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Med Surg 2 > angina and myocardial infarction > Flashcards

angina and myocardial infarction Flashcards

1
Q

continuum from angina and myocardial infarction

A

acute coronary sundrome

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2
Q

what is a warning sign for impending acute mi

A

angina pectoris

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3
Q

what improves outcome for mi

A

treated with aspirin, beta‑blockers, and angiotensin‑converting enzyme inhibitors or angiotensin receptor blockers.

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4
Q

what causes chest pain

A

When blood flow to the heart is compromised, ischemia causes chest pain.

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5
Q

anginal pain s/s

A

Can radiate to the jaw, neck, or arm.

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6
Q

what differentiates mi from angina

A

Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min

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7
Q

what is ischemia

A
  • is reversible
  • can lead to tissue necrosis (infarction) if blood supply and oxygen are not restored.
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8
Q

what produces myocardial ischemia

A

An abrupt interruption of oxygen to the heart muscle produces myocardial ischemia`

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9
Q

what provides specific markers of MI

A

When the cardiac muscle suffers ischemic injury, cardiac enzymes are released into the bloodstream, providing specific markers of MI

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10
Q

types of angina

A

stable
unstable
variant

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11
Q

stable angina

A

(exertional) angina occurs with exercise or emotional stress and is relieved by rest or nitroglycerin.

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12
Q

unstable angina

A

(pre-infarction) angina occurs with exercise or at rest, but increases in occurrence, severity, and duration over time

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13
Q

variant angina

A

(Prinzmetal’s) angina is due to a coronary artery spasm, often occurring during periods of rest

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14
Q

acute coronary syndrome steps

A
  1. deterioration
  2. rupture
  3. platelet aggrgation
  4. thrombus
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15
Q

results of acute coronary syndrome

A
  • Partial occlusion of coronary artery: NSTEMI
  • Total occlusion of coronary artery: STEMI
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16
Q

risk factors for acs

A
  • Male gender or postmenopausal women
    Ethnic background
    Sedentary lifestyle
    Hypertension
    Tobacco use
    Hyperlipidemia
    Obesity
    Excessive alcohol consumption
    Metabolic disorders (diabetes mellitus, hyperthyroidism)
    Methamphetamine or cocaine use
    Stress (with ineffective coping skills)
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17
Q

PHYSICAL ASSESSMENT FINDINGS of acs

A
  • Pallor, and cool, clammy skin
  • Tachycardia and heart palpitations
  • Tachypnea and shortness of breath
  • Diaphoresis
  • Vomiting
  • Decreased level of consciousness
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18
Q

Diagnostic Procedures for MI

A

Electrocardiogram (ECG)
Stress test
Cardiac catheterization
Thallium scan
Assesses for ischemia or necrosis.

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19
Q

nursing actions for diagnostic procedures

A

Instruct the client to avoid smoking and consuming caffeinated beverages 4 hr prior to the procedure. These can affect the test.

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20
Q

Cardiac catheterization

A
  • Used to evaluate the presence and degree of coronary artery blockage.

Angiography
- Coronary artery narrowing and occlusions are identified by the injection of contrast media under fluoroscopy.

21
Q

angina ecg changes

A

ST depression and/or T-wave inversion indicates presence of ischemia.

22
Q

mi ekg changes

A

T-wave inversion indicates ischemia; ST-segment elevation indicates injury; abnormal Q-wave indicates necrosis.

23
Q

nursing assessment: Angina precipitated by exertion or stress:

A
  • Relieved by rest or nitroglycerin
  • Symptoms last less than 15 min
  • Not associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis
24
Q

nursing assessments myocardial infarction

A
  • Can occur without cause, often in the morning after rest
  • Relieved only by opioids
  • Symptoms last more than 30 min
  • Associated with nausea, epigastric distress, dyspnea, anxiety, diaphoresis
25
Q

MI classification

A
  • Affected area of the heart: anterior, lateral, inferior, or posterior
  • ECG changes produced: ST elevation myocardial infarction vs. non-ST elevation myocardial infarction
  • The time frame within the progression of the infarction: acute, evolving, old
26
Q

nursing care for MI

A
  • Vital signs every 5 min until stable, then every hour
  • Serial ECG, continuous cardiac monitoring
  • Location, precipitating factors, severity, quality, and duration of pain
  • Hourly urine output: greater than 30 mL/hr indicates renal perfusion
  • Laboratory data: cardiac enzymes, electrolytes, ABGs
  • Administer oxygen: 2 to 4 L/min.
  • Obtain and maintain IV access.
  • Promote energy conservation.
  • Cluster nursing interventions.
27
Q

vasodilators for MI

A
  • Nitroglycerin prevents coronary artery vasospasm and reduces preload and afterload, decreasing myocardial oxygen demand.
28
Q

nursing consideration for nitroglycerin

A
  • Used to treat angina and help control blood pressure.
  • Used cautiously with other antihypertensive medications.
  • Can cause orthostatic hypotension
29
Q

CLIENT EDUCATION FOR CHEST PAIN: vasodilators

A
  • Instruct the client to stop activity and rest.
  • Instruct the client to place a nitroglycerin tablet under the tongue to dissolve (quick absorption).
  • If pain is unrelieved in 5 min, the client should call 911 or be driven to an emergency department.
  • The client can take up to two more doses of nitroglycerin at 5-min intervals.
  • Remind the client that a headache is a common side effect of this medication.
  • Encourage the client to sit and lie down slowly
30
Q

analgesics for mi

A

morphine

31
Q

morphine

A

Analgesics act on receptors that help alleviate pain

  • Produces analgesia (pain relief)
  • Respiratory depression
  • Euphoria
  • Sedation
  • Lowers myocardial oxygen consumption and gastrointestinal (GI) motility.

