Answer to Question 1
Serial cardiac enzymes; the order should read creatine kinase (CK), troponin T and I q8h. In addition,
a D-dimer test should be ordered to rule out pulmonary embolus. A fasting lipid panel in the
morning is needed to evaluate lipid levels.
Address his feelings of loss of control by acknowledging his legitimate issues of craving (cigarettes)
and pain or discomfort. Assure him you will call the physician and get something to help him feel
more comfortable.
Explain that smoking could cut off oxygen to his heart and increase his pain, burning, or
discomfort (use his choice of words).
Reassure him that you will be available if he needs help.
Offer him a choice by asking him whether he would like an antacid (such as Maalox or Mylanta,
which are combination products that contain aluminum and magnesium) per your unit protocol
for his heartburn while you contact the physician. Ask whether there is anything else you can do to
make him more comfortable. (No, he still can't smoke.)
Remind him that lit cigarettes are not safe when oxygen is being delivered by NC.
Professional confidence and competence communicate themselves to people experiencing fear
and help meet their need for security.
Answer to Question 2
Explain that use of the nicotine patch should be avoided in patients with severe angina or
uncontrolled hypertension (HTN) and for 8 weeks after an MI. Nicotine in the patch will constrict his
coronary arteries and might decrease blood flow and oxygen to his heart. At this time his condition
is unstable, and it is best not to risk these adverse effects.
Bupropion (Zyban) is an antidepressant that is used for smoking cessation. Varenicline (Chantix) is
another drug that can be used for smoking cessation. However, these drugs take several weeks to
have any effect on nicotine cravings. It may be useful to give him a mild antianxiety medication such
as alprazolam (Xanax) to help with the cravings.
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