Mr

Mr. G asks if he will receive “clot busting” drugs like he did when he had a heart attack a few years ago. I. In response to G.G.’s question, you explain that thrombolytic therapy may not be indicated this time, primarily because 1. This therapy can only be used once for treatment of an MI. 2. His impaired kidney function puts him at greater risk for hemorrhage and serious reperfusion dysrhythmias. 3. This therapy is only used if percutaneous coronary intervention (PCI) is unsuccessful. 4. Percutaneous coronary intervention (PCI) is the preferred first-line treatment for patients with evidence of an MI. CAD w/ACS S2025 NUR 2006 JW 6 An EKG indicates ischemic changes without ST elevation. He is admitted to the CCU with dx of ACS. Additional orders are written: ● Continuous cardiac monitor, rhythm strips, and dysrhythmia analysis ● Vital signs per CCU protocol, I&O ● Clear liquid diet with advancement as tolerated ● Bed rest with bathroom privileges; CCU protocol for dysrhythmias ● Full ACLS ● Heparin IV bolus and continuous infusion, dose according to weight- based nomogram ● Eptifibatide (Integrilin) IV bolus and continuous infusion based upon weight-based dosing chart ● Metoprolol 50 mg po bid ● Lisinopril 5 mg po daily ● Docusate sodium 100 mg po bid ● Titration of IV nitroglycerin until patient is pain free or systolic BP is less than 90 mm Hg The nurse teaches Mr. G about the Heparin and Integrilin drips and initiates these drips. J. You review the weight-based nomogram to calculate the amount of heparin that G.G. should receive. Based on his weight of 209 lbs, you administer a bolus of 4000 units of heparin. The nomogram also states that the patient should receive heparin 12 units/kg/hr as a continuous infusion following the bolus. You correctly calculated this dose as 1. 1100 units/hr 2. 1140 units/hr 3. 2508 units/hr 4. 10900 units/hr K. The pharmacy sends heparin 25,000 units in 250 mL D5W. At which rate would you set the IV infusion pump? 1. 11.4 ml/hr 2. 12 ml/hr 3. 20 ml/hr 4. 34.2 ml/hr L. The health care provider has ordered a weight-based infusion of eptifibatide (Integrilin). The RN understands that this medication works by _______________________________________. CAD w/ACS S2025 NUR 2006 JW