Pharmacology - Case Study #2

A 56-year-old male client is admitted to the intensive care unit with a diagnosis of acute
myocardial infarction. He has a T wave inversion and elevation of the ST segment. The EKG
indicates myocardial ischemia and necrosis. He is started on Lidocaine Hydrochloride by IV
infusion. He is also given aspirin 325 mg po, heparin subcutaneous 5,000 units B.I.D, and
atenolol (Tenormin) 50 mg po daily. It should be noted the client received morphine 10 mg IV
to relieve chest pain in the emergency room.
1. For each of the medications listed, what is the action and rationale for their
administration? Lidocaine Hydrochloride- Action:inhibits Na ion channels, inhibits nerve
impulse conduction and initiation. Rationale- Heart is in arrhythmia. Aspirin- Action:
reduces platelet aggregation and has anti-inflammatory and anti-pyretic effects,
Rationale- prevent further MI and decrease risk of stroke because pt not pumping as
much blood. Heparin- Action: prevents blood clots inhibitory effect on antithrombin,
Rationale- decrease risk of clot due to impaired pumping abiltity. Tenormin-
Action:blocks stimulation of beta 1 adrenergic receptors, Rationale: decrease HR and
BP to reduce the task to the heart. Morphine- Action:binds to opiod receptors alters
response to painful stimuli, Rationale- given to reduce pain associated with MI.
(Epocrates, 2011) (Davis Drug Guide, 2010)
2. What adverse reactions of the medications should the nurse be alert for?
Risk of increased bleeding with aspirin/Heparin, respiratory distress with
morphine,Tenormin-watch for bradycardia, Lidocaine watch for anaphylaxis.
(Epocrates, 2011) (Davis Drug Guide, 2010)
3. What assessments should be made prior to administration of these medications?
Regular vitals especially respiratory rate, BP, EKG, pain level and O2 saturation, health
history. (Adams, Holland, Urban. p.57)
4. What information about the medications should be explained to the client?
The patient should know why they are taking the drug, what it does and when to
take it as well as potential adverse reactions to taking the drug. (Adams, Holland,
Urban. p.63)
Adams, M., Holland, N., Urban, C. (2014). Pharmalcology For Nurses: A Pathophysiologic
Approach. Indianapolis: Pearson Education,Inc.
Deglin, J. H., & Vallerand, A. H. (2010). Daviss Drug Guide for Nurses (12
th
ed.)
[Mobile application software]. Retrieved from
http://www.skyscape.com/estore/productdetail.aspx?productid=219
Epocrates. (2011). Epocrates Essentials for iPhone (Version 3.14) [Mobile application
software]. Retrieved from http://www.epocrates.com/products/iphone/index.html