Myocardial Infarction: NCLEX Priorities
MI for NCLEX: STEMI vs NSTEMI, MONA, troponin, door-to-balloon, post-MI care.
MI is the high-stakes cardiac topic. NCLEX tests recognition, initial management, and post-MI teaching.
Recognition
Crushing substernal chest pain, radiating to left arm/jaw. Diaphoresis, N/V, dyspnea, anxiety. Women, diabetics, elderly often atypical (fatigue, jaw pain, back pain).
Diagnostics
ECG: ST elevation (STEMI) or ST depression/T inversion (NSTEMI). Troponin elevated (peaks 12-24h, stays elevated 7-10 days). CK-MB historical.
Initial management (MONA)
Morphine (pain), Oxygen (if hypoxic), Nitroglycerin (chest pain), Aspirin (325 mg chewed). Anticoagulation. Beta-blocker if stable.
Reperfusion
STEMI: PCI within 90 min door-to-balloon. If PCI unavailable: tPA (fibrinolytic) within 30 min if no contraindications. NSTEMI: medical management → cath within 24-72h based on risk.
Post-MI discharge
Beta-blocker, ACE inhibitor, statin, antiplatelet (aspirin + clopidogrel for 12 mo post-stent). Cardiac rehab. Lifestyle (diet, exercise, smoking cessation).
Frequently asked
Nitroglycerin, how many?
Up to 3 sublingual q5 min. If no relief after first, call 911 (per AHA 2020 guidance).
Aspirin, chew or swallow?
Chew for faster absorption in suspected MI.
Quick check
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