Acute Coronary Syndrome

The nurse is caring for a patient recently returning from cardiac catheterization after a severe myocardial infarction (MI). In discussing the plan of care with the patient, which statement is most appropriate to describe care for the immediate post procedure period?

"I can assist you onto the bedpan if you need help." Use of a bedpan is based on patient preference and is appropriate care after a large MI to avoid extra movement that could stress the myocardium.

A patient comes to the emergency department with complaints of chest pain. The initial ECG shows ST-segment elevation in more than three leads. Which intervention should the nurse perform first?

Administer oxygen and nitrates. A patient with an ST-segment-elevation myocardial infarction (STEMI) requires oxygen to decrease the amount of damage to the myocardium and nitrates to increase coronary blood flow.

The emergency department receives a report from a paramedic who is transporting a patient with chest pain that is unrelieved by three sublingual nitroglycerin tablets. Which priority collaborative care intervention should be implemented on the patient's arrival?

Administration of morphine intravenously Administration of morphine will decrease pain. This is the priority intervention at this time.

The nurse is caring for a patient who arrives in the emergency department with complaints of chest pain. Which nursing intervention is a priority for this patient?

Elevate the head of bed. Elevating the head of bed places the patient in an upright position to maximize oxygenation and promote myocardial perfusion.

On entering a patient's room, the nurse sees the patient clutch his chest, and he states he is in pain. Which nursing interventions are priorities? Select all that apply.

Have the patient rate the pain on a number scale. Asking the patient with chest pain to describe the severity of the pain using a number scale is a priority nursing intervention to help determine whether the pain is cardiac in origin. Determine when the pain started. Asking the patient with chest pain when the pain started is a priority nursing intervention to help determine whether the pain is cardiac in origin. Ask the patient to describe his pain. Asking the patient with chest pain to describe the quality of the pain is a priority nursing intervention to help determine whether the pain is cardiac in origin. Question the patient about the location of the pain. Asking the patient with chest pain about the location and possible radiation of pain is a priority nursing intervention to help determine whether the pain is cardiac in origin.

The surgeon has explained the coronary artery bypass graft (CABG) procedure to a patient. Afterward the patient asks the nurse why he "just can't get more stents." How can the nurse explain the difference between these procedures?

Long-term benefits are expected to be better with CABG. Studies have shown improved patient outcomes, quality of life, and survival after CABG surgery if stent placement is not successful.

The nurse is caring for a patient who returns to the unit after percutaneous coronary intervention (PCI). Which intervention is a priority on the patient's arrival on the unit?

Monitor the ECG for heart rate and rhythm. Because PCI is used to open a blocked artery in patients with segment-elevation myocardial infarction, the priority nursing intervention is to assess the ECG for changes after the procedure.

A patient is complaining of angina that has increased in intensity. The patient's vital signs are as follows: blood pressure 94/52, heart rate 122, respiratory rate 20, temperature 99.9, and oxygenation saturation 93%. An electrocardiogram for the patient shows elevated ST segment in leads II and III. Which intervention has the highest priority in the nursing management of this patient?

Notification of the health care provider Notifying the health care provider is highest priority because ST-segment elevation usually requires percutaneous coronary intervention to restore myocardial perfusion. The health care provider determines the need for immediate PCI.

A patient has been diagnosed with acute coronary syndrome. Which assessment findings would the nurse expect to see?

Pain occurs at rest. The pain from acute coronary syndrome may occur while the patient is active or at rest, asleep or awake. Pain may radiate to other areas. The pain from acute coronary syndrome may radiate to the neck, lower jaw, and arms or to the back. Severe, immobilizing chest pain. Pain from acute coronary syndrome usually lasts for 20 minutes or longer, is more severe than usual chest pain, and may be described as immobilizing.

Which patients are more likely to require off-pump coronary artery bypass (OPCAB) surgery instead of coronary artery bypass graft (CABG) surgery?

