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NUR 250 - Exam II > Acute Coronary Syndromes > Flashcards

Acute Coronary Syndromes Flashcards

Cardiovascular Disorders - PPT 1

1
Q

Signs & Symptoms of Acute Coronary Syndrome

KNOW THIS!!!

A
  • ↑ BP
  • EKG changes
  • Shortness of breath
  • Tachypnea
  • Nausea / vomiting
  • Cool, clammy, diaphoretic
  • Light headedness
  • Crackles (L ventricle is failing causing fluid to back up in the lungs)
  • Anxiety
  • Restlessness
  • Fear / feeling of impending doom
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2
Q

Signs & Symptoms of Acute Coronary Syndrome in patient populations

  • Males
  • Females
  • Geriatric
  • Diabetics

KNOW THIS!!!

A

Males:
* chest pain,
* ↑ BP
* EKG changes
* SOB
* tachypnea
* N/V
* diaphoresis
* lightheadedness
* crackles

Females:
* back pain / chest pain with radiation
* tired
* more likely to deny pain

Geriatrics:
* ONLY shortness of breath
* ↑ RR
* crackles
* confusion
* dyspnea
* weakness

Diabetics:
* No pain (unaware ACS is occuring)

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3
Q

KEY signs & symptoms of Acute Coronary Syndrome (ACS) in males

KNOW THIS!!!

A
  • Chest pain
  • ↑ BP
  • EKG changes
  • SOB
  • Tachypnea
  • N/V
  • Diaphoresis
  • Light-headedness
  • Crackles (L ventricular failure = fluid back up in the lungs)
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4
Q

KEY signs & symptoms of Acute Coronary Syndrome (ACS) in females

KNOW THIS!!!

A
  • Tired / lack of energy
  • SOB
  • Pain with radiation to the back or shoulder
  • More likely to deny pain
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5
Q

KEY signs & symptoms of Acute Coronary Syndrome (ACS) in diabetics

KNOW THIS!!!

A

Silent Ischemia
* no pain
* no s/s

Pt is unaware Acute Coronary Syndrome event / heart attack is occuring

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6
Q

KEY signs & symptoms of Acute Coronary Syndrome (ACS) in the elderly

KNOW THIS!!!

A
  • Weakness
  • Dyspnea
  • Confusion
  • SOB (may be the only symptom they have)
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7
Q

List 4 potential diagnoses of Acute Coronary Syndrome

A
  • STEMI
  • NSTEMI
  • Unstable Angina
  • Non-Cardiac
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8
Q

Signs & Symptoms of Acute Coronary Syndrome in males

KNOW THIS

A
  • Chest pain
  • ↑ BP
  • EKG changes
  • SOB
  • Tachypnea
  • N/V
  • Cool, clammy, & diaphoretic
  • Light headed
  • Crackles
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9
Q

Signs & Symptoms of Acute Coronary Syndrome in Geriatric Population

KNOW THIS

A
  • only SOB (no pain)
  • Dyspnea
  • Confusion
  • Weakness
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10
Q

Signs & Symptoms of Acute Coronary Syndrome in Females

KNOW THIS

A
  • Chest pain with radiation to the back or shoulder
  • Tired / lack of energy
  • More likely to deny pain
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11
Q

Signs & Symptoms of Acute Coronary Syndrome in Diabetics

KNOW THIS

A

No Pain (unaware pain is occuring due to nerve damage)

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12
Q

Nursing Interventions for Acute Coronary Syndrome (ACS)

Know These

A
  • Priority Concern = treat angina pain
  • Have patient sit & rest (no activity)
  • EGK assessed or obtained
  • Administer O2
  • Administer ordered meds
  • Reperfusion (cardiac cath lab)
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13
Q

EKG changes seen on a STEMI

KNOW THIS!!!

A
  • T wave inversion = ischmeia
  • ST elevation = injury has occured
  • Q wave = tissue death / infarction

hyperacute / peaked T-waves (due to hyperkalemia)

Elevated Troponin, CK, & CK-MB (Cardiac Biomarkers) are also seen

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14
Q

What does T-wave inversion on an EKG indicate?

KNOW THIS!!!

A

Ischemia

inadequate blood supply to the heart

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15
Q

What does ST elevation on an EKG indicate?

KNOW THIS!!!

A

Injury has occured

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16
Q

What does the presence of a Q-wave on an EKG indicate?

KNOW THIS!!!

