心梗影响护士资格证注册不

General TreatmentMonitoring, O2 Bed rest initially, with early ambulationLow-salt, low-fat dietStool softeners, anxiolytics as neededDrugsAspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph , clopidogrel Some Trade Names PLAVIXClick for Drug Monograph , or bothβ-BlockerGlycoprotein IIbIIIa inhibitor for patients undergoing PCI and for those at high risk (eg, with markedly elevated cardiac markers, TIMI risk score ≥ 4, persistent symptoms)A heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph (unfractionated or low mol wt heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph )IV nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph (unless low-risk, uncomplicated MI)Fibrinolytics for select patients with STEMI when timely PCI unavailableACE inhibitor (as early as possible) and statinAntiplatelet and antithrombotic drugs, which stop clots from forming, are usedAnti-ischemic drugs (eg, β-blockers, IV nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph ) are frequently added, particularly when chest pain or hypertension is present (see Table 3: Coronary Artery Disease: Drugs for Coronary Artery Disease ) Fibrinolytics should be used if not contraindicated for STEMI if primary PCI is not immediately available but worsen outcome for unstable angina and NSTEMIChest pain can be treated with morphine Some Trade Names DURAMORPHMS CONTINMSIRROXANOLClick for Drug Monograph or nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug MonographMorphine Some Trade Names DURAMORPHMS CONTINMSIRROXANOLClick for Drug Monograph 2 to 4 mg IV, repeated q 15 min as needed, is highly effective but can depress respiration, can reduce myocardial contractility, and is a potent venousHypotension and bradycardia secondary to morphine Some Trade Names DURAMORPHMS CONTINMSIRROXANOLClick for Drug Monograph can usually be overcome by prompt elevation of the lowerNitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph is initially given sublingually, followed by continuous IV drip if BP is normal or slightly elevated in most patients on arrival at the emergency department; BP gradually falls over the next severalContinued hypertension requires treatment with antihypertensives, preferably IV nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph , to lower BP and reduce cardiacSevere hypotension or other signs of shock are ominous and must be treated aggressively with IV fluids and sometimes vasopressors (see Shock and Fluid Resuscitation: Prognosis and Treatment)Antiplatelet drugs: Aspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph , clopidogrel Some Trade Names PLAVIXClick for Drug Monograph , ticlopidine Some Trade Names TICLIDClick for Drug Monograph , and glycoprotein (GP) IIbIIIa inhibitors areAll patients are given aspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph 160 to 325 mg (not enteric-coated), if not contraindicated, at presentation and 81 mg onceday indefinitelyChewing the first dose before swallowing quickensAspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph reduces short- and long-term mortalityIf aspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph cannot be taken, clopidogrel Some Trade Names PLAVIXClick for Drug Monograph 75 mg onceday or ticlopidine Some Trade Names TICLIDClick for Drug Monograph 250 mg bid may beClopidogrel Some Trade Names PLAVIXClick for Drug Monograph has largely replaced ticlopidine Some Trade Names TICLIDClick for Drug Monograph for routine use because neutropenia is a risk with ticlopidine Some Trade Names TICLIDClick for Drug Monograph and WBC must be monitoredPatients with unstable angina or NSTEMI in whom intervention is not possible or recommended are given both aspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph and clopidogrel Some Trade Names PLAVIXClick for Drug Monograph for at least 1The optimal duration of double antiplatelet therapy for these patients is the subject of ongoing In patients undergoing PCI, a clopidogrel Some Trade Names PLAVIXClick for Drug Monograph loading dose (300 to 600 mg po once) improves outcomes, particularly when administered 24 h inHowever, delaying PCI for 24 h is not appropriate for manyFurther, such a loading dose increases risk of perioperative bleeding in patients who require coronary artery bypass grafting (CABG) because their coronary anatomy proves unfavorable for PCI Thus, many clinicians administer a clopidogrel Some Trade Names PLAVIXClick for