A nurse educator who leads a residency program for new nurses is educating the new nurses on the trajectory of chronic illness. The nurse recognizes a need for further teaching when one of the new nurses states which of the following?

Client's Response to Nitroglycerin Therapy

• Unstable Angina:
o Typically, unstable angina responds well to nitroglycerin. The relief of discomfort after nitroglycerin administration suggests that the chest pain was likely related to unstable angina, as it indicates a reduction in coronary artery spasm or temporary ischemia.
• Myocardial Infarction:
o In an MI, nitroglycerin may help alleviate pain, but it does not address the underlying cause of myocardial injury. The pain relief in an MI is generally more variable and may not be as effective if there is significant myocardial damage.

2. Client's Initial Report of Manifestations

• Unstable Angina:
o The symptoms described (shortness of breath, dizziness, and discomfort in the jaw, neck, and left arm) are consistent with unstable angina, which is characterized by episodes of chest pain or discomfort at rest or with minimal exertion, often associated with transient ischemia.
• Myocardial Infarction:
o These symptoms can also be consistent with MI, especially if they are severe or persistent. However, MI often presents with more intense and prolonged pain, and the discomfort might not always resolve with rest.

3. 12 Lead EKG Report

• Unstable Angina:
o ST depression on an EKG is more commonly associated with unstable angina, which indicates transient ischemia rather than a sustained myocardial injury.
• Myocardial Infarction:
o ST depression indicates ischemia commonly in angina.

4. Troponin Results

• Unstable Angina:
o Troponin levels are typically normal in unstable angina. The client’s troponin I (0.01 ng/mL) and troponin T (0.03 ng/mL) are within the normal range, suggesting no significant myocardial injury. This is consistent with unstable angina.
• Myocardial Infarction:
o Elevated troponin levels are a key marker of myocardial injury. The normal troponin results in this case do not support an MI diagnosis, as elevated troponin levels would be expected in MI.

A. Methylprednisolone is a corticosteroid used to reduce inflammation and suppress the immune system. While corticosteroids are sometimes used in critical care settings, they are not specifically used to prevent stress ulcers. In fact, corticosteroids can increase the risk of gastrointestinal bleeding and may require additional measures to protect the stomach lining.
B. Enoxaparin is a low molecular weight heparin (LMWH) used primarily for the prevention of deep vein thrombosis (DVT) and pulmonary embolism (PE). It works as an anticoagulant, preventing blood clots. While enoxaparin is important for preventing thromboembolic events in critically ill patients, it does not specifically address the prevention of stress ulcers.
C. Pantoprazole is a proton pump inhibitor (PPI) that reduces gastric acid production by inhibiting the proton pumps in the stomach lining. PPIs are commonly used to prevent and treat stress ulcers because they help decrease gastric acid secretion, thereby reducing the risk of ulcer formation and bleeding. This makes pantoprazole the appropriate medication to administer to prevent physiologic stress ulcers in a patient with sepsis on a ventilator.
D. Ibuprofen is a nonsteroidal anti-inflammatory drug (NSAID) that is used for pain relief and inflammation. NSAIDs can actually increase the risk of gastrointestinal bleeding and ulceration, especially in critically ill patients.