A

Infarction

tissue death

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17
Q

What do the following EKG changes identify?

  • T wave inversion
  • ST Elevation
  • Q Wave

KNOW THIS!!!

A
  • T wave inversion = ISCHEMIA (inadequate blood supply)
  • ST Elevation = injury has occured
  • Q wave = tissue death / infarction
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18
Q

What labs are drawn on patients with suspected Acute Coronary Syndrome?

KNOW THIS!!!

A
  • CBC
  • BMP
  • BNP
  • Troponin
  • CK
  • CK-MB
  • PT, PTT, & INR are helpful to know about clotting ability

bold = cardiac biomarkers

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19
Q

EKG Changes seen in NSTEMIs (non-ST elevated MI)

KNOW THIS!!!

A
  • ST segment depression
  • T-wave inversion = ischemia
  • Elevated cardiac biomarkers (Troponin, CK, CK-MB)
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20
Q

Cardiac Biomarkers

A

Troponin = most sensitive cardiac markers
* levels rise 4-6 hours after onset of ischemic symptoms
* Peak at 18-24 hours after MI
* Most sensitive cardiac markers (Troponin I & Troponin T)

Creatinine Kinase (CK-MB)
* not as sensitive in early MI less than 6 hours after onset
* levels rise 4-8 hours after onset
* Peak 12-24 hours
* Returns to normal around 24-48 hours

Myoglobin = muscle damage
* very sensitive marker, but not cardiac specific
* can be increased due to intense exercise, crush injuries, car accident, etc.

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21
Q

Primary Therapeutic Goals for MIs

A
  • Optimize blood flow
  • Reduce amount of myocardial necrosis
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22
Q

Order of Medications that are given for Chest Pain suggestive of Ischemia

KNOW THIS!!!

A

Aspirin – 160 - 325 mg
Oxygen – 4 L/min (if O2 less than 94%)
Nitroglycerin (assess pain, HR, BP, & RR before & after admin)
Morphine

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23
Q

Aspirin for Ischemic chest pain
* action
* normal dosage
* who should receive this medication?
* risks with this medication

KNOW THIS!!!

A

ACTION = Anti-Platelet

DOSE: 160 - 325 mg (taken ASAP)

RISKS: ↑ bleeding risk

  • Administer as soon as possible for ALL patients w/ acute MI chest pain
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24
Q

Oxygen - when is it given in patients with a potential acute MI?

KNOW THIS

A

4 L / min if O2 saturation is less than 94%

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25
Q

SUBLINGUAL Nitroglycerin for patients with potential acute MI

  • How does it work?
  • Nursing Responsibilities

KNOW THIS!!!

A

Sublingual = up to 3 doses every 5 minutes

How it works
* ↑ venous dilation
* ↓ venous blood return to heart (orthostatic hypotension)
* ↓ preload
* ↓ cardiac oxygen consumption

Nursing Responsibilities
* pain rating
* vitals

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26
Q

IV Nitroglycerin
* Nursing responsibilities

A
  • Frequent BP monitoring
  • Continuous EKG monitoring
  • do not stop abruptly (titrate off)
  • Usually only used for 24 hours
  • MUST be done in an ER or critical care setting
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27
Q

Morphine
* Dose
* Nursing Responsibilities
* When is it given?

KNOW THIS!!!

A

Dose: 1-5 mg every 5-30 minutes

Nursing Responsibilties (what to monitor)
* BP
* RR
* HR
* Level of consciousness
* Respiratory depression
* Assess pain

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28
Q

How does Nitroglycerin work in patients with acute MIs?

Know This!!!

A

Venous Dilation: heart doesn’t have to pump as hard

  • ↓ venous blood return to the heart (orthostatic hypotension)
  • ↓ preload
  • ↓ O2 demand of the heart
  • dilation (↑) coronary artery
  • venous pooling
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29
Q

How does Morphine work for patients who might have an acute MI?

KNOW THIS!!!

A

↓ O2 demand of the heart

CONCERNS:
* ↓ RR
* ↓ BP

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30
Q

How do ADP-Receptor Inhibitors work?

Examples & typical dosing

Risks associated with the medication

KNOW THIS!!!

A

decrease platelet aggregation

  • Clopidogrel (Plavix): 300-600 mg PO (ASAP)
  • Prasugrel (Effient): 60 mg PO (ASAP)

Risks: ↑ bleeding risks

can be used WITH Aspirin

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31
Q

Glycoprotein IIb-IIIa Inhibitors

  • What is it / how does it work?
  • When is it indicated?
  • Examples

KNOW THIS!!!

