Author Question: A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of ... (Read 38 times)

Arii_bell · **on:** Jul 23, 2018

A nurse is discussing fibrinolytic therapy for the acute phase of STEMI management with a group of nursing students. Which statement by a student indicates understanding of this therapy?

a. Fibrinolytics are effective when the first dose is given up to 24 hours after symp-tom onset.
b. Fibrinolytics should be given once car-diac troponins reveal the presence of STEMI.
c. Fibrinolytics should be used with caution in patients with a history of cerebrovascu-lar accident.
d. Patients should receive either an anti-coagulant or an antiplatelet agent with a fibrinolytic drug.

Question 2

A patient who has arthritis has been taking ibuprofen Motrin and a glucocorticoid medication. The patient reports having tarry stools but denies gastric pain. Which action by the nurse is cor-rect?

a. Contact the provider to discuss ordering an antiulcer medication.
b. Counsel the patient to use over-the-counter antacids.
c. Reassure the patient not to worry unless there is gastric pain.
d. Tell the patient to stop taking the gluco-corticoid immediately.

aham8f · **Reply #1 on:** Jul 23, 2018

Answer to Question 1

C
Patients with a history of cerebrovascular accident (CVA) should not receive fibrinolytic agents because of the increased risk of intracranial hemorrhage. Fibrinolytics are most effective when given within 30 minutes of arrival in the emergency department. Because cardiac troponins are not detectable until 2 to 4 hours after the onset of symptoms, fibrinolytics should be administered before these laboratory values are available. Patients receiving fibrinolytics should receive both an anticoagulant and an antiplatelet drug.

Answer to Question 2

A
Glucocorticoid therapy, especially when combined with NSAIDs, can increase the risk of gastric ulcer and possibly GI bleeding. Treatment with antiulcer medications is indicated, but not with OTC antacids, since the provider needs to be aware of this adverse effect. Gastric pain is usually decreased because of the glucocorticoids, so absence of gastric pain is not reassuring. The glu-cocorticoid should be withdrawn slowly, not immediately.