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NURS 3512 - Class 1-6 > Week 3 - Acute Coronary Syndrome/MI > Flashcards

Week 3 - Acute Coronary Syndrome/MI Flashcards

1
Q

what is acute coronary syndrome

A
  • when myocardial ischemia is prolonged and not immediately reversible
  • umbrella term for situations where the blood supplied to the heart muscle is suddenly blocked or reduced
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2
Q

acute coronary syndrome encompasses the spectrum of… (3)

A
  • unstable angina
  • non ST segment elevation MI
  • ST segment elevation MI

each remains a seperate diagnosis, but ACS reflects the relationship among them

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3
Q

ACS is associated w…

A
  • an atherosclerotic plaque that was once stable
  • plaque ruptures = stimulates platelet aggregation & local vasoconstriction w thrombus formation
    = either partial occlusion by a thrombus or total occlusion by a thombus
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4
Q

what does partial occlusion by a thrombus manifest as

A
  • unstable angina

- NSTEMI

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5
Q

what does total occlusion by a thrombus manifest as

A
  • STEMI
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6
Q

what is unstable angina

A
  • chest pain that is new in onset, occurs at rest, or has a worsening pattern
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7
Q

what is the difference between unstable agina & chronic stable angina

A

UA =

  • unpredictable
  • progresses rapidly in past few hours, days, or weeks
  • more frequent
  • easily provoked by minimal or not exertion (even at rest or sleep)
  • medical emergency
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8
Q

what are prodormal symptoms of UA (4)

A
  • fatigue
  • SOB
  • indigestion
  • anxiety
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9
Q

what diagnostic tests are used for UA (2)

A
  • EKG

- bloodwork (serum cardiac markers) 4-8 hx2 after a MI

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10
Q

what are 3 types of serum cardiac markers

A
  • troponin
  • CK-MB
  • myoglobin
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11
Q

what is the difference between a NSTEMI and STEMI

A
  • STEMI = classic heart attack, extensive cardiac damage, infarction, injury to heart
  • NSTEMI = ischemia
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12
Q

what causes a MI

A
  • occurs as a result of sustained ischemia, causing irreversible myocardial cell death
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13
Q

what do most MIs occur d/t

A
  • thrombus formation
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14
Q

what does a thrombus in the myocardium result in

A

= perfusion to the myocardium distal to the thrombus stops = necrosis = contractile fnxn of heart in that area stops

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15
Q

the degree of altered fnxn in MI depends on

A
  • area of heart involved and size of infarction
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16
Q

how long can cardiac cells withstand ischemic conditions before dying? how long until full thickness death

A
  • 20 min
  • full thickness death = 5-6 hr
    = time matters!
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17
Q

location of infarction depends on

A
  • the involved coronary circulatio
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18
Q

the description of an infarction depends on

A
  • location of damage
    ex. anterior, inferior, lateral, etc.
  • often involves left vent.*
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19
Q

what kind of pain is associated w MI

A
  • severe, immobolizing chest pain not relieved by rest, position change, or nitrate admin
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20
Q

how is pain in MI described (7)

A
  • heavy
  • pressure
  • tightness
  • burning
  • constriction
  • crushing sensation
  • more severe than usual anginal pain
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21
Q

what are common location of pain during an MI (7)

A
  • retrosternal
  • substernal
  • epigastric
  • neck
  • jaw
  • arms
  • back
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22
Q

when does pain during an MI occur (3)

A
  • while active or at rest
  • asleep or awake
  • common in morning hours
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23
Q

how long does pain during an MI last

A
  • 20 min or more
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24
Q

what are some non-classic signs of an MI (4)

A
  • discomfort
  • weakness
  • SOB
  • fatigue
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25
Q

patients w DM are more likely to…

A
  • experience silent MIs d/t cardiac neuropathy
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26
Q

older adults experiencing an MI may have what symptoms? (5)

A
  • change in mental status (confusion)
  • SOB
  • pulmonary edema
  • dizziness
  • arhythmias
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27
Q

why do you experience SNS stimulation during an MI

A
  • during initial phase, catecholamines are released from the ischemic myocardial cells
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28
Q

what signs of SNS stimulation are seen during an MI (4)

A
  • release of glycogen
  • diaphoresis
  • vasoconstriction of peripheral blood vessels
  • ashen, clammy, cool skin
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29
Q

what cardio & resp signs are seen during an MI (7)

A
  • initially: HR & BP increase
  • later, BP drops d/t decreased CO
  • crackles in lungs (= left vent dysfunction)
  • jugular venous distension
  • hepatic enlargement
  • peripheral edema (this + 3 above indicate right vent dysfnxn)
  • abnormal heart sounds
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30
Q

what does the drop in BP later in an MI cause

A
  • decreased renal perfusion & urine output
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31
Q

why does NV occur during MI (2)

