Medical Management: Goal: To minimize myocardial damage, preserve myocardial function, and prevent complications.

. use rapid transit to the hospital

. obtain 12-lead ECG to be read within 10 minutes.

. obtain laboratory blood specimens of cardiac biomarkers, including troponin.

. obtain other diagnostics to clarify the diagnosis.

Begin routine medical interventions:1. supplemental oxygen2. nitroglycerin3. morphine4. aspirin 162-325 mg5. beta-blocker 6. angiotensin-converting enzyme inhibitor within 24 hours

Evaluate for indication for reperfusion theraphy:. percutaneous coronary intervention.. thrombolytic theraphy

continue theraphy as indicated:. intravenous heparin or low molecular-weight heparin.clopidogrel( Plavix) or ticlopidine(Ticlid).Glycoprotein IIb /IIIa inhibitor. Bed rest for a minimum of 12 to 24 hours.

Nursing intervention:

. relieving pain and other signs of ischemia

1. reperfusion with thrombolytic theraphy( it aids in minimizing or avoiding permanent injury to the myocardium.

2. administration of aspirin, an IV beta-blocker and nitroglycerin is indicated. administration of morphine to relieve pain and anxiety and to promote vasodilation, reducing preload and afterload.

3. administration of oxygen along medication theraphy to assist with relief of symptoms and increases the circulating level of oxygen to reduce pain associated with low levels of myocardial oxygen.

4. vital signs are assessed frequently as long as the patient is experiencing pain and other symptoms of ischemia.

5. Physical rest in bed with the backrest elevated or in a cardiac chair helps decrease chest discomfort and dyspnea.

.improving respiratory function

1. regular and careful assessment of respiratory function can help the nurse to detect early signs of pulmonary complications.

2. scrupulous attention to fluid volume status prevents overloading the heart and lungs.

3. encouraging the patient to breath deeply and change position frequently helps keep fluid from pooling in the bases of the lungs.

. promoting adequate tissue perfusion

1. limiting the patient to bed or chair rest during the initial phase of treatment is particularly in helping in reducing myocardial oxygen consumption. This limitation should remain until the patient is painfree and hemodynamically stable. 2. checking skin temperature and peripheral pulses frequently is important to monitor tissue perfusion. 3. oxygen may be administered.

. reducing anxiety

1. providing information to the patient and family in an honest and supportive manner encourages the patient to be a partner in care and greatly assists in developing a positive relationship.

2. ensuring a quiet environment, preventing interruptions that disturb sleep, using a caring and appropriate touch, teaching the patient relaxation techniques, using humor and encouraging laughter are the other interventions that can be used to reduced the patients anxiety.

3. music therapy.

.monitoring and managing potential complications

1. monitor the patient closely for changes in cardiac rate and rhythm, heart sounds, blood pressure, chest pain, respiratory status, urinary output, skin color and temperature, sensorium, ECG changes, and laboratory values.