ASSIGNMENT

Assignment

1. Outline and justify the nursing care required for Mr. Varga with his presenting symptoms, placing this nursing care in order of clinical priority. (600 words)

As the ECG of Mr. Varga has already revealed an acute ST elevation myocardial infarction (STEMI), the nursing care steps and the therapy will be started accordingly. It is already decided to treat him through thrombolysis, he must be immediately transferred the cardiac catheterization laboratory for primary percutaneous transluminal coronary angioplasty (PTCA). Time management is really crucial in his condition. Therefore angioplasty to open the blood vessels must be done within 90 minutes.

To maintain oxygen levels, his Pulse oximetry should be performed very soon, and supplemental oxygen should be given while maintaining the oxygen saturation greater than 90%. This will help in preventing the condition of hypoxemia.

As the medications, 325mg aspirin to be given him for chewing (Kososky J.M, et. al, 2009), it will help in inhibiting the platelets. Clopidogrel in addition, also inhibits platelets. As Mr.. Varga is 49 years old, he will be given an oral loading dose of 300 mg.

As Mr.. Varga reported intense pain, the main management in this case requires prompt and adequate analgesia. To relief Mr.. Varga's chest pain, and make him stable, Nitrates must be provided. The administration of sublingual nitroglycerin must be included in the medication. If pain his still persists, he will be given its 2 additional doses at 5-minute intervals. Another agent of choice is morphine sulfate, which will be given initially IV at the intervals of 5 to 15 minute intervals at the typical doses of 2 to 4 mg.

Beta blockers will also be used, as it is contraindicated for him in the presenting symptoms. Beta-adrenergic blockers must be given within 4 hours, as he has a complaint of severe chest pain (Zafari A.M., 2012). The same can be continued on the long-term basis, if no adverse effects seen during the first 24 hours (Neff M.J.,2004, pp. 2014).

Mr. Varga's relative hypotension will be treated by elevating the lower extremities. He will also be given fluids. Doses of Heparins ([UFH] or [LMWH]) result in inhibiting thrombin (Rivera-Bou, et. al, 2011). Mr. Varga must be given the recommended dose of UFH which is an intravenous bolus of 60 Units per kg (maximum 4,000 Units at maximum). It must be followed by an initial infusion of 12 Units/kg/hr (maximum 1000 Units/h). Through this drug administration, his APTT will be controlled upto 1.5 to 2 times. ACE inhibitors will also be useful for Mr. Varga in long-term therapy.

The balance between myocardial oxygen supply and demand for Mr.Varga will be improved with the administration of both beta-adrenergic blockers and ACE inhibitors; it will also help in limiting the infarct size. It will also be beneficial to treat the fluid status in optimizing the left ventricular filling pressures, maintaining oxygen saturation, and controlling his heart rate by avoiding reflex sympathoadrenal stimulation.

Alternative to UFH, Enoxaparin (LMWH) may be administered as ...