Drug Monograph loading dose only in the catheterization laboratory once coronary anatomy and lesions have been proven to be amenable to PCIFor patients receiving a stent for revascularization, aspirin Some Trade Names BUFFERINECOTRINGENACOTEClick for Drug Monograph is continued indefinitely, and clopidogrel Some Trade Names PLAVIXClick for Drug Monograph should be used for at least 1 mo in patients with a bare-metalPatients with a drug-eluting stent have a prolonged risk of thrombosis and may benefit from 12 mo of clopidogrel Some Trade Names PLAVIXClick for Drug Monograph treatment, although the recommended duration is still GP IIbIIIa inhibitors ( abciximab Some Trade Names REOPROClick for Drug Monograph , tirofiban Some Trade Names AGGRASTATClick for Drug Monograph , eptifibatide Some Trade Names INTEGRILINClick for Drug Monograph ) are potent antiplatelet drugs that must be given IV Patients undergoing PCI should receive a GP IIbIIIa inhibitor; results appear to be better if the drug is initiated at least 6 h before PCI and continued for 18 to 24 hIf PCI is not being done, a GP IIbIIIa inhibitor is given to all high-risk patients (eg, those with markedly elevated cardiac markers, a TIMI risk score ≥ 4, or persistent symptoms despite adequate drug therapy) The GP IIbIIIa inhibitor is continued for 24 to 36 h, and angiography is done before the infusion period isRoutine use of GP IIbIIIa inhibitors with fibrinolytics is not recommended at thisAlthough abciximab Some Trade Names REOPROClick for Drug Monograph is the drug recommended in most published guidelines, eptifibatide Some Trade Names INTEGRILINClick for Drug Monograph is cheaper and is thought to have comparable efficacy and is thus oftenStudies continue to investigate the comparative efficacy of the different GP IIbIIIa Anticoagulant drugs: Either a low mol wt heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph (LMWH) or unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph is given routinely to patients with ACS unless contraindicated (eg, by active bleeding or planned use of streptokinase Some Trade Names STREPTASEor anistreplase) Choice of agent is somewhat Unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph is more complicated to use because it requires frequent (q 6 h) dosing adjustments to achieve an activated PTT (aPTT) 5 to 2 times the controlIn those undergoing angiography, further dosing adjustment is performed to achieve an activated clotting time (ACT) of 200 to 250 sec if the patient is treated with a GP IIbIIIa inhibitor and 250 to 300 sec if a GP IIbIIIa inhibitor is not beingHowever, the effects of unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph are shorter and can be reversed (with prompt discontinuation of heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph infusion and with administration of protamine sulfate Some Trade Names No US trade nameClick for Drug Monograph ) if bleeding develops following The LMWHs have better bioavailability, are given by simple weight-based dose without monitoring aPTT and dose titration, and have lower risk of heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph -inducedThey also may produce an incremental benefit in outcomes relative to unfractionated in patients with ACS Of the LMWHs, enoxaparin Some Trade Names LOVENOXClick for Drug Monograph appears to be superior to dalteparin Some Trade Names FRAGMINClick for Drug Monograph or nadroparin Some Trade Names No US trade nameClick for Drug MonographHowever, enoxaparin Some Trade Names LOVENOXClick for Drug Monograph may pose a higher bleeding risk in patients with STEMI who are > 75, and its effects are not completely reversible with Thus, taking all into account, many published guidelines recommend LMWH (eg, enoxaparin Some Trade Names LOVENOXClick for Drug Monograph ) over unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph in patients with unstable angina or NSTEMI and in patients < 75 with STEMI who are not undergoing PCI By contrast, unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph is recommended when emergency PCI is performed (eg, patients with acute STEMI who proceed to the catheterization laboratory), when CABG is indicated within the next 24 h, and in patients at high risk for bleeding complications (eg, history of GI bleeding within the last 6 mo) or with creatinine clearance < 30 mL Ongoing studies should help clarify the choice between LMWH and unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph For those undergoing PCI, post-procedure heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph is no longer recommended unless patients are at high risk of thromboembolic events (eg, those with large anterior MI, known LV thrombus, atrial fibrillation), as post-procedure ischemic events have decreased with the use of stents and antiplateletFor those not undergoing PCI, heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph is continued for 48 h (or longer if symptoms persist)The difficulties with the heparins (including bleeding complications, the possibility of heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph -induced thrombocytopenia, and, with unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph , the need for dosing adjustments) have led to the search for betterThe direct thrombin inhibitors, bivalirudin Some Trade Names ANGIOMAXClick for Drug Monograph and argatroban Some Trade Names No US trade nameClick for Drug Monograph , may have a lower incidence of major bleeding and improved outcomes, particularly in patients with renal insufficiency (hirudin, another direct thrombin inhibitor, appears to cause more bleeding than the other drugs) The factor Xa inhibitor, fondaparinux Some Trade Names ARIXTRAClick for Drug Monograph , reduces mortality and reinfarction in patients with NSTEMI who undergo PCI without increasing bleeding but may result in worse outcomes than unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph in patients with STEMI Although routine use of these alternative anticoagulants is thus not currently recommended, they should be used in place of unfractionated heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph or LMWH in patients with a known or suspected history of heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph -induced Patients at high risk of systemic emboli also require long-term therapy with oral warfarin Some Trade Names COUMADINClick for Drug MonographConversion to warfarin Some Trade Names COUMADINClick for Drug Monograph should begin 48 h after symptom resolution or PCIβ-Blockers: These drugs are recommended unless contraindicated (eg, by bradycardia, heart block, hypotension, or asthma), especially for high-riskβ-Blockers reduce heart rate, arterial pressure, and contractility, thereby reducing cardiac workload and O2IV β-blockers given within the first few hours improve prognosis by reducing infarct size, recurrence rate, incidence of ventricular fibrillation, and mortalityInfarct size largely determines cardiac performance after Heart rate and BP must be carefully monitored during treatment with β- Dosage is reduced if bradycardia or hypotensionExcessive adverse effects may be reversed by infusion of the β-adrenergic agonist isoproterenol Some Trade Names ISUPRELClick for Drug Monograph 1 to 5 μgNitrates: A short-acting nitrate, nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph , is used to reduce cardiac workload in selectedNitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph dilates veins, arteries, and arterioles, reducing LV preload andAs a result, myocardial O2 demand is reduced, lesseningIV nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph is recommended during the first 24 to 48 h for patients with heart failure, large anterior MI, persistent chest discomfort, orBP can be reduced by 10 to 20 mm Hg but not to < 80 to 90 mm HgLonger use may benefit patients with recurrent chest pain or persistent pulmonaryIn high-risk patients, nitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph given in the first few hours reduces infarct size and short-term and possibly long-term mortalityNitroglycerin Some Trade Names NITRO-BIDNITRO-DURNITROLNITROQUICKClick for Drug Monograph is not routinely given to low-risk patients with uncomplicated MIFibrinolytics: Tenecteplase Some Trade Names TNKASEClick for Drug Monograph (TNK), alteplase Some Trade Names ACTIVASEClick for Drug Monograph (rTPA), reteplase Some Trade Names RETAVASEClick for Drug Monograph (rPA), streptokinase Some Trade Names STREPTASE, and anistreplase (anisoylated plasminogen activator complex—APSAC), all given IV, are plasminogenThey convert single chain plasminogen to double chain plasminogen, which has fibrinolyticThey have different characteristics and dosing regimens (see Table 7: Coronary Artery Disease: IV Fibrinolytic Drugs Available in the US) and are appropriate only for