Patient with renal complications whose urine output is 50 mL per day OPCAB is associated with less renal dysfunction and would be more likely to be used for a patient with current renal dysfunction. Patient with left ventricular heart failure, obesity, and poor wound healing OPCAB is used for patients with multiple comorbidities because of decreased complications when compared with CABG. Patient with history of an ischemic stroke who has difficulty using the right arm OPCAB is associated with fewer neurological complications and would be more likely to be used for a patient with a history of ischemic stroke, since neurological deficits may already be present.

Unstable angina is considered an emergency because of which pathophysiological occurrence?

Platelet aggregation blocks the artery. Unstable angina results from a ruptured plaque that causes platelet aggregation, which forms a thrombus. The thrombus can partially block blood flow to the heart resulting in myocardial injury, making this a medical emergency.

How does acute coronary syndrome cause injury to the heart?

Platelets adhere to the plaque, occluding blood flow to the myocardium. A thrombus develops from platelets that adhere to the plaque, resulting in lack of blood flow to the myocardium distal to the blockage, which causes necrosis.

A patient diagnosed with myocardial infarction is transferred to the intensive care unit (ICU) for observation after percutaneous coronary intervention (PCI) with stent placement in the right circumflex artery. The nurse will assess for effectiveness of the intervention by monitoring for which changes?

Resolution of ST-elevation changes on a 12-lead ECG Opening of the affected coronary artery allows perfusion manifested by resolution of ST elevation on a 12-lead ECG.

"You are having decreased blood flow to part of the heart." This is the most appropriate response because T-wave inversion indicates a zone of ischemia resulting from decreased blood flow to part of the heart.

ST elevation ST elevation indicates myocardial infarction and requires immediate intervention.

A patient has just been diagnosed with a myocardial infarction. The patient has begun to cry and is verbalizing doubts about being able to care for her family. How would the nurse approach the patient to address these concerns?

"Can you tell me what your concerns are? I have time." Asking the patient to be specific about concerns gives the nurse the opportunity to assist.

A patient comes to the emergency department with complaints of chest pain, and heart monitoring is initiated. The nurse notes T-wave inversion on the electrocardiogram (ECG). The patient questions the nurse about what this means. Which is the nurse's best response?

"You are having decreased blood flow to part of the heart." This is the most appropriate response because T-wave inversion indicates a zone of ischemia resulting from decreased blood flow to part of the heart.

Which statement best describes acute coronary syndrome (ACS)?

ACS is the progression of untreated ischemia. When ischemia is prolonged and not immediately reversible, ACS develops and encompasses the spectrum of unstable angina, non-ST-segment-elevation myocardial infarction, and ST-segment-elevation myocardial infarction.

A patient is being discharged with prescriptions for aspirin and clopidogrel after percutaneous coronary intervention (PCI) to treat acute coronary syndrome. The patient wants to know why these medications need to be taken if the artery is open after the stent was placed. Which is the best response?

Aspirin and clopidogrel can prevent another clot from forming. After PCI, the patient is treated with dual antiplatelet agents until the intimal lining can grow over the stent and provide a smooth vascular surface that will inhibit thrombus formation.

The nurse administers morphine as ordered to a patient experiencing chest pain of 9 on a scale of 10 that is unrelieved by three doses of nitroglycerin. Which assessment finding would be most concerning?

Distended neck veins Distended neck veins indicate heart failure resulting from myocardial infarction, making this the most concerning finding.

What is a primary difference in the clinical manifestations of acute coronary syndrome between men and women?

Fewer women than men manifest the "classic" signs and symptoms of unstable angina or myocardial infarction. Fewer women than men manifest the "classic" signs and symptoms of a cardiac event. Women are more likely to have nontypical symptoms (e.g., fatigue, shortness of breath, indigestion, anxiety).

A male patient diagnosed with acute ST-segment-elevation myocardial infarction (STEMI) is receiving thrombolytic therapy. Which assessment finding by the nurse would require immediate intervention?

The skin is pale and cool with bilateral pedal pulses faintly palpable. Bleeding is a complication associated with thrombolytic therapy. Skin that is pale and cool, in association with faint peripheral pulses, can indicate low blood pressure related to major bleeding, which requires immediate intervention.

Which statement describes how unstable angina differs from chronic stable angina?

Unstable angina has a random onset. Unstable angina differs from chronic stable angina because it is not predictable and can have a random onset.