A
  • d/t reflex stimulation of vomitting centre by severe pain

- vasovagal reflexes initiated from the area of infarction

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32
Q

describe fever during MI (2)

A
  • may rise during first 24 h

- may last as long as 1 week

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33
Q

why does fever occur during MI

A
  • systemic manifestation of the inflammatory process caused by myocardial cell death
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34
Q

what are complications of a MI (7)

A
  • dysrhythmias
  • HF
  • cardiogenic shock
  • papillary muscle dysfunction
  • ventricular aneurysm
  • pericarditis
  • dressler’s syndrome
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35
Q

how can dysrhythmias occur in MI

A
  • dysrhythmia is caused by any condition that affects the myocardial cell’s sensitivity to nerve impulses –> ex. ischemia
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36
Q

how can MI cause HF

A
  • if enough tissue has died that the pumping power of the heart has diminished
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37
Q

what is cardiogenic shock

A
  • condition in which inadequate O2 and nutrients are supplied to the tissues d/t severe left ventricular failure
  • body suddenly cannot pump enough blood to meet body’s needs
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38
Q

how does MI cause papillary muscle dysfnxn

A
  • occurs if infarcted area includes or is adjacent to the papillary muscle that attaches to the mitral valve
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39
Q

what does papillary muscle dysfnxn cause

A
  • mitral valve regurgitation = backflow of blood = increased vol of blood in left atrium
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40
Q

how can a MI lead to ventricular aneurysm

A
  • if the infarcted myocardial wall becomes thinned and bulges out during contraction
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41
Q

what is used to diagnose UA/MI (5)

A
  • history
  • physical exam
  • ECG
  • measurement of serum cardiac markers
  • coronary angiography
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42
Q

what should you look at in an EKG for MI

A
  • QRS complex
  • ST segment
  • T wave
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43
Q

what are serum cardiac markers

A
  • proteins released into the blood in large quantities from the heart muscle after a MI
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44
Q

what do serum cardiac markers indicate

A
  • whether cardiac damage is present

- approx extent of damage

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45
Q

list 3 cardiac markers; which two are usually used to diagnose MI

A
  • troponin and creatine kinase usually used

- myoglobin

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46
Q

what is the pro and con of CK levels

A

-

47
Q

what is the pro of using troponin lvls

A
  • myocardial specific
  • goes up 3-12 hour post MI
  • peaks at 24 hr
  • goes back to baseline after 5-14 days
48
Q

what is the pro and con of myoglovin (3)

A
  • one of the first serum cardiac markers to increase after MI
  • not cardiac specific
  • rapidly excreted in urine = back to normal range in 24 hr after an MI
49
Q

what is the pro to CK

A
  • don’t return to normal for 2-3 days
50
Q

what is a coronary angiography

A
  • procedure that uses a special dye (contrast material) and x-rays to see how blood flows through the arteries in your heart.
  • determine if any blockage in coronary arteries
51
Q

why is a coronary angiography used as a diagnostic for MI

A
  • evaluate extent of disease

- determine most approp treatment

52
Q

what is imp in treatment of ACS

A
  • rapid diagnosis & treatment to preserve cardiac muscle
53
Q

what initial management is completed for ACS (12)

A
  • ensure patent airway
  • O2 (2-4L)
  • continuous ECG (12-lead)
  • establish IV route (2 IVs)
  • assess pain
  • give meds for pain
  • vitals & O2 sats
  • obtain baseline blood test results (cardiac monitors)
  • bed rest & limitation for 12-24 hr, w gradual increase
  • percutaneous coronary intervention
  • reperfusion therapy
  • admin antidysrhythmic therapy if needed
54
Q

why is it important to establish an IV in inital treatment of ACS

A
  • for emergency drug therapy
55
Q

what meds are given in treatment of ACS (3)

A
  • sublingual nitro
  • aspirin
  • Iv morphine ( for pain unrelieved by nitro)
56
Q

what is done if dysrhythmias are detected during ECG monitoring

A
  • appropriate treatment administered
57
Q

when specifically should VS and O2 sats be monitored

A
  • monitor frequently during first few hrs of admission

- closely after

58
Q

what does reperfusion therapy do

A
  • opens coronary artery that was occluded

= restored blood flow to the heart & saved heart muscle

59
Q

when is PCI considered for treatment of ACS

A
  • when pt is stabilized and angina is controlled

- or if angina returns & increases in severity

60
Q

what are types of reperfusion therapy done for treatment of ACS (5)

A
  • emergent percutaneous intervention
  • fibrinolytic therapy
  • meds/drug therapy
  • CABG
  • minimally invasive direct coronary artery bypass
61
Q

what is percutaneous coronary intervention

A
  • intervention to treat CAD in which a catheter equipped with an inflatable balloon is inserted into a narrowed coronary artery & the balloon is inflated
62
Q

where can an emergency PCI be performed

A
  • in facilities w an interventional cardiac catheterization lab
63
Q

what type of ongoing monitoring should occur in treatment of ACS/MI (7)

