Exam 2- Acute Coronary Syndromes Flashcards
Chronic (stable) Angina
Angina that has not increased in frequency or severity over time
Unstable Angina (UA)
Angina that is changed in frequency, severity, or duration or occurs with less exertion or rest
Prinzmetal’s (variant) Angina
Resting angina caused by coronary artery spasm
Non-ST-segment elevation MI (NSTEMI)
Intermittently occlusive thrombus that may cause myocardial necrosis of the inner most layer of the myocardium
ST segment elevation MI (STEMI)
Thrombus occluding a coronary vessel for a prolonged period of time
Unstable Angina onset
New onset
Unstable Angina duration of pain
usually more than 20 minutes
ST segment elevation MI (STEMI) is what kind of thrombus
Occlusive
STEMI reduced blood flow results
Results in myocardial ischemia, injury and necrosis with damage extending through all myocardial layers
Chest Pain Assessment: PQRST Method
P (provoke)
Q (Quality)
R (Radiation)
S (Severity)
T (Timing)
Clinical Presentation: Characteristics of the patient’s symptoms (5)
- Duration
- Location and radiation of discomfort
- Associated symptoms
- Effect of exertion and rest (timing of discomfort is critical)
- Effect of nitrates
Atypical Clinical Presentation: Women (4)
- Tired
- Lack of energy
- Shortness of breath
- More likely to deny pain
Atypical Clinical Presentation: Diabetics (1)
-Silent ischemia
Atypical Clinical Presentation: Elderly (3)
- Weakness
- Dyspnea
- Confusion
Atypical Clinical Presentation General (2)
- Numbness
- Burning
Atypical Clinical Presentation: general pain location
Substernal or left side
Atypical Clinical Presentation: Chest pain location (6)
- Back
- Area between the shoulder blades
- Upper abdomen
- Shoulders
- Elbows
- Ears
Typical Clinical Presentation (10)
- Pain or discomfort
- Nausea/Vomiting
- Pallor
- Diaphoretic/Cool clammy skin
- Hemodynamic instability
- Dyspnea
- Arrhythmias
- Weakness/Lightheadedness
- Anxiety/Apprehension
- Denial
Clinical Presentation: Additional considerations (4)
- Presence of risk factors for CAD
- Medication History (including use of illicit drugs)
- History of tests, interventions, coronary artery bypass grafts (CABG), percutaneous coronary angioplasty (PTCA)
- Allergies
Nursing Diagnoses: Main one!
Risk for decreased cardiac perfusion
Nursing Diagnoses (4)
- Risk for decreased cardiac perfusion
- Anxiety related to cardiac symptoms and possible death
- Deficient knowledge about underlying disease and methods for avoiding complication
- Noncompliance, ineffective management of therapeutic regimen related to failure to accept necessary lifestyle changes
Nursing Interventions (6)
- Treatment of angina pain is a priority nursing concern
- Stop all activity and sit or rest in bed
- ECG is assessed or obtained
- Administer oxygen
- Medications as ordered, usually NTG
- Reperfusion
Interventions/Medications (9) (5 important ones!)
- Position of comfort
- Oxygen
- Nitroglycerin
- Morphine sulfate
- Aspirin
- Heparin
- Quiet and calm environment
- Beta-adrenergic blocking agents
- Calcium channel blocking agents
Health Teaching (8)
- Smoking cessation
- Diet control
- Complementary and alternative therapies
- Physical activity
- Sexual activity
- Blood pressure, blood glucose control
- Cardiac medications
- Self-monitoring; seeking medical assistance if needed
