A client enters the ER complaining of severe chest pain. A myocardial infarction is suspected. A 12 lead ECG appears normal, but the doctor admits the client for further testing until cardiac enzyme studies are returned. All of the following will be included in the nursing care plan. Which activity has the highest priority?
A. Monitoring vital signs.
B. Completing a physical assessment.
C. Maintaining cardiac monitoring.
D. Maintaining at least one IV access site.
Correct Answer: C. Maintaining cardiac monitoring
Even though initial tests seem to be within normal range, it takes at least 3 hours for the cardiac enzyme studies to register. In the meantime, the client needs to be watched for bradycardia, heart block, ventricular irritability, and other arrhythmias. Heart rate and rhythm respond to medication, activity, and developing complications. Dysrhythmias (especially premature ventricular contractions or progressive heart blocks) can compromise cardiac function or increase ischemic damage. Acute or chronic atrial flutter may be seen with coronary artery or valvular involvement and may or may not be pathological. Other activities can be accomplished by the MI monitoring.
Option A: Measure cardiac output and other functional parameters as appropriate. Cardiac index, preload, afterload, contractility, and cardiac work can be measured noninvasively with thoracic electrical bioimpedance (TEB) technique. Useful in evaluating response to therapeutic interventions and identifying the need for more aggressive and/or emergency care.
Option B: Note the response to activity and promote rest appropriately. Overexertion increases oxygen consumption and demand and can compromise myocardial function. Large meals may increase myocardial workload and cause vagal stimulation, resulting in bradycardia or ectopic beats. Caffeine is a direct cardiac stimulant that can increase heart rate. Note: New guidelines suggest no need to restrict caffeine in regular coffee drinkers.
Option D: Maintain IV or Hep-Lock access as indicated. Patent line is important for the administration of emergency drugs in presence of persistent lethal dysrhythmias or chest pain.
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