Perfusion (CAD)
What are the effects of beta-blockers (Metoprolol, Atenolol)
Hypotension Bradycardia
The ________________ provides information that assists in ruling out or diagnosing an acute MI, and should be obtained within 10 minutes from the time a patient reports pain or arrives to the ED.
12-lead ECG
What test identifies the type and location of an MI?
12-lead ECG
What are performed to clarify whether a patient has unstable angina, NSTEMI, or STEMI?
12-lead ECG Lab testing (Serial cardiac bio markers)
What procedures may be used to restore the blood supply to the myocardium?
-Percutaneous transluminal coronary angioplasty -Intracoronary stents -CABG
Myoglobin levels in an MI starts to increase within what time frame?
1 to 3 hours Peaks 12 hours
Thrombolytics should be given within what time of presentation to hospital?
30 minutes
An increased Troponin level can be detected within ____________ and remains elevated for as long as ______________
A few hours -Can be detected for up to 2 weeks
Creatine Kinase (CK-MB) level begins to increase within what time frame?
A few hours and peaks within 24 hours of an infarct
The use of ___________ in patients after MI decreased mortality rates and prevents remodeling of myocardial cells that is associated with the onset of heart failure.
ACE inhibitors
If ACE inhibitor is contraindicated in inpatient management following ACS/MI what might be prescribed?
ARB (Angiotensin receptor blocker)
Thrombolytics should not be used if the patient has:
Active bleeding (recent trauma or surgery) Bleeding disorder Hemorrhagic stroke Pregnancy
Is an emergent situation characterized by an acute onset of myocardial ischemia that results in myocardial death.
Acute Coronary Syndrome
What are some collaborative problems/potential complications of angina?
Acute coronary syndrome and/or MI Dysrhythmia and cardiac arrest Heart failure Cardiogenic shock
Chest pain that occurs suddenly and continues despite rest and medications (unstable angina) is the presenting symptoms of most patients with ________________
Acute coronary syndrome/MI
What is included in nursing prevention of angina?
Assessment findings reviewed Identify level of activity that causes symptoms Plans the patient activities according -Balance of rest and activity is important
What is usually the cause of angina?
Atherosclerotic disease
What medication class reduces myocardial oxygen consumption by blocking beta-adrenergic sympathetic stimulation to the heart?
Beta-Blockers -Metoprolol -Atenolol
What nursing education should be included for a diabetic patient receiving beta-blockers?
Blood sugar should be checked frequently because these medications can mask hypoglycemic shy proms
What laboratory tests are used to diagnose acute MI?
Cardiac enzymes -Troponin -Creatine Kinase (CK) -Myoglobin
Following PCI or thrombolytic therapy, continuous ____________ is indicated
Cardiac monitoring
What are contraindications for Beta-blocker use?
Hypotension Bradycardia AV block Acute heart failure (Cause bronchoconstriction, therefor contraindicated in chronic pulmonary disorders such as asthma)
Indications for thrombolytic therapy include:
Chest pain lasting more than 20 minutes, unrelieved by Nitroglycerin ST elevated in at least two leads Less than 6 hours from onset of pain
Physical examination of a patient suspect of ACS/MI is always conducted, but alone does not:
Confirm diagnosis
Management following PCI or thrombolytic therapy includes:
Continuous cardiac monitoring Aspirin, Beta-blockers, and ACE inhibitor
What should be monitored closely in inpatient management of patients receiving ACE inhibitors
Hypotension Urine output Serum sodium Potassium And creatinine levels
Clinical manifestations of ACS/MI include:
Unstable angina SOB Indigestion Nausea Anxiety Cool, pale, and moist skin Tachycardia and tachypnea
What is the objective in the medical management of angina?
Decrease the oxygen demand of the myocardium (medications) and to increase oxygen supply
Side effects of Beta-blockers (olol) include:
Depression Fatigue Decreased libido Dizziness
Patient history for evaluation of ACS/MI should include:
Description of symptoms History of previous cardiac/other illness Family history of cardiac disease Patient's risk factors for CAD
What is often the presenting symptom of angina in older adults ?
Dyspnea
Treat major bleeding of a patient on thrombolytic therapy via:
Direct pressure with notification of PCP
What should nursing education include for patient's receiving beta-blockers?
Do NOT stop taking them abruptly, because angina may worsen and MI may develop Should be decreased gradually over several days
The __________ is used to evaluate ventricular function and may be used to diagnose MI when an ECG is nondiagnostic
Echocardiogram
A common adverse effect of Nitroglycerin is:
Headache
S/S to watch out for a patient on thrombolytic therapy:
Headache Tachycardia Hypotension Decreased H/H AMS Back pain Weakness
What is involved in the diagnosis of angina?
History 12-lead EKG Laboratory studies Stress testing Heart Catheterization
What can cause cardiac Troponin levels to rise outside of MI?
