Acs Flashcards
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.
What vital signs should be assessed during an anginal attack?
Vital signs and pulse oximetry
This helps determine the patient’s respiratory and cardiovascular status.
What is the recommended initial medication for pain relief in an anginal attack?
Nitrate
An opioid analgesic may be used if further pain relief is needed.
What should be monitored continuously in Acute Coronary Syndrome (ACS)?
ECG
Continuous ECG monitoring is critical to detect dysrhythmias and other cardiac complications.
What are common acute interventions for ACS?
Pain relief with nitroglycerin, morphine, and oxygen
These interventions help manage symptoms and improve oxygenation.
What emotional support should be provided to clients experiencing ACS?
Maximize client’s social support systems
Consider open visitation to help alleviate anxiety.
What is the purpose of a pulmonary artery catheter after CABG?
Measuring cardiac output and other hemodynamic parameters
This helps in monitoring the client’s cardiovascular status post-surgery.
What is a potential complication of coronary artery bypass grafting (CABG)?
Bleeding and anemia
These can result from damage to RBCs and platelets during the procedure.
What should be monitored for complications related to cardiopulmonary bypass (CPB)?
Fluid status and bleeding
This includes monitoring chest tube drainage and incision sites.
What is the focus of care in the first 24–36 hours post-CABG?
Continuous ECG monitoring and assessing for dysrhythmias
Atrial dysrhythmias are particularly common during this period.
Fill in the blank: The main goal of client teaching post-ACS includes _______.
Risk factor reduction
What factors should be considered for resuming sexual activity after ACS?
Emotional readiness of client and partner, physical expenditure
Education on the use of ED medications may also be necessary.
What are the key evaluation criteria after ACS treatment?
Relief of pain, preservation of myocardium, effective coping with anxiety
Participation in a rehabilitation plan and reduction of risk factors are also important.
What are the nonmodifiable risk factors for CAD?
Age, gender, family history
These factors cannot be changed and contribute to CAD risk.
What are modifiable risk factors for CAD?
Hypertension, smoking, obesity, physical inactivity
These can be addressed through lifestyle changes and medical management.
What should the nurse teach a client about their risk for developing CAD?
Importance of regular checkups and lifestyle modifications
This includes managing hypertension and maintaining a healthy weight.
