Author Question: The nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for ... (Read 33 times)

geoffrey · **on:** Jul 23, 2018

The nurse is evaluating a patient admitted to the emergency department with an evolving STEMI for possible administration of thrombolytic therapy.

Which of the following identified during history taking would contraindicate this type of therapy?
a. The patient just completed her last menstrual cycle.
b. The patient states that the chest pain started 1 hour ago.
c. The patient has a history of a small cerebral aneurysm.
d. The patient has hypertension that is well controlled by diuretic therapy.

Question 2

A patient arrives in the emergency department with complaints of pain, cramping, and weakness of the calf muscles while walking. The nurse would be correct to suspect ___________ and anticipate the administration of ___________.

a. thrombophlebitis; heparin
b. tendonitis; cephalosporins
c. intermittent claudication; cilostazol (Pletal)
d. deep vein thrombosis; streptokinase (Streptase)

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

Answer to Question 1

ANS: C
The absolute contraindications to thrombolytic therapy include known structural cerebrovascular lesions. This patient has a known cerebral aneurysm.
Active internal bleeding is an absolute contraindication for thrombolysis except for menses, and the patient has indicated she has completed her last cycle. There is no contraindication to administration.
Current guidelines indicate that thrombolytic therapy should be administered for chest pain that has been present for no longer than 12 hours. The patient meets this criterion for administration.
Although severe, poorly controlled hypertension is a relative contraindication, the patient's hypertension is well controlled by medication therapy. Thrombolytics can be administered with caution.

Answer to Question 2

ANS: C
Intermittent claudication is a syndrome characterized by pain, cramping, and weakness of the calf muscles that is brought on by walking and relieved by resting a few minutes. Cilostazol, a platelet inhibitor and vasodilator, is used to treat intermittent claudication.
The patient's clinical manifestations do not correlate with thrombophlebitis, which is characterized by localized pain, warmth, and swelling. Typical treatment includes cool followed by warm compresses and elevation.
The patient's clinical manifestations do not correlate with tendonitis, which is characterized by tendon tenderness. Cephalosporins are not indicated in the treatment of tendonitis.
The patient's clinical manifestations do not correlate with DVT, which is characterized by edema, tenderness, and a feeling of heaviness in the affected extremity. Streptokinase may be used for DVT but would not be a first-line treatment.