Med- Surg Final- Fall 2015

Question 1

When in doubt- remember…?

Answer 1

• ABCs and Safety
• Try to go with first answer- usually correct
• Assess patient
• When delegating to UAP- they cannot assess or teach…

Question 2

What are the different types of angina?

Answer 2

angina, ischemia, chronic stable angina, unstable angina.

Question 3

What is angina?

Answer 3

chest pain caused by a temporary imbalance between the coronary arteries ability to supply oxygen and the cardiac muscles demand for oxygen

• Substernal chest discomfort
• Left arm pain
• Starts with exertion or stress
• Relieved with nitro or rest
• Less than 15min

Question 4

What is ischemia?

Answer 4

lack of oxygen, occurs with angina and is limited in duration and does not cause permanent damage to myocardial tissues

Question 5

What is chronic stable angina?

Answer 5

is chest discomfort that occurs with moderate to prolonged exertion in a pattern that is familiar to the patient (frequency, duration, and intensity remain the same)

• CSA results in only slight limitation of activities and is usually associated with a fixed atherosclerotic plaque
• Usually relieved with nitroglycerine or rest and is managed with drug therapy

Question 6

What is acute coronary syndrome?

Answer 6

unstable angina or MI; believed that the plaque ruptures resulting in: platelet aggregation, thrombosis formation, and vasoconstriction. Needs >40% plaque accumulation to block blood flow

• MI diagnosed with an ST elevation on the 12-lead ECG
• Positive serum tropin markers
  - ST-elevation MI (STEMI)
  - Non-ST elevation MI (NSTEMI)
  - Unstable angina pectoris

Question 7

What is unstable angina?

Answer 7

occurs at rest or with exertion and causes severe activity limitations

• An increase in the number of attacks and in the intensity of the pressure indicates unstable angina. It may last longer than 15m or may be poorly relieved by rest or nitroglycerine
• Pt. with unstable angina presents with ST changes on a 12 lead ECG but DO NOT have changes in tropin or creatine kinase levels

Question 8

Describe a MI.

Answer 8

most severe acute coronary syndrome. Occurs when myocardial tissue is abruptly and severely deprived of oxygen. Ischemia can lead to injury and necrosis of the tissue if the blood flow is not restored.
o	Substernal chest pain/pressure
o	Left arm, jaw, back, and shoulder pain
o	Without cause usually in the morning
o	Relieved with opioids
o	30m or more

Question 9

Describe NSTEMI.

Answer 9

ST and T-wave change on a 12 lead ECG. Cardiac enzymes may elevate in 3-12 hours. Causes include coronary vasospasm, spontaneous dissection, and slow blood flow due to narrow coronary arteries.

Question 10

Describe a STEMI.

Answer 10

ST-elevation in two continuous leads on a 12 lead ECG. STEMI is attributed to rupture of the fibrous atherosclerotic plaque leading to platelet aggregation and thrombus formation at the site of rupture.

• The thrombus causes and abrupt 100% occlusion to the coronary artery and is a medical emergency that requires immediate revascularization of the blocked artery.