Adjunctive Treatment

A

inhibit platelet aggregation

Indications:
* ACS w/ NSTEMI
* Unstable Angina
* ACS undergoing PCI (cath lab)

Examples:
* eptifibatide (Integrilin)
* abciximab (Reopro)

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32
Q

List the 3 Anti-Ischemic Adjuvent Therapies

KNOW THIS!!!

Adjuvant Therapies

A
  • Beta Blockers:
  • ACE Inhibitors
  • Caclium Channel Blockers
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33
Q

Beta Blockers

  • How do they work?
  • Effects on the body
  • Contraindications
  • Examples

KNOW THIS!!!

Adjunctive Therapies

A

How do they work?
* ↑ fill time
* ↓ Oxygen consumption of the heart

Effects on the Body
* ↓ HR
* ↓ BP
* ↓ myocardial O2 demand & workload

Contraindications:
* Heart failure
* Low cardiac output
* Increased risk of cardiogenic shock

Examples
* Metropolol
* Propranolol
* Atenolol

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34
Q

Calcium Channel Blockers
* How do they work?
* Examples

KNOW THIS!!!!

Adjunctive Therapies

A

Action = VASODILATION
* prevent ischemia

Examples
* Verapamil
* Diltiazem

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35
Q

ACE Inhibitors
* How do they work?
* Actions
* Nursing Considerations
* Examples

KNOW THIS!!!

Adjunctive Therapies

A

Convert angiotensin I to II

ACTIONS
* ↓ BP
* ↓ O2 demand
* ↓ sudden death & recurrent MI
* lowers peripheral vascular resistance

Nursing Considerations
* Monitor for orthostatic hypotension
* Monitor potassium levels
* Monitor renal function
* Nagging cough = common side effect

Examples:
* Enalapril
* Captopril

“-pril”

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36
Q

What is the primary action of Beta Blockers (ACS)?

  • What effects do beta blockers have on the body?
  • Examples of Beta Blockers

KNOW THIS!!!

PER HAYLEY

A

↑ ventricular filling time
* ↓ oxygen demand of the heart

EFFECTS ON THE BODY:
* ↓ HR & ↓ BP

EXAMPLES:
* metropolol
* propranolol
* atenolol

“-olol”

37
Q

What is the primary action of nitrates, diuretics, & morphine (ACS)?

KNOW THIS!!!

PER HAYLEY

A

↓ Preload

heart does *NOT need to stretch/fill as much to reach maximum fill

heart won’t have to work as hard

38
Q

What is the primary action of ACE inhibitors on the heart (ACS)?

KNOW THIS!!!

PER HAYLEY

A

↓ afterload

Heart won’t have to pump/push against as much of a force to get blood out to the rest of the body

39
Q

List the Anti-Coagulation Adjunctive Therapies

KNOW THIS!!!

A
  • Heparin
  • Low Molecular Weight Heparin (LMWH)
  • Direct Thrombin Inhibitors
40
Q

What is the reversal agent for heparin?

KNOW THIS!!!!!!!!!!!!

A

Protamine Sulfate

41
Q

Heparin (Adjunctive therapy)
* What does it do?
* What is the reversal agent?
* Administration
* Considerations

Know This!

A

Anti-Thrombin (prevents formation of thrombi)

Reversal = Protamine Sulfate

Administration
* 60 units/kg IV bolus (maximum 4,000 units initial dose)
* 12/units/kg/hr continuous IV infusion

Considerations
* contraindicated in active bleeding
* caution after recent surgery, bleeding, or severe HTN

1.) IV Bolus
2.) Continuous IV Infusion

Goal aPTT = 2.5 - 5.0

42
Q

Which medications for treatment of Acute Coronary Syndromes (including acute MIs) are types of anti-platelet therapy?

A
  • Aspirin
  • Clopidogrel
43
Q

Early Invasive Strategies for the treatment of Acute Coronary Syndrome

A
  • Percutaneous Coronary Intervention (PCI) = cath lab
  • Fibrinolytic therapy (dissolves clots)
  • Combination of PCI with fibrinolytic therapy
44
Q

How fast does coronary stent placement have to occur?

KNOW THIS!!!

A

within 90 minutes

  • from door to cath lab
45
Q

How fast does Fibrinolytic Therapy need to occur?

