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Year 2: Nursing Adults with Acute conditions > Acute Coronary Syndrome > Flashcards

Acute Coronary Syndrome Flashcards

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1
Q

Which ward should patient’s diagnosed with ACS be admitted to as soon as possible?

A

Coronary Care Unit - ccu

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2
Q

What causes ACS?

A

atherosclerosis - plaque ruptures and thrombus formation

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3
Q

What should be considered when proving information and support to a patient with ACS?

A

• Patients will be anxious
• A warm welcome from staff is important to establish a
therapeutic relationship

  • Sufficient information to understand their diagnosis and treatment plan
  • A personalised approach
  • Managing realistic expectations from patient & family
  • If chest pain assess/ Differential diagnosis
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4
Q

When treating a patient with chest pain what should you treat for first?

A

The most serious case - myocardial infarction

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5
Q

What protein causes localised vassoconstriction?

A

Thromboxane A2

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6
Q

What is Acute coronary syndrome (ACS)?

A

An acute coronary syndrome represents a
combination of clinical signs and symptoms that
result from myocardial ischaemia

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7
Q

What would be the condition of a person with a stable intact lesion?

A

stable angina

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8
Q

What would be the condition of a patient with breached endothelium with or without superimposed fibrin clot and
coronary spasm?

A

ustable angina

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9
Q

What would be the condition of a patient with Plaque rupture with superimposed fibrin clot leading to total coronary
occlusion and coronary spasm?

A

myocardial infarction

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10
Q

What factors make a thorough cardiac assessment?

A
  • Patients require a detailed clinical assessment including ABCDE
  • ECG

• Repeat 12 lead ECGS if diagnostic
uncertainty or any change in clinical status

• Continuous cardiac monitoring

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11
Q

When presented with a patint with chest pain what type of questions should be considerdered or factors?

A
  • History of current problem
  • Onset
  • What makes symptoms better/worse
  • Maybe stable angina
  • ACS
  • Unstable angina
  • Acute myocardial infarction
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12
Q

Suggest some contributory factors for ACS

A
  • Age
  • S
  • FH or CHD
  • Prior hx IHD
  • Diabetes mellitus
  • Renal impairment
  • High risk features
  • Worsening angina
  • Prolonged pain> 20mins in duration
  • Pulmonary oedema
  • Hypotension
  • Arrhythmias
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13
Q

Suggest some risk factors for ACS

A
  • Smoking – mortality 60% higher in smokers
  • Hypercholestraemia
  • Diet – 1/3 of men & women consume 5 portions fruit & veg
  • Sedentary lifestyle 5 x 30mins week
  • Alcohol consumption
  • Hypertension
  • Obesity
  • Socioeconomic deprivation
  • Diabetes
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14
Q

How does alcohol consumption increase risk of ACS?

A

induces slight hypertension which increases risk of damage to endothlium

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15
Q

What protective mechanism do pre-menopusal woman have against ACS?

A

oestrogen

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16
Q

What mnemonic should be used to assess patient chest pain?

A

PQRST

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17
Q

What does PQRST stand for?

A 
P = Precipitating factors
Q = Qualitative factors
R = Region & Radiation
S = Severity & associated symptoms
T = Timing
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18
Q

What would assessment would you expect from an unstable angina?

A 
P = 
Q = Pressing, squeezing
R = Across Chest,jaw, shoulders, back, arms
S = Mild to moderate
T = 1-20mins
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19
Q

What would assessment would you expect from a Myocardial infarction?

A 
P = 
Q = Tight, heavy, burning
R = Across Chest,jaw, shoulders, back, arms
S = Not always severe
T =  20 mins-several hrs
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20
Q

What would assessment would you expect from a dissecting aortic aneurysm?

A 
P = 
Q = Ripping, tearing
R = Anterior chest,radiating to neck,back or abdomen
S = Very severe
T = Abrupt onset Pesistent for hrs
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21
Q

When assessing the type of chest pain what should you ask the patient?

