Chapter 17 Unstable angina

Question 1

What should be ordered before physical examination in patients who have chest pain?

Answer 1

Oxygen, IV access, cardiac monitoring and EKG, Continuous BP monitoring, aspirin and nitroglycerin (if blood pressure can tolerate it). All stat

Question 2

What should be initiated immediately if ECG denotes unstable Angina or NSTEMI? What should also be ordered?

Answer 2

Heparin. Only after negative FOBT is obtained; Beta blocker should also be ordered to keep the heart rate 60 to 70

Question 3

What serial enzymes should be checked?

Answer 3

Two sets eight hours apart, Troponin and CKMB

Question 4

Where should the patient be transferred after cardiac enzymes are ordered? What else should be ordered?

Answer 4

ICU; Basic labs (CBCBMP LFTs PT/INR PTT) portable chest x-ray

Question 5

When should echocardiogram be ordered?

Answer 5

should be performed after acute management and coronary intervention

Question 6

What is the criteria for early invasive therapy in unstable angina? What should be done soon after?

Answer 6

ST depressions, cardiologist consulted and Cath is indicated.

Question 7

What should be added before sending a patient for catheterization?

Answer 7

GP 2B/3A inhibitors should be added to any patient scheduled for Cath

Question 8

What should be ordered for risk reduction after cath is complete?

Answer 8

Lipid profile and if dyslipidemia is present, TSH should be obtained.

Question 9

How should the patient be counseled?

Answer 9

Smoking cessation, cardiac diet (low sodium and cholesterol), exercise program, discharge medications (aspirin Metoprolol, Statin, sublingual nitro, Clopidogrel). Patient counseling, smoking cessation, limit alcohol, exercise program, medication compliance, relaxation techniques, diet, low sodium. Diet, low cholesterol. Follow up in 2 to 6 weeks (SPACED)

Question 10

When should IV Morphine be giving?

Answer 10

When the chest pain is not relieved by nitroglycerin or acute pulmonary congestion and or severe agitation is present

Question 11

What unstable angina patients should undergo Early invasive therapy?

Answer 11

High risk (ST depression, recurrent symptoms, refractory ischemia, or hemodynamic instability)

Question 12

What should be monitored throughout the hospital stay?

Answer 12

Pulse ox, cardiac monitor, BP monitor, PTT (for unfractionated heparin)

Question 13

When should Heparin IV continuous be ordered?

Answer 13

Right after ST elevations and FOBT plus metoprolol IV one time orders

Question 14

We should be ordered to monitor heparin use?

Answer 14

PTT Q6 (not needed for LMWH)