KNOW THIS!!!

A

less than 30 minutes

  • from door to drug time
46
Q

How fast should the initial EKG be obtained in patients with a potential MI?

KNOW THIS!!!

A

within 10 minutes of arrival

47
Q

Patients with what type of MI should NOT receive fibrinolytic therapy?

A

NSTEMI

PCI within 24 hours

48
Q

Patient Teachings for MIs

Know what is in bold

A

Recognize & take action for recurrent symptoms
* call 911 if chest pressure or pain is not relieved in 15 minutes by taking 3 nitroglycerin

  • healing is not complete post MI for 6-8 weeks

Lifestyle Modifications
* stop smoking
* reduce stress
* decrease caffeine
* modify intake of calories, sodium, & fat

maintain regular physical activity

49
Q

What is happening to the heart during a STEMI?

A

Acute injury is occurring

  • Cath lab ASAP
50
Q

If you see a “fire helmet” on an EKG, what should you do?

A

Get the patient to the cath lab within 3 hours

51
Q

What is ischemia?

A

Inadequate blood supply to the heart

52
Q

Describe what is seen in an NSTEMI

KNOW THIS!!!

A
  • ST segment depression
  • T-wave inversion
  • Elevated biomarkers
53
Q

Describe the difference in what is seen during a STEMI vs. an NSTEMI

A

STEMI: ST elevation, hyperacute / peaked T-waves, Q-wave formation

NSTEMI:
* ST depression
* T-wave inversion

54
Q

Describe unstable angina

KNOW THIS!!!

A

Unexpected, occurs at rest, usually lasts more than 20 minutes

  • angina that has changed in frequency, severity, or duration
55
Q

What are the most sensitive cardiac biomarkers?

A

Troponin I & Troponin T

56
Q

True or False:

The biomarker myogloboin is very sensitive, but it is not cardiac specific

A

True: myoglobin is elevated with all tissue damage, not just cardiac tissue damage

57
Q

What is the treatment protocol for any patient who presents with chest pain?

KNOW THIS!!!!!!

A

Aspirin

Oxygen (if less than 94%)

Nitroglycerin (SL - up to 3 times 5 minutes apart)
* assess pain, HR, BP, RR (before & after nitro)

Morphine (IV)
* control pain
* reduce myocardial oxygen demands

58
Q

What is the action of Aspirin?

KNOW THIS!!!

A

Anti-Platelet

  • inhibits platelet aggregation
59
Q

What is the action of nitroglycerin?

KNOW THIS!!!

A

Venous Dilation - so heart doesn’t have to work as hard

  • ↓ venous blood return to heart
  • ↓ preload
  • ↓ cardiac O2 consumption
60
Q

Side effect of nitroglycerin

KNOW THIS!!!

A

Orthostatic hypotension

61
Q

Action, Side Effects, & Nursing Responsibilities of Nitroglycerin

KNOW THIS!!!

A

ACTION: Venous Dilation - heart doesn’t have to pump as hard

  • ↓ venous blood return to heart
  • ↓ preload
  • ↓ cardiac oxygen consumption

SE: orthostatic hypotension

Nursing Responsibilities
* Initial pain assessment (and regular rechecks)
* Vitals (and rechecks)

62
Q

True or False:

You should stop IV nitroglycerin abruptly

A

FLASE

63
Q

Nursing responsibilities associated with nitroglycerin

A
  • Initial pain assessment
  • Vitals

Continuous EKG monitoring for IV nitro; done in critical care setting or ER; usually only used for 24 hours; don’t stop suddenly

64
Q

Actions of ADP-Receptor Inhibitors
Side Effects of ADP-Receptor Inhibitors
Examples of ADP-Receptor Inhibitors

KNOW THIS!!!

A

Anti-Platelet
* inhibits platelet aggregation

Side Effects:
* severe bleeding risk

EXAMPLES:
* clopidogrel (Plavix)
* prasugrel (Effient)

65
Q

Examples of ADP-Receptor Inhibitors

A
  • clopidogrel (Plavix)
  • prasugrel (Effient)
66
Q

Actions of ADP-Receptor Inhibitors & Glycoprotein IIb-IIIa Inhibitors

KNOW THIS!!!

A

Anti-Platelet
* inhibit platelet aggregation

67
Q

Examples of Glycoprotein IIb-IIIa Inhibitors

KNOW THIS!!!

