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Presenting and Associated Symptoms
Chest pain from acute myocardial infarction is usually sudden onset in the substernal area, which may or may not radiate. Associated symptoms are weakness, dyspnea, diaphoresis, nausea, vomiting, palpitations, and anxiety. The pain usually lasts thirty minutes or more. Morphine and nitroglycerin do not completely relieve the pain (Uphold, & Graham, 2013).
Specific diagnostic tests used in the work up
Vital signs including heart rate, temperature, and blood pressure, and oxygen saturation should be done at regular intervals. Diagnostic tests include a 12 lead ECG, the cardiac biomarkers of CPK with isoenzymes, troponin T or I, high sensitivity C-reactive protein, CBC, erythrocyte sedimentation rate, serum electrolytes, BUN and serum creatinine. Perform a complete heart and lung exam. Assess peripheral pulses, and assess extremities for edema, cyanosis, and clubbing. Echocardiography should be ordered. This is the gold standard in diagnosing wall motion abnormalities, ventricular function, valvular or septal defects, and ejection fractions (Mcconaghy, & Oza, 2013).
1st line therapeutic interventions, patient education and follow up expectations
The first line therapeutic interventions are: aspirin 162-325 mg chewed, give nitroglycerin every 5 minutes times three doses or until chest pain is perceived as a 0 out of 10 on the pain score. Monitor the patient for hypotension. The patient should be transferred to a hospital emergency department with access to a cardiac catheterization lab. This will allow immediate reperfusion therapy with angioplasty within 2 hours if available (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
Support whether or not you would refer the patient to another health care provider for treatment. Include the name of the specialty and your rationale for the referral.
Patients who present with chest pain, with or without radiation, SOB, weakness, diaphoresis, nausea, lightheadedness and a suspected MI, should be transported to the ER (Uphold & Graham, 2013). Patients with a negative ECG but their clinical presentation is suspicious should be referred to the ER. Non-urgent cases can be referred to cardiology for further investigation (Biesemans, Cleef, Willemsen, Beatriis, Reniere, Buntinx…Dinant, 2018).
Patient education should include teaching about medications usage, adverse effects, and how to take nitroglycerin prophylactically. Patients should also be taught proper care of the nitroglycerin tablets. Patients with a higher BMI should be placed on a low-fat reduced calorie diet. Patients should be encouraged to enter a cardiac rehabilitation program of safe exercise and risk factor modification including smoking cessation (Dunphy, Winland-Brown, Porter, & Thomas, 2015).
Biesemans, L., Cleef, L. E., Willemsen, R. T. A., Beatrijs, B. N. H., Renier, W. S.,
Buntinx, F., . . . Dinant, G. (2018). Managing chest pain patients in general practice: An interview-based study. BMC Family Practice, 19doi:http://dx.doi.org/10.1186/s12875-018-0771-0
Dunphy, L. M., Winland-Brown, J. E., Porter, B. O., & Thomas, D. A. (2015). Primary care. The art and science of advanced practice nursing. (4th Ed.). Philadelphia, PA. F. A. Davis Company.
Mcconaghy, J. R., & Oza, R. S. (2013). Outpatient diagnosis of acute chest pain in adults.
American family physician. 87(3)177-82. Retrieved from www.aafp.org/afp
(Links to an external site.)
Links to an external site.
Uphold, C. R., & Graham, M. V. (2013). Clinical guidelines in family practice.
Gainsville, FL. Barmarrae Books, Inc.