CAD / ACS pt. 3 (Exam 1) Flashcards
Collaborative Care ACS: Initial Assessment
Chest discomfort, SOA or other suggestive symptoms
12 lead EKG within 10 min of arrival (repeat every 10-15 mins if non diagnostic, but suspicion remains)
STEMI with 12 lead EKG
ST segment elevated in two anatomically contiguous leads
T/F: We can we diagnose a STEMI via telemetry
False
it has to be done via a 12 lead EKG
NSTEMI or UA with 12 lead EKG
ST depression or deep T wave inversions without Q waves or possibly not EKG changes
Acute Coronary Syndrom: Initial Interventions
Assess stabilize ABC
Position patient upright
Administer O2 (NC)
Obtain VS including O2 sat
Attach to telemetry (can not diagnose)
Establish IV access
Give ASA 325 (chew / swallow)
Assess Pain PQRST
Obtain baseline lab work
Monitor heart and lung sounds
What baseline lab work do you want on someone who comes in with ACS
Cardiac markers
Electrolytes
H&H
Possible COAGS
If patient is on tele and ST changes, what is the next best nursing action?
12 lead EKG (provider order)
Before giving NTG always
Assess vital signs. If BP = to low give morphine
Collaborative Care ACS: Pain
Give 3 SL NTG one at a time, spaced 5 min apart for persistent chest pain (monitor BP)
Give morphine sulfate for unacceptable, persistent discomfort
Baseline labs for ACS
Cardiac Markers (Troponin)
Electrolytes
H&H
Possible Coags
PQRST: ACS
Precipitating
Quality
Radiation
Severity
Timing
Heart cath shows blockage: What is next?
3 Reperfusion Strategies
1: Emergent percutaneous coronary intervention (PCI)
-STEMI and NSTEMI
2: Thrombolytic (fibrinolytic therapy)
-STEMI
3: Coronary Artery Bypass Graft (CABG)
-DM &/or 3 vessel disease
(open heart surgery)
(PCI) Percutaneous coronary intervention is for
STEMI or NSTEMI
Thrombolytic therapy is for
STEMI
Coronary artery bypass graft (CABG) is for
DM & /or 3 vessel disease
Percutaneous coronary intervention
First line treatment for patients with MI
Goal of PCI
Open the coronary artery within 90 minutes of ED arrival
Before PCI what must be done first?
Cardiac Cath
Before a PCI a cardiac cath is done to
-Locate blockages
-Assess severity of blockages
-Determine presence of collateral circulation
-Evaluate left ventricular function
Percutaneous Coronary Intervention
(PCI)
(Angioplasty)
Procedure
With guide wire a deflated balloon catheter is placed in the coronary artery and blown up to allow for blood flow
Balloon is smashed plaque against the wall and then stens can be placed
Re Establish patency
PCI: Advantages
Alternative to surgical intervention
is performed with local anesthesia
Patient is ambulatory shortly after procedure
Length of hospital stay = 1-3 days (4-6 with CABG)
Can return to work sooner
What do we monitor closely following PCI
-Chest pain
-EKG changes
-Dysrhythmias
-Unstable BP
-Unstable HR
After PCI procedure patient will be on
Dual antiplatelet therapy
ASA and Heparin
We do not want to body to turn on the new device
After PCI. The vascular sheath is removed in _____ and pressure is held for _______
4-6 hrs and pressure is help for 20 min
Check distal site for perfusion
Thombolytic Therapy
Clot Buster Drugs (Fibrinolytics)
Thrombolytic Therapy can be administered during _________
Thrombolytic Therapy is most effective within _________
Cardiac catheterization
6 hours of ACS
Common Thrombolytic Therapy Drugs
Tissue Plasminogen Activator (TPA)
Reteplase (Retavase)
Goal of Thrombolytic Therapy
Start within 30 min of ED admission
Thrombolytic Therapy: Contraindications
History of intracranial hemorrhage
Recent abdominal surgery
Stroke
Any active bleed (excluding menses)
Important post TPA (thrombolytic therapy) administration
Monitor for bleeding post-administration
Coronary Artery Bypass Graft (CABG)
Graft is taken from aorta and bypasses blockage to artery
Can have up 6 different grafts
What is used for grafts in CABG
Internal mammary artery
Saphenous vein (between groin and ankle) (Remove the valves)
Potential Complication: Post CABG
Stroke
MI
Infection (Sternal wound - Vein harvest)
-especially with PVD
Dysrhythmias
Pleural Effusion
Pericardial effusion
Cardiac tamponade
Renal Failure
Pericardial effusion that becomes an emergency
cardiac tampondade
Ongoing Care: CABG
Continuous monitor (tele)
Rest and comfort
-Activity restriction
Help Deal with Anxiety
Helping deal with emotional and behavioral reaction
Patient teaching
