessel to allow blood to flow more easily.
