Page 143 - Critical Care Nursing Demystified

128 CRITICAL CARE NURSING DeMYSTIFIED

• Chest x-rays are done to determine cardiac size and lung congestion.
• BNP (B-type natriuretic peptide) is monitored according to hospital pro-
tocol to diagnose whether the ACS is from heart failure. A BNP of greater
than 400 pg/mL usually indicates significant HF. The higher this value
goes, the poorer the prognosis of the patient.
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• Serum electrolytes (K , Ca , Mg ) are monitored to determine if treat-
ment needs to be initiated. Alterations in serum electrolytes may increase
the chance for cardiac dysrhythmias.
• An echocardiogram is done to see if there is a decrease in wall motion or
malfunctioning of the heart valves.

Hallmark Signs and Symptoms
Monitor the patient using a consistent, well-defined structure for pain assess-
ment as angina or MI can mimic noncardiovascular events such as abdominal
aortic aneurysm (AAA), gastric esophageal reflux disease (GERD), pulmonary
embolism (PE), cholecystitis, and pneumonia. OPQRST is one that is easily
remembered. Classic symptoms using an organized pain assessment include
• Onset – When did it start? Usually sudden. Downloaded by [ Faculty of Nursing, Chiangmai University 5.62.158.117] at [07/18/16]. Copyright © McGraw-Hill Global Education Holdings, LLC. Not to be redistributed or modified in any way without permission.
• Precipitating factor – What caused it? Usually stress or exertionally in-
duced.
• Quality – What does the patient tell you it feels like? “Crushing, viselike,
heavy.” May be atypical in the elderly, in women, and/or in diabetics. They
might say “stomach-ache, shortness of breath, tired feeling.”
• Radiation – Where does it go? This can travel to the jaw, back, or arm(s).
• Timing – How long does it last? Longer than angina and it is not relieved
with nitroglycerin (NTG) and rest. What time did it occur?
Other associated symptoms that can occur with an MI include

• Shortness of breath
• Diaphoresis
• Epigastric distress
• Nausea and vomiting
• Dysrhythmias
• Syncope (feeling like passing out)

• Feeling like something really bad is going to happen; impending doom
• Hypotension and shock