A patient who had a STEMI one day ago reports anxiety and difficulty breathing while sitting upright. What should the nurse expect to administer?

A patient who had a STEMI one day ago reports anxiety and difficulty breathing while sitting upright. What should the nurse expect to administer?

• A. Beta-blocker only
• B. Antibiotics
• C. Furosemide (Lasix) and nitroglycerin (NTG)
• D. Morphine and oxygen

Answer: (C)

When a patient recently having a STEMI develops anxiety and difficulty breathing while sitting up, the most likely issue is left-sided heart failure with pulmonary edema causing orthopnea. The main goal is to unload fluid and reduce the heart’s workload to relieve the edema and improve oxygenation. Furosemide is used to remove excess fluid, decreasing preload and helping to clear pulmonary congestion. Nitroglycerin reduces preload (and afterload to some extent) by venodilation, which lowers filling pressures and further eases pulmonary edema, while also potentially relieving ischemia by lowering myocardial oxygen demand. Together, they directly address the fluid overload and ischemic stress seen after a STEMI with pulmonary congestion. Antibiotics would not address this hemodynamic problem. Morphine and oxygen are not routinely required for this scenario unless hypoxia is present, and beta-blockers alone do not rapidly relieve acute pulmonary edema. If oxygen is needed, it should be given based on oxygen saturation. Monitor blood pressure and renal function, and watch for hypotension with nitro and diuresis.

When a patient recently having a STEMI develops anxiety and difficulty breathing while sitting up, the most likely issue is left-sided heart failure with pulmonary edema causing orthopnea. The main goal is to unload fluid and reduce the heart’s workload to relieve the edema and improve oxygenation.

Furosemide is used to remove excess fluid, decreasing preload and helping to clear pulmonary congestion. Nitroglycerin reduces preload (and afterload to some extent) by venodilation, which lowers filling pressures and further eases pulmonary edema, while also potentially relieving ischemia by lowering myocardial oxygen demand. Together, they directly address the fluid overload and ischemic stress seen after a STEMI with pulmonary congestion.

Antibiotics would not address this hemodynamic problem. Morphine and oxygen are not routinely required for this scenario unless hypoxia is present, and beta-blockers alone do not rapidly relieve acute pulmonary edema. If oxygen is needed, it should be given based on oxygen saturation. Monitor blood pressure and renal function, and watch for hypotension with nitro and diuresis.