A
  • eptifibatide (Integrilin)
  • abciximab (Reopro)
68
Q

Action of Glycoprotein IIb-IIIa Inhibitors
Indications for Glycoprotein IIb-IIIa Inhibitors
Examples of Glycoprotein IIb-IIIa Inhibitors

KNOW THIS!!!!!

A

Anti-Platelet
* inhibits platelet aggregation

INDICATIONS:
* ACS with NSTEMI
* Unstable angina
* ACS undergoing percutaneous cardiac intervention (PCI / cath lab)

EXAMPLES:
* eptifibatide (Integrilin)
* abciximab (Reopro)

69
Q

What are indications for eptifibatide (Integrilin) or abciximab (Reopro) (Glycoprotein IIb-IIIa Inhibitors)?

A
  • ACS with NSTEMI (non-Q-wave MI)
  • Unstable angina medically managed
  • ACS undergoing PCI (cath lab)
70
Q

List 3 types of anti-ischemia therapies for ACS

A
  • Beta-blockers
  • ACE Inhibitors
  • Calcium Channel Blockers
71
Q

Action of Beta Blockers
Contraindications for Beta Blockers
Examples of Beta Blockers

KNOW THIS!!!

A

block sympathetic nervous system
* ↓ HR
* ↓ BP

CONTRAINDICATIONS:
* Heart failure
* Low cardiac output
* Increased risk of cardiogenic shock

EXAMPLES:
* Metropolol
* Propranolol
* Atenolol

72
Q

What drug class ends in -olol?

A

Beta Blockers

73
Q

List examples of beta-blockers

A
  • Metropolol
  • Propranolol
  • Atenalol
74
Q

How do beta blockers work?

A

↓ activity of the heart (↓ cardiac work load & ↓O2 demand)
* ↓ BP
* ↓ HR

75
Q

What do beta-blockers reduce?

A

Workload of the heart & oxygen demand

76
Q
  • Action of Calcium Channel Blockers
  • Examples of Calcium Channel Blockers

KNOW THIS!!!

A

Vasodilation
* prevents ischemia

EXAMPLES:
* verapamil
* diltiazem (Cardizem)

77
Q

What drug class ends in -pril?

A

ACE Inhibitors

78
Q

Action of ACE Inhibitors
Examples of ACE Inhibitors

KNOW THIS!!!

A

↓ BP
↓ O2 demand

EXAMPLES:
* lininopril
* enalapril
* captopril

79
Q

What should nurses monitor for / what are common side effects in patients who are on ACE Inhibitors for the treatment of ACS?

A

SE = Nagging Cough

Monitor for:
* orthostatic hypotension
* potassium levels & renal function

80
Q

What is the main anticoagulant used for acute coronary syndrome (ACS)?

Heparin

A

Heparin

81
Q

What is the antedote for a Heparin overdose?

KNOW THIS!!!!!!

A

Protamine sulfate

82
Q

A patient with a STEMI should receive PCI (catheter) within how many minutes of arrival to the hospital / ER?

KNOW THIS!!!

A

90 minutes

83
Q

A patient with a STEMI should receive a fibrinolytic agent within how many minutes of arrival to the hospital / ER?

KNOW THIS!!!

A

30 minutes

84
Q

A patient with an NSTEMI should have PCI (cath) can be done within how many hours of arrival to the hospital / ER?

KNOW THIS!!!

A

24 hours

85
Q

**For a patient wiht a poptential MI (STEMI or NSTEMI), an initial EKG should be obtained within how many minutes of arrival to the hospital / ER? **

KNOW THIS!!!!

A

10 minutes

86
Q

For patients with an NSTEMI, they should receive fibrinolytic therapy within how many minutes of arriving to the hospital / ER?

KNOW THIS!!!

A

NOT RECOMMENDED

No fibrinolytic therapy

87
Q

Patients with a STEMI should receive PCI and fibrinolytic therapy within how many minutes of arriving to the hospital / ER?

KNOW THIS!!!

A
  • PCI = within 90 minutes of arrival
  • Fibrinolytics = within 30 minutes of arrival
88
Q

Patients with an NSTEMI should receive PCI and Fibrinolytic therapy therapy within how many minutes of arriving to the hospital / ER?

KNOW THIS!!!

A

PCI = within 24 hours of arrival

Fibrinolytics =
NEVER (contraindicated)

NUR 250 - Exam II (11 decks)

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