Med Surg ACS and HF

Question 1

What are the learning outcomes for ACS?

Answer 1

Compare and contrast clinical manifestations of stable angina, unstable angina and MI

Interpret diagnostic and physical assesssment findings in patients who have ACS

Differentiate between modifiable and non-modifiable risk factors for CAD

Discuss patient-centered collaborative treatment

Question 2

What is the pathophysiology of ACS?

Answer 2

Imbalance between coronary blood supply and myocardial demand

Myocardial cells ischemic within 10 seconds:

• Decreased pump function
• Deprived of glucose so anaerobic processes take over
• Lactic acid accumulates
• Cardiac output decreases

Question 3

What is chronic stable angina pectoris?

Answer 3

Angina pectoris: chest pain r/t no permanent myocardia

Ischemia: chest discomfort, familiar to patient, limit exercise, managed by drug therapy

Chronic stable angia: caused by rest or exercise. longer then 15 minutes-not relieved by rest or nitro

Unstable angina: various forms

Question 4

What are the different forms of unstable angina?

Answer 4

New-onset angina: first symptoms after exertion

Variant angina: artery spasm

Pre-infarction: chest pain before MI weeks before

Question 5

What is Acute Coronary Syndrome?

Answer 5

Unstable angina

MI

• non-ST elevation MI: ischemia
• ST elevation MI: in 2 adjacent leads
• Subendocardial: only myocardium, T wave inverse, no Q wave
• Transmural: extends through myocardial, Q waves
• Zones of infarction: necrosis, injury & ischemia

Question 6

What is the Incidence and Prevelence of ACS?

Answer 6

35% of all deaths among individuals 65 years

Average age is 64.5 years for men and 70 for women

CAD is leading cause of prematur, permanent disability in the US

Non-modifiable risk factors: age, gender, family history, ethnicity

Modifiable risk factors: diabetes mellitus, HTN, hyperlipidemia, obesity, smoking, stress, limited physical activity, excessive alcohol, methamphetamine or cocaine use

Question 7

What are ways to promote health and maintenance?

Answer 7

reducing elevated serum lipid levels

using complementary and alternative therapies

eliminating tobacco use

increasing physical activity

managing other factors: HTN, DM, obesity, alcohol, stress

Question 8

What are the ACS assessment?

Answer 8

History

Physcial: pain, pallor with cool, clammy skin, tachycardia and or heart palpitations, diaphoresis, vomitting, decreased LOC, diminished or absent pulses

Cardiac markers: CK-MB, Troponin T, Troponin I, myoglobin

Imaging

12-lead ECH

Cardiac Catheterization

Question 9

What are the cardiac markers and the normal levels?

Answer 9

CK-MB isoenzyme: 0% of total CK

Troponin T: <0.20ng/ml

Troponin I: <0.03ng/ml

Myoglobin: <90mcg/L

Question 10

What is the planning and implementation?

Answer 10

Managing acute pain

Improving cardiopulmonary tissue perfusion

Drug therapy

Increasing activity tolerance

Promoting effective coping

Identifying and managing dysrhythmias

Monitoring for and managing heart failiure

Manaing recurrent symptoms and extension of injury

Question 11

What is the planning and implementation of managing actue pain?

Answer 11

Purpose of pt-centered collaborative care is to elimate discomfort of providing pain relef measures, decreasing myocardial oxygen demand, and increasing myocardial oxygen supply

• nitroglycerin: increases collateral blood flow, redistributes blood flow toward the subendocardium and dilates the coronary arteries
• morphine sulfate
• supplemental oxygen
• semi-fowlers position

Question 12

What is the planning and implementation for improving cardiopulmonary tissue perfusion?

Answer 12

Primary outcome: pt will have increased myocardial perfusion as evidenced by an adequate cardiac output, normal sinus rhythm and vital signs within normal limits

Intervention: restore perfusion to injured area within 4-6 hours

• drug therapy chew and swallow aspirin
• reperfusion therapy

Question 13

Planning and Implementing Drug Therapy?

Answer 13

Glycoprotein inhibitors: target platelets in thrombus, IV given

Beta-adrenergic blocking agents: decrease infarction size, decrease mortality, show heart rate and decrease force of contration

Angiotensin-coverting enzyme inhibitors or angiotensin receptor blockers: when 48 hrs MI, prevent heart failure

Calcium channel blockers: used for variant and chronic stable angina

Reperfusion therapy

Question 14

What are the planning and implementation of the phases?

Answer 14

Phase 1: disease until leave

Phase 2: discharge-convalescence at home

Phase 3: long term conditioning

Question 15

Planning and implementing of promoting effective coping?

Answer 15

Patient is expected to learn to cope with the cardiac event and identify effective coping strategies with the help of support systems:

• Denial
• Anger
• Depression

Question 16

What are the expected outcome & intervention?

Answer 16

pt will be free of dysrhythmias, heart failure

Question 17

What are CABG Nursing Considerations

Answer 17

Fluid and Electrolyte imbalance

Bleeding cardiac tamponade

Hypotension

Hpothermia

Hypertension

Decreased level of consciousness

Dysrhythmias

Anginal pain

Postpericardiotomy syndrome