Inflammation and other forms of mechanical stress on the myocardium (Sepsis, HF, and respiratory failure)
The goals of medical management in ACS/MI are to:
Minimize myocardial damage Preserve myocardial function Prevent complications
What are nursing considerations for a patient on thrombolytic therapy?
Minimize the number of times the patient's skin is punctured Avoid IM injections Draw blood for laboratory tests when starting IV Avoid continual use of noninvasive BP cuff Monitor for reperfusion, acute dysrhythmias, and hypotension Check for signs of bleeding, decreased BP, tachycardia, back pain, muscle weakness, AMS, headaches
In an ____________, plaque rupture and subsequent thrombus formation result in complete occlusion of the artery, leading to ischemia and necrosis of the myocardium supplied by that artery.
Myocardial infarction (MI)
Which cardiac laboratory testing is not very specific in indicating an acute cardiac event, but its negative results can be used to rules out an acute MI?
Myoglobin
The patient has elevated cardiac bio markers (Troponin) but no definite ECG evidence of acute MI
NSTEMI
Alerting GI symptoms while assessing a patient for ACS/MI include:
Nausea Vomiting Indigestion
What type of intervention should be made for cardiac patients who are active smokers?
Nicotine replacement therapy Smoking cessation counseling
What medication class are a standard treatment for angina pectoris?
Nitrates -Nitroglycerin
__________ therapy for ACS/MI is initiated when primary PCI is not available or the transport time to a PCI-capable hospital is too long?
Thrombolytic (Activase, Retavase, TNkase
TREATMENT GUIDELINES FOR ACUTE MYOCARDIAL INFARCTION:
Obtain 12-lead ECG to be read within 10 minutes Obtain Lab blood specimen for cardiac bio markers Obtain other diagnostics to clarify diagnosis Begin routine medical interventions: Supplementary O2 Nitro Morphine Aspirin Beta-blockers ACE inhibitor within 36 hours Statin
The patient with suspected MI should IMMEDIATELY receive what?
Oxygen (2 liters) Aspirin Nitroglycerin Morphine
What in combination with pharmacologic therapy is usually initiated at the onset of chest pain?
Oxygen therapy -O2 delivery to Myocardium and decrease pain
Nursing education for patients with angina is designed for what?
Patient and family members understand the illness, identify symptoms or MI, state actions to take when symptoms develop, discuss preventions of chest pain and advancement of CAD.
Medical management of angina involves decreasing the oxygen demand of the myocardium. This is met via what?
Pharmacologic therapy Control of risk factors (HTN, DM etc)
Alerting respiratory symptoms while assessing for ACS/MI include:
SOB Dyspnea (older population) Tachypnea Crackles (if MI has caused pulmonary congestion)
What are the goals of education for patients with angina?
Reduce the frequency and severity of anginal attacks To delay progress of underlying disease To prevent complications
Regardless of MI location, the goals of medical therapy are to:
Relieve symptoms Prevent or minimize myocardial tissue death Prevent complications
What is a major indication for used of Nitrates (Nitroglycerin)?
Short-and long-term reduction of myocardial oxygen consumption through selective vasodilation
Predicate let and consistent pain that occurs on exertion and is relieved by rest and/or Nitrogylcerin
Stable angina
If a patient begins reporting angina, which may include sensation of indigestion or nausea, choking, heaviness, weakness, or numbness in the upper extremities, dyspnea, or dizziness what should the nurse do?
Stop all activities Sit in bed in semi-fowlers position to reduce oxygen requirement Assess pain features Measure vitals and obtain ECG If O2 is low 2 liters is started Nitroglycerin is given sublingually
In relation to blood pressure, when is Nitroglycerin considered contraindicated?
Systolic blood pressure less than 90
The first signs of an acute MI on an ACG are generally seen in the:
T-wave and ST segment
Major goals for patients with angina includes:
Treatment when angina occurs Prevention of angina Reduction of anxiety Awareness of the disease Adherence to self-care program
In __________________ with acute coronary syndrome, there is reduced blood flow in a coronary artery, often due to rupture of an atherosclerotic plaque.
Unstable angina
Symptoms increase in frequency and severity; may not be relieved with rest or Nitroglycerin
Unstable angina
The patient has clinical manifestations of coronary ischemia , but ECG and Troponin show no evidence of acute MI
Unstable angina
Alerting cardiovascular symptoms while assessing for ACS and acute MI include:
Unstable angina (not relived by rest or nitro) JVD (MI has caused HF) Hypertension Irregular pulse (A-fib) ST-segment and T-wave changes, rate changes
General alerting symptoms while assessing for ACS/MI include:
Unstable angina, JVD SOB, dyspnea Nausea, vomiting, indigestion Decreased urinary output (may indicate cardiogenic shock) Cool, clammy, diaphoretic Anxiety, dizziness, light-headedness
What are causes of an MI?
Vasospasm (sudden constriction or narrowing of a coronary artery) Decreased O2 supply (acute blood loss, anemia, or low blood pressure) Increased demand for O2 (Tachycardia, Thyrotoxicosis, or ingestion of cocaine)
