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This Concept Map, created with IHMC CmapTools, has information related to: Acute MI, Explain the benefits/risks of thrombolytic therapy (bleeding) Include family in decision making Comfort family (ref needed) ???? Mr. X questioning whether will die??? (would this be a transition???) Wife..., ER Nurse Initiates -cardiac monitor -Oxygen therapy -IV D5W x 2 -Blood studies -NTG (sublingual) -Aspirin (chewable) (ACC/AHA guidelines) lab results Blood results -Trop 7.7 -CPK 1433 -CK-MB 197 no renal failure, Triage nurse assesses -assess S&S of STEMI -12 lead ECG -brief, targeted Hx (ACC/AHA Guidelines) Mr. X to acute area and call for ACT team ????, Provide Comfort Measures (phys/emo) to help Mr.X with Monitor Chest Pain and BP -titrate NTG gtt to pain relief and maintain syst BP mmHg -?Morphine 5 mg IV prn -5/10 pain persists, Rescue PCI shows Angiography shows -diseased circumflex artery -occlusion of LAD with TIMI flow 0, Wife son daughter is ++ concerned for husband Comfort Mr. X and wife while performing ECG and explain what is happening, ACS-STEMI (ant. wall) Killip III necessitates immediate transfer for Rescue PCI, Mr. X 50 y.o. engineer has symptoms of Chest pain at home with n & v and SOB, Mr. X 50 y.o. engineer has risk factors 2PPD smoker BMI=33 Age=50 ?Stress level ?family Hx, Triage nurse assesses -assess S&S of STEMI -12 lead ECG -brief, targeted Hx (ACC/AHA Guidelines) Mr. X to acute area and call for ACT team Medical diagnosis Acute Myocardial Infarction (Ant/septal), ???? leads to Medical diagnosis Acute Myocardial Infarction (Ant/septal), Administer Reperfusion Therapy as indicated -TNK 50 mg IV -Heparin 4,000 units IV bolus -Heparin 12 u/kg requires Monitor reperfusion and SE of Thrombolytics -cardiac monitoring -ECG (ST changes) -V/S Q 15 min -Neuro V/S Q 15 min -s&s of bleeding (ref needed), Administer Diuretic -Lasix 40 mg IV (?more) -Foley inserted ???? Assess breathing post diuretic Assess need for additional dose, Administer Diuretic -Lasix 40 mg IV (?more) -Foley inserted influences Monitor In/Outs, Prep for PCI -shave groin -pain control -VS monitoring -cardiac monitoring -S&S bleeding ???? NTG gtt @50 mcg/min, Prep for PCI -shave groin -pain control -VS monitoring -cardiac monitoring -S&S bleeding ???? VS P80 BP110/70 Normal Sinus Rhythm no arrhythmias no N&V, Xray=mod pulmonary edema exhibited by Monitor ABCs -Resp rate/effort -SpO2 95% on 5L/min NP -mod. crackles lower 1/3 lungs -no JVD/HJR, Mr. X 50 y.o. engineer lives with family Wife son daughter, Xray=mod pulmonary edema leads to diagnosis of ACS-STEMI (ant. wall) Killip III, Monitor reperfusion and SE of Thrombolytics -cardiac monitoring -ECG (ST changes) -V/S Q 15 min -Neuro V/S Q 15 min -s&s of bleeding (ref needed) leads to diagnosis of ACS-STEMI (ant. wall) Killip III