ACS, MI, CATH week 2 Flashcards
What is the cause of CAD
atherosclerosis
What are the types of CAD
- Stable CAD (stable angina)
2. Acute coronary syndrome (ACS) - plaque ruptures, thrombus formation
Acute clinical presentation of CAD
Unstable angina
Non-ST Elevation MI (NSTEMI)
ST Elevation MI (STEMI)
Severity of blood obstruction with Unstable Angina (UA), Non-ST elevation MI (NSTEMI), and ST elevation MI (STEMI)
Unstable angina = minor
NSTEMI = partial
STEMI = complete
knowing the stages of many heart issues (flip)
Angina –> arrhythmias –> MI –> HF or cariogenic shock
How do we ID someone having an MI
look at ST elevation on ECG; however, they may be having an NSTEMI where the ST segment is not elevated. If this is the case, you need to look at patient’s s/s and cardiac markers
Chest pain assessment scale: PQRST
Provoke: what provokes or precipitates the discomfort?
Quality: What is the quality of your pain?
Radiation: Does your discomfort/pain go to any other location?
Severity: Can you rank your discomfort on scale 1-10
Timing: When did the discomfort start and what were you doing at the time?
Describe stable angina
“effort” angina: triggered by physical or mental exertion
resolves with rest or nitrates
Describe unstable angina
new onset or worsening angina that is unpredictable
rest/med do not resolve
– also called acute coronary syndrome, may lead to MI
What is you client likely to experience if they have an inferior wall MI?
Drop in blood pressure - it involves the right coronary artery
What are reasons someone may have chest pain?
Angina ACS MI Unstable angina Pericarditis Pulmonary pneumonia PE
What are non-cardiac reasons that someone may experience chest pain?
Esophageal disorders Hiatal hernia Reflux Spasm Esophagitis Anxiety/panic disoder Costochondriasis Dissecting aorta
How to relieve pericarditis pain
lean forward
ACS patho
Includes unstabe angina - NSTEMI, STEMI
Unstable angina patho
medical emergecy when changes from previous - fatigue, significant pain with little exertion
MI patho
Ischemia and necrosis - usually thrombus blockage of vessel - severity affected by collateral circulation
What are assessments for someone experiencing ACS, Unstable angina or MI
HR and RR (check for elevation) BP (increased or decreased) saturation (decreased) Chest pain (not relieved with rest) Perfusion in extremities LOC UOP N/V Fever Diaphoresis, ashen, pale skin Anxious appearance
Why might diabetics experience pain differently
d/t neuropathy
When does angina become a medical emergency
when stable angina turns to unstable angina
MI diagnostic tools: ECG - what will you see?
ST elevation, Q wave, T wave inversion
Cardiac marker: Troponin
Troponin I: < 0.35 mcg/L
Troponin T: <0.2 mcg/L
3-4 hours normal in 10-14 days)
Cardiac markers: Ck with MB
38-174 u/L MB
< 5% increase 4 hours peak 24 normal 48
Cardiac marker: Myoglobin
5-70 mcg/mL, increase 1-3 hour peak 12 hour
Goal for coronary angio with MI
Need to get to cath lab, goal is to get them in there in 60 minutes of MI
Interventions when MI
Bestrest, HOB up, need IV access, will progress to more activity slowly
Intervention unstable angina
if MI is ruled out, patient will be put on anti-platlet medication and heparin
MONA for MI
Morphine - give to alter preload (vasodilation), decreases anxiety, only medication that is analgesic, bronchodilation
Oxygen - increase O2 supply
Nitroglycerine SL - vasodilator for coronary arteries which will relieve pain, decrease the myocardial o2 demand because its increasing the size of the coronary arteries, it increases the artery size (patient might get HA)
Chewable aspirin - anti- platelet properties to limit extent of clot
MI - reperfusion therapy
a. Cath / PTCA stent
b. Surgical revascularization CABG
Thrombolytics MI
30 minutes from presentation to max 6 hours after symptoms start - tPA (retaplase)
Meds that can be used for cardiac problems
BB
Ace inhibitors
Antiplatlet and anticoagulant
Beta blocker
reduce myocardial o2 consumption
reduce myocardial contractility
antiplatlet and anti-coagulant
Prevent platlet aggregation and subsequent thrombus
What does HIT stand for
Heparin induced thrombocytopenia
education for MI
Cardiac rehab - for progressive activity
Diet - low in cholesterol and sodium and high in fiber
decrease stress
benefits of lifestyle change
Cardiac catheterization
Angiography into the right or left coronary artery. Contrast dye inserted into the artery. NCLEX considers the access in the femoral artery
Cardiac catheterization: assessments
BP, HR, RR, sat., assess for hemostasis, assess extremities, movement, sensation
What do we need to consider if someone is require to have contrast dye?
making sure they are not on metformin (kidney damage), assess kidney function before resuming metformin, need to know creatinine
What can occur with femoral access for cardiac catheterization?
Retroperitoneal bleed
Complications of coronary cath
Restenosis Dissection perforation abrupt closure vasospasm acute MI acute arrhythmia cardiac arrest Risk for thrombosis
Why will a patient be on anti-platelet medication for up to a year after coronary catheterization
Risk of thrombosis and restenosis
6 P’s to assess for cardio
pulse paralysis pain perishingly cold pallor paraesthesia