selected patients with STEMI (see below)Tenecteplase Some Trade Names TNKASEClick for Drug Monograph and reteplase Some Trade Names RETAVASEClick for Drug Monograph are recommended most often because of their simplicity of administration; tenecteplase Some Trade Names TNKASEClick for Drug Monograph is given as a single bolus over 5 sec and reteplase Some Trade Names RETAVASEClick for Drug Monograph as a double bolus 30 minAdministration time and drug errors are reduced compared with otherTenecteplase Some Trade Names TNKASEClick for Drug Monograph , like alteplase Some Trade Names ACTIVASEClick for Drug Monograph , has an intermediate risk of intracranial hemorrhage, has a higher rate of recanalization than other fibrinolytics, and isReteplase Some Trade Names RETAVASEClick for Drug Monograph has the highest risk of intracranial hemorrhage and a recanalization rate similar to that of tenecteplase Some Trade Names TNKASEClick for Drug Monograph , and it is Streptokinase Some Trade Names STREPTASEmay induce allergic reactions, especially if it has been used previously, and must be given by infusion over 30 to 60 min; however, it has a low incidence of intracerebral hemorrhage and is relativelyAnistreplase, related to streptokinase Some Trade Names STREPTASE, is similarly allergenic and slightly more expensive but can be given as a singleNeither requires concomitant heparin Some Trade Names HEPFLUSH-10Click for Drug MonographFor both, recanalization rate is lower than that with other plasminogenBecause of the possibility of allergic reaction, patients who previously received streptokinase Some Trade Names STREPTASEor anistreplase are not given that Alteplase Some Trade Names ACTIVASEClick for Drug Monograph is given in an accelerated or front-loaded dosage over 90Alteplase Some Trade Names ACTIVASEClick for Drug Monograph with concomitant IV heparin Some Trade Names HEPFLUSH-10Click for Drug Monograph improves patency, is nonallergenic, has a higher recanalization rate than other fibrinolytics, and isTable 7IV Fibrinolytic Drugs Available in the USThis table is presented as a PDF and requires the free Adobe PDFGet Adobe ReaderOther drugs: ACE inhibitors appear to reduce mortality risk in MI patients, especially in those with anterior infarction, heart failure, orThe greatest benefit occurs in the highest-risk patients early duringACE inhibitors are given > 24 h after thrombolysis stabilization and, because of continued beneficial effect, may be prescribed long-Angiotensin II receptor blockers may be an effective alternative for patients who cannot tolerate ACE inhibitors (eg, because of cough) Currently, they are not first-line treatment after MI Contraindications include hypotension, renal failure, bilateral renal artery stenosis, and known HMG-CoA reductase inhibitors (statins) have long been used for prevention of CAD and ACS, but there is now increasing evidence that they also have short-term benefits, such as stabilizing plaque, reversing endothelial dysfunction, decreasing thrombogenicity, and reducingThus, all patients without contraindications to therapy should receive a statin as early as possible following ACS LDL levels of 70 to 80 mgdL (81 to 07 mmolL) are the recommended ultimate

【导读】心肌梗死的主要病因是冠脉粥样硬化，一般情况下，心梗后1～12小时会出现心肌凝固性坏死，紧接着这种坏死物质会被人体吸收，出现发热等症状，并且发病人群逐渐年轻化，引起了国家卫生部门的重视，为此小编预测在护士考试中，心肌梗死将作为重点考察内容，下面是小编为大家整理的2021年考护士的题目预测：心肌梗死，希望对各位考生有所帮助。心肌梗死的主要病因是：A冠状动脉栓塞B冠状动脉炎C先天性畸形D冠脉粥样硬化E冠状动脉痉挛心梗后心肌出现凝固性坏死的时间为：A20～30分钟B1～12小时C1～2周D6～8周 E以上都不是急性心梗病人出现发热、白细胞计数增高和血沉增快，主要是由什么原因引起：A感染B坏死物质吸收C疼痛刺激B血栓形成 E以上都不是前间隔心梗的心电图定位诊断：AV1～V3导联BⅡ、Ⅲ、aVF导联CⅠ、aVL导联DV3～V5导联EV7～V8导联下壁心梗的心电图定位诊断：AV1～V3导联BⅡ、Ⅲ、aVF导联CⅠ、aVL导联DV3～V5导联EV7～V8导联极化液的组成成分是：A维生素C、辅酶A、肌苷B1，6-磷酸果糖、辅酶QC氧化钾、普通胰岛素、葡萄糖D三磷酸腺苷、辅酶A、维生素B6E低分子右旋糖酐右冠状动脉闭塞引起的心肌梗死部位：A左心室高侧壁B前壁C广泛前壁D下后壁 E前间隔左冠状动脉回旋支闭塞引起的心肌梗死部位：A左心室高侧壁B前壁C正后壁D下壁 E前间隔 左冠状动脉前降支闭塞引起的心肌梗死部位：A左心室前壁B下壁C后壁D前间隔和二尖瓣前乳头肌E以上都是心肌梗死时ST-T段改变：A呈弓背向上抬高B呈弓背向下抬高C呈鱼钩状D一过性抬高 E以上都不是答案D B B A BC D A E A以上就是小编今天给大家整理发布的关于“2021年考护士的题目预测：心肌梗死”的相关内容，希望对大家有所帮助。同时值得注意的是护士证注册流程也需要注意，免得做了无用功。

诊断心肌梗死，心电图一定要有梗死图形，T波倒置，S--T段抬高，Q波加深加宽。心肌梗死临床可分 早期，数分钟至数小时出现巨大高耸T波，S--T段称谢上型抬高，不出现异常Q波。 急性期，6---12小时出现，常需48---72小时才出现急性期心电图，ST段抬高工背向上，T波倒置，病理性Q波。亚急性期，梗死后数周至数月，图形逐渐恢复。但Q波不改变。陈旧期，大部分图形回复，只剩病理性Q波。这种病早发现早治疗预后良好，提供给的心电图有S--T 段抬高但不太清楚不太典型可能和时间有关系。治疗应在医师指导下用药。祝早日康复。

首先保证绝对卧床休息，给予吸氧、心电监护，严密监测心电变化，及时发现心律失常并处理， 同时建立静脉通道，遵医嘱予以波利维、拜阿司匹林嚼服，低分子肝素皮下注射，推注泵泵硝酸甘油根据血压调节剂量，疼痛剧烈者皮下注射吗啡止痛，指导大便勿用力。如出现休克对症处理。护理评估从最重要的危及生命的问题入手，心梗病人及时抢救、预防并发症是关键。