A
  • Pain
  • What’s the position of pain
  • Radiation
  • Quality
  • Circumstances
  • Time span
  • Relief
  • Pain score
22
Q

what obs should be assessed in particular in a patient with chest pain?

A
  • Blood pressure
  • Heart rate
  • Temperature
23
Q

What scale is used to assess severety for patients with heat failiure?

A

New York Heart association classification of heart failiure

24
Q

When visually inspecting a patient,what factors you consider

A 
• Does the patient look unwell
• Colour
• Signs of shock
• Weight loss
• Look at the face – pain, xanthelasma, thyroid
disease
• Hands
• Chest – breathing
• Oedema
25
Q

What symptoms would you expect from a atient with class II heart failiure?

A

Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath)

26
Q

In what groups might you find an atypical presentation of ACS?

A
  • Women
  • Elderly
  • Diabetics
  • Ethnic minority groups
27
Q

List some common symptoms of ACS?

A
  • Chest pain
  • Hypotension
  • Autonomic nervous system activation
  • Pallor
  • Sweating
  • Rhythm disturbances
28
Q

What biochemical marker sugeest a myocardial infarction?

A

Cardiac troponins released after myocardial
damage
• Troponin I & troponin T are markers of
myocardial necrosis
• Cardiac specific
• Also take 3-4hrs to detect but are elevated
for 1-2 weeks

29
Q

What does a basic ECG record?

A

• It is a simple recording of the electrical activity of cardiac cells during contraction and relaxation of the heart

30
Q

How do Basic ECG work?

A

The electrical currents are conducted through the body tissues and can be picked
up by electrodes attached to the skin

These are amplified and displayed on paper
or a monitor screen.

31
Q

What is the name of triangle formed from the 3 leads in an ECG?

A

Einthoven’s triangle

32
Q

What wave represent atrial contraction?

A

the P-wave

33
Q

what wave represent ventricular contraction?

A

qrs complex

34
Q

What is an ST elevation?

A

trace in the ST segment is abnormally high above the baseline

35
Q

What does the ST segment show?

A

reflects pause between the end of ventricular depolarisation and start of ventricular
repolarisation.

36
Q

what is another word for the baseline on an ECG?

A

isoelectric line

37
Q

What could ST segment elevation be caused by?

A

MI; non-ischaemic causes:

hyperkalaemia;

38
Q

What could ST segment depression be caused by?

A

MI, hypokalaemia; hypothermia.

39
Q

What secondary prevention methods are put in place for patients who have had an ACU

A
  • LIFESTYLE
  • CARDIAC REHABILITATION
  • DRUG THERAPY
  • CARDIOLOGIST REVIEW
40
Q

What medication is given to ptients following an ACU?

A

• Antiplatelet therapy: Aspirin 75 mg OD indefinitely

• Clopidogrel 300mg/75mg for 12 months (NSTEMI)
at least 4 weeks for STEMI unless other indications
for dual antiplatelet therapy

OR

• Tigacrelor 180mg/90,g BD for 12 months inhibits
platelet aggregation & thrombus formation

• Maybe PPI Omeprazole

41
Q

when should statins be given?

A

at night

42
Q

When should b blockers be given?

A

as soon as patient clinically

stable

43
Q

What are the 4 types of Anti-hypertensives?

A

Beta-Blockers
ACE inhibitors
Aldosterone affecting medication?
Calcium antagonists

44
Q

When suffering from on MI which arm is likely to feel pain?

A

left arm

45
Q

What happen during a PEA non-shockable rhythm?

A

When there is a normal ECG but no cardiac output

46
Q

Which rhythms are non-shockable?

A

PEA and asystole

47
Q

Which rhythms are shockable?

A

Ventricular fibrillation and pulseless ventricular tachycardia

48
Q

According to the New York Association classification of heart failiure how would one class an ACS patient with no limitation of physical activity,no undue fatigue, palpitation or dyspnea?

A

Class 1 Mild

49
Q

How does Hyperkalaemia affect st on ECG?

A

cauess st elevation

50
Q

How does Hypokalaia affect st on ECG?

A

caueses st depression

Year 2: Nursing Adults with Acute conditions (12 decks)

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