A 60-year-old male client comes into the emergency department with complaints of crushing chest pain that radiates to his shoulder and left arm. The admitting diagnosis is acute myocardial infarction. Immediate admission orders include oxygen by NC at 4L/minute, blood work, chest X-ray, an ECG, and two (2) mg of morphine given intravenously. The nurse should first:
A. Administer the morphine.
B. Obtain a 12-lead ECG.
C. Obtain the lab work.
D. Order the chest x-ray.
Correct Answer: A. Administer the morphine.
Although obtaining the ECG, chest x-ray, and blood work are all important, the nurse’s priority action would be to relieve the crushing chest pain. Opioids may be used for pain control in addition to sublingual nitroglycerin if the blood pressure is adequate. All patients with STEMI and NSTEMI require immediately chewed aspirin 160 mg to 325 mg. Furthermore, the patient should have intravenous access and oxygen supplementation if oxygen saturation is less than 91%.
Option B: The ECG is highly specific for MI (95% to 97%), yet not sensitive (approximately 30%). Right-sided, posterior lead placement, and repeat ECG testing can increase ECG sensitivity. For example, peaked T-waves on ECG, known as “hyperacute T waves,” often indicate early ischemia and will progress to ST elevation.
Option C: There are diagnostic guidelines that can assist the practitioner in determining whether further testing is useful in identifying patients with NSTEMI. Given the poor sensitivity of ECG for STEMI, troponins are almost universally used for patients with a suspicious clinical history.
Option D: Cardiac angiography is used to perform percutaneous coronary intervention (PCI) or determine obstructions in the coronary vessels. An echocardiogram is used to assess wall motion, degree of valve abnormality, ischemic mitral regurgitation (MR), and presence of cardiac tamponade
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