Exam 2: CAD DAY 2 Flashcards
Other Care for Acute Coronary Syndrome
- CABG
- Minimally Invasive Direct CAB
- Fibrinolytic Therapy
CABG
New passage between aorta and past coronary arterial obstruction
Commonly used grafts for CABG
Internal Mammary Artery
Saphenous Vein
Very important point to remember after CABG
Antiplatelet Therapy
When is fibrinolytic therapy used?
When facility does not have an interventional cardiac cath lab
What is a fibrinolytic
Dissolves thrombus (clot buster)
When should fibrinolytic be given?
W/in 6 hours of onset of symptoms
Ideally within the 1st hour
Advantages of minimally invasive direct coronary artery bypass
Decreased cost and length of stay
Shorter Recovery
Not true open heart surgery
Criteria for fibrinolytic therapy
- Chest pain typical of MI (< 12 hrs in duration)
- ECG finding consistent w/ acute STEMI
- No absolute contraindications
Absolute Contraindications of fibrinolytic therapy
Hx: intracranial hemorrhage, intracranial tumor, ischemic stroke, severe uncontrolled HTN, active bleeding, aortic dissection, streptokinase therapy w/in 6 mo.
What should the patient’s blood pressure be in order to use fibrinolytics?
> 180/110 mmHg
Potential Nursing responsibilities w/ fibrinolytic therapy
- Baseline labs. 2. IV lines. 3. All invasive procedures before infusion started. 4. Monitor HR, V/S, O2 sat. Watch for repercussion dysrhythmias. 5. Monitor Heparin drip. 6. Watch for bleeding. 7. Monitor Cardiac Biomarkers
Treatments based on Evidence based practice
Core Measures
Core Measures for Acute MI
- Aspirin on arrival. 2. Aspirin prescribed @ discharge. 3. ACE or ARB @ discharge. 4. Smoking Cessation Advice. 5. B-Blocker @ discharge. 6. Fibrinolytic therapy w/in 30 min of arrival. 7. PCI w/in 90 min of arrival. 8. Inpatient mortality. 9. Statin prescribed @ discharge.
Potential Nursing Dx for Acute MI:
Acute Pain
Decreased Cardiac output
Ineffective tissue perfusion
Anxiety; Activity intolerance
Complications of MI
- Dysrhythmias. 2. Heart Failure. 3. Cardiogenic shock. 4. Papillary muscle dysfunction. 5. Pericarditis. 6. Dressler Syndrome
Friction rub r/t inflammation in pericardial sac
Pericarditis
Dressler syndrome
Pericarditis w/ effusion and fever 4-6 weeks after MI
Dressler Syndrome
Nursing care after Acute MI
Provide Education: Cardiac rehab; proper NTG use; dietary teaching; maintain ideal body weight; exercise; emotional support; resumption of sexual activity
Team of people who work together to improve patient quality of life; collaborative
Cardiac rehabilitation
What should nurse teach about diet after MI
low fat; low sodium
Why is it important for patient to exercise after MI
Decrease mortality rate and risk of heart failure
Why should the nurse be concerned with emotional support for the patient after MI?
Increased risk of depression; scared and complete lifestyle change
When can the patient resume sexual activity after MI?
7-10 days after
Avoid ED meds w/ nitrate use.