! Use cautiously with clients who have asthma or emphysema due to the risk of respiratory depression.

32
Q

nursing considerations for morphine

A
  • Assess pain every 5 to 15 min.
  • Watch for manifestations of respiratory depression, especially in older adults.
  • If respirations are 12/min or less, stop medication, and notify the provider immediately.
  • Monitor vital signs for hypotension and decreased respirations.
  • Assess for nausea and vomiting.
33
Q

beta blockers

A

Beta‑blockers

Metoprolol has antidysrhythmic and antihypertensive properties that decrease the imbalance between myocardial oxygen supply and demand by reducing afterload and slowing heart rate.

NURSING CONSIDERATIONS
Beta-blockers can cause bradycardia and hypotension.
Hold the medication if the apical pulse rate is less than 60/min, and notify the provider.
Use with caution in clients who have heart failure.
Monitor for decreased level of consciousness, crackles in the lungs, and chest discomfort.

CLIENT EDUCATION
Encourage the client to sit and lie down slowly.
Remind the client to notify the provider immediately of shortness of breath, edema, weight gain, or cough.

34
Q

Thrombolytic agents for mi

A
  • Alteplase and reteplase are used to break up blood clots.
  • Thrombolytic agents have similar side effects and contraindications as anticoagulants.
  • For best results, give within 6 hr of infarction.
35
Q

Thrombolytic agents nursing considerations

A
  • Assess for active bleeding, peptic ulcer disease, history of stroke, recent trauma
  • Monitor for effects of bleeding
  • mental status changes
  • hematuria
  • Monitor bleeding times: PT, aPTT, INR, fibrinogen levels, and CBC.
  • Monitor for the same side effects as anticoagulants (thrombocytopenia, anemia, hemorrhage).
  • Remind the client of the risk for bruising and bleeding while on this medication.
36
Q

Antiplatelet agents

A
  • Aspirin and clopidogrel prevent platelets from forming together, which can produce arterial clotting.
  • Aspirin prevents vasoconstriction.
  • Should be administered with nitroglycerin at the onset of chest pain.
  • Antiplatelet agents can cause GI upset.
  • Use cautiously with clients who have a history of GI ulcers.
  • Tinnitus (ringing in the ears) can be a sign of aspirin toxicity.
37
Q

antiplatelet agents nursing considerations

A
  • Risk for bruising and bleeding
  • Encourage the client to use aspirin tablets with enteric coating and to take with food.
  • Tell the client to report ringing in the ears.
38
Q

anticoagulants

A
  • Heparin and enoxaparin are used to prevent clots from becoming larger or other clots from forming.
  • Assess for active bleeding, peptic ulcer disease, history of stroke, recent trauma
  • Monitor platelet levels and bleeding times: PT, aPTT, INR, and CBC.
  • Monitor for adverse effects thrombocytopenia, anemia, hemorrhage.
39
Q

Client Education for MI

A
  • Cardiac rehabilitation for a specific exercise program related to the heart.
  • Nutritional services, for diet modification or weight management.
  • Instruct the client to monitor and report signs of infection, such as fever, incisional drainage, and redness.
  • Teach the client to avoid straining, strenuous exercise, or emotional stress when possible.
  • Regarding response to chest pain: follow instructions on use of sublingual nitroglycerin.
  • If client is a smoker, encourage smoking cessation.
40
Q

what to do in acute mi

A
  • A complication of angina not relieved by rest or nitroglycerin
  • Administer oxygen.
  • Notify the provider immediately.
41
Q

Injury to the left ventricle can lead to

A

decreased cardiac output and heart failure.

42
Q

Progressive heart failure can lead to

A

cardiogenic shock

43
Q

Heart failure/cardiogenic shock

A

This is a serious complication of pump failure, commonly following an MI of 40% blockage.
- Tachycardia/Hypotension
- Inadequate urinary output
- Altered level of consciousness
- Respiratory distress (crackles and tachypnea)
- Cool, clammy skin/Decreased peripheral pulses
- Chest pain

44
Q

what to do for Heart failure/cardiogenic shock

A
  • Administer oxygen
  • Intubation and ventilation may be required
  • Administer IV morphine, diuretics, and/or nitroglycerin to decrease preload.
  • Administer IV vasopressors and/ or positive inotropes to increase cardiac output and maintain organ perfusion.
  • Maintain continuous hemodynamic monitoring
45
Q

Ischemic mitral regurgitation

A
  • Evidenced by development of a new cardiac murmur.
  • Administer oxygen.
  • Notify the provider immediately
46
Q

Dysrhythmias An inferior wall MI

A

can lead to an injury to the AV node, resulting in bradycardia and second-degree AV heart block.

47
Q

complications of an mi

A

dysthymia
Ischemic mitral regurgitation
hf/shock

48
Q

An anterior wall MI can lead to an

A

injury to the ventricle, resulting in premature ventricular contractions, bundle branch block, or complete heart block.
- Monitor ECG and vital signs.
- Administer oxygen.
- Administer antidysrhythmic medications.
- Prepare for cardiac pacemaker if needed.

Med Surg 2 (35 decks)

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