[Answered]: Patient Management While obtaining the history and…

Patient Management While obtaining the history and assessing the patient’s status, the emergency nurse should convey a calm and reassuring manner. Any patient with AMI or suspected AMI should have low-flow oxygen (2 to 6 L/min) and the head of the bed should be elevated. Maintain oxygen saturation greater than 95%. If oxygenation cannot be maintained or the patient is acidotic, intubation and mechanical ventilation are indicated. After oxygen therapy is initiated, establish IV access for medications and fluid therapy. Insert at least two large-bore (18-gauge) catheters and infuse normal saline as needed. Ongoing assessment includes frequent determination of blood pressure, continuous ECG monitoring, and continuous pulse oximetry monitoring. Assessment of pain inten-sity, location, radiation of pain, and applicable descriptors establishes baseline. Assessment parameters should be reassessed after any intervention for chest pain. Nitroglycerin is the initial drug of choice for treatment of chest pain related to angina pectoris and AMI. Nitroglycerin can be administered sublingually in 0.3- or 0.4-mg tablets or in a spray. One tablet or spray is administered every 5 minutes, up to three doses. Nitroglycerin dilates coronary arteries, reduces afterload by dilating peripheral venous circulation, and reduces preload; that is, decreases venous return to the heart. Nitroglycerin is not usually given unless systolic blood pressure (SBP) is at least 100 mm Hg because of potential decreased blood pressure that can occur. If sublingual nitroglycerin is not effective, IV nitroglycerin (Tridil) can be used. Initiate nitroglycerin infusion at 10 to 20 mcg/min and titrate in increments of 5 to 10 mcg/min up to 50 to 180 mcg/min. 431 If nitroglycerin fails to relieve chest pain, the next drug of choice is morphine sulfate. This narcotic analgesic relieves chest pain and anxiety, which decreases myocardial oxygen consumption.? If SBP is greater than 100 mm Hg, administer morphine 2 to 4 mg IV every 5 to 10 minutes until pain is relieved. Monitor respiratory status and hemodynamic response carefully after morphine administration. After the patient is initially evaluated, aspirin should be given orally (to be chewed) unless contraindicated (e.g., al-lergy, active gastrointestinal [GT] bleeding). If the patient is unable to tolerate oral aspirin, one rectal suppository can be given. Recommended dosage ranges from 160 to 325 mg. If the patient is “allergic” to aspirin, other antiplatelet agents such as dipyridamol, ticlopidine, or clopidogrel can be considered. 1.Analyses and evaluates the changes in nursing practice over the last 20 years. Critically analyses new current practices from the related MI guideline and draws on up-to-date contemporary literature to support the answer. The answer is concise and accurate. Adheres to assessment guidelines. Sources a recent Australian guideline for the management of an MI. 2. Critically analyses the pathophysiology of an MI. Evaluates and justifies improved patient outcomes, using contemporary literature to support the answer. Adheres to assessment guidelines.