Acs Flashcards
(39 cards)
What is acute coronary syndrome (ACS)?
A condition that develops when ischemia is prolonged and not immediately reversible, encompassing unstable angina, NSTEMI, and STEMI.
What are the two results of occlusion in acute coronary syndrome?
- Partial occlusion leads to unstable angina (UA) or NSTEMI
- Total occlusion leads to STEMI
What characterizes unstable angina (UA)?
- Change in usual pattern
- New in onset
- Occurs at rest
- Worsening pattern
- Unpredictable and a medical emergency
What is the result of sustained ischemia in myocardial infarction?
Irreversible myocardial cell death (necrosis) after more than 20 minutes of ischemia.
How long does it take for necrosis of the entire thickness of the myocardium to occur?
5–6 hours.
What area of the heart is most commonly involved in myocardial infarctions?
Most MIs involve some portion of the left ventricle.
What type of pain is associated with total occlusion in myocardial infarction?
Severe, immobilizing chest pain not relieved by rest, position change, or nitrate administration.
What are common descriptions of chest pain in myocardial infarction?
- Heaviness
- Constriction
- Tightness
- Burning
- Pressure
- Crushing
What sympathetic nervous system responses occur during myocardial infarction?
- Release of glycogen
- Diaphoresis
- Vasoconstriction of peripheral blood vessels
- Skin may appear ashen, clammy, and/or cool to touch
What cardiovascular changes occur during myocardial infarction?
- Initially increased HR and BP
- Then decreased BP due to reduced cardiac output
- Crackles
- Jugular venous distension
- Abnormal heart sounds (S3 or S4, new murmur)
What are common complications after a myocardial infarction?
- Dysrhythmias
- Heart failure
- Ventricular aneurysm
- Cardiogenic shock
- Pericarditis
What is the most common complication following myocardial infarction?
Dysrhythmias, present in 80% of MI clients.
What is the significance of pathological Q waves on an ECG?
Indicates that at least half the thickness of the heart wall is involved in infarction.
What diagnostic studies are used to assess unstable angina and myocardial infarction?
- Detailed health history and physical exam
- 12-lead ECG
- Serum cardiac markers
- Coronary angiography
- Exercise stress testing
- Echocardiogram
What is the treatment of choice for confirmed myocardial infarction?
Emergent PCI (percutaneous coronary intervention).
What is the goal of fibrinolytic therapy in myocardial infarction?
To dissolve the thrombus in the coronary artery and reperfuse the myocardium.
What is the recommended time frame for administering fibrinolytic therapy after symptom onset?
Ideally within 2 to 3 hours, no greater than 12 hours.
What are some contraindications for fibrinolytics?
What is coronary artery bypass graft (CABG) surgery?
A surgical procedure that requires sternotomy and cardiopulmonary bypass, using arteries and veins for grafts.
What is the purpose of nutritional therapy in acute coronary syndrome?
To initially keep the patient NPO and then progress to a low salt, low saturated fat, and low cholesterol diet.
What are the overall goals in nursing management for patients with acute coronary syndrome?
- Relief of pain
- Preservation of myocardium
- Immediate and appropriate treatment
- Effective coping with anxiety
- Participation in a rehabilitation plan
- Reduction of risk factors
What is the first intervention during an anginal attack?
Administration of supplemental oxygen.
What are some common nursing diagnoses for patients with acute coronary syndrome?
- Acute pain
- Decreased cardiac output
- Anxiety
- Activity intolerance
- Ineffective health management
What is the first acute intervention for an anginal attack?
Administration of supplemental oxygen
This is followed by assessing vital signs and administering medications.