A
  • VS + O2 sats
  • LOC
  • cardiac rhythmn
  • monitor response to meds (pain) & readminister if needed
  • provide reassurance and support to pt and family
  • anticipate need for intubation if respiratory distress is evident
  • prep for CPR, defib, cardioversion
64
Q

what is the goal of emergency PCI

A
  • open the affected artery within 90 min of pt’s arrival to ED
  • urgent!
65
Q

what occurs in EPCI

A
  • pt undergoes cardiac catheterization to locate blockage, assess severity, etc.
66
Q

what are benefits of EPCI (5)

A
  • alternative to surgery
  • uses local anasthetic
  • pt ambulatory 24 hr after procedure
  • length of hospital stay 1-3 days = lower hospital costs
  • pt can make rapid return to work (5-7 days)
67
Q

what is the goal of fibrinolytic therapy

A
  • stopping the infarction process by dissolving the thrombus in the coronary artery and reperfusing the myocardium
68
Q

when should fibrinolytics be given

A
  • within 30 min to 1st hour = ideal

- within first 6 hours = preferred

69
Q

how are fibrinolytics administered

A
  • IV
70
Q

what is a risk associated w fibrinolytics

A
  • may lyse other clots (ex. a postop site)
71
Q

what are absolute contraindications for fibrinolytics (8)

A
  • active internal bleeding or bleeding diathesis
  • Hx of cerebral aneurysm
  • arteriovenous malformation
  • intracranial neoplasms
  • previous cerebral hemorrhage
  • ischemic stroke past 3 mo.
  • signif close head or facial trauma within past 3 mo
  • aortic dissection
72
Q

what are relative contraindications for fibrinolytics (7)

A
  • active peptic ulcer disease
  • use of anticoags
  • prior ischemic stroke not within 3 mo
  • surgery or puncture of noncompressable vessel within past 3 week
  • serious systemic disease
  • severe uncontrolled HTN
  • traumatic or prolonged cardiopulmonary resus (>10 min)
73
Q

what must be done before fibrinolytic therapy (3)

A
  • basline lab studies collected
  • 2-3 lines for IV therapy started
  • invasive procedures performed before

= reduced risk of bleeding

74
Q

how long is fibrinolytic therapy give

A
  • depends on drug selected

- either in 1 IV bolus or over time (30-90 min)

75
Q

what should be monitored frequently during fibrinolytic therapy (3)

A
  • VS
  • O2 sat
  • heart & lung assessments
76
Q

what is a major concern w fibrinolytic therapy? what is done to avoid this

A
  • reocclusion of the artery
  • site of thrombus is unstable = another clot may form or spasm of the artery may occur
  • may start on IV heparin to prevent
77
Q

what is the major complication of fibrinolytic therapy

A
  • bleeding = assessment is important!
78
Q

what should nurses monitor for d/t the complication of bleeding in fibrinolytic therapy

A
  • drop in BP
  • increase HR
  • decreased LOC
  • blood in urine or stool
    = bad
79
Q

what is to be expected after fibrinolytic therapy

A
  • minor bleeding
    ex. surface bleeding at IV sites, gingival bleeding
  • control by applying pressure or ice pack
80
Q

what are the meds of choice for ACS (10)

A
  • IV nitro
  • aspirin
  • beta blockers
  • systemic anticoag
  • IV antiplatlets
  • ACE-I
  • calcium channel blockers
  • antidysrhtymias
  • cholestrol lowering drugs
  • stool softeners
81
Q

what med is used in initial treatment of ACS

A
  • IV nitro
82
Q

what effect does IV nitro have

A
  • immediate onset of action
  • decrease preload
  • decrease afterload
    = increased myocardial supply
83
Q

what should be monitored when giving IV nitor

A
  • BP
84
Q

when is morphine sulfate given in tx of ACS

A
  • for pain unrelieved by nitro
85
Q

what effect does morphine have in tx of ACS

A
  • vasodilator
  • lowers myocardial O2 consumption
  • reduced contractility
  • decreases BP and HR
86
Q

what is a s/e of morphine

A
  • resp depression –> monitor for signs of bradypnea or hypoxia
87
Q

who should IV beta blockers not be given to ? when should oral beta blockers be initiated for w STEMI

A
  • pts w STEMI

- initiate in first 24 hr (if no contra)

88
Q

what effect do beta blockers have in tx of ACS (4)

A
  • reduce HR
  • reduce BP
  • reduce contractility
    = decreased O2 demand
89
Q

what is the most common complication aftee MI

A
  • dysrhythmias
90
Q

why are stool softeners given after MI

A
  • pt is predisposed to constipation d/t bed rest and opioid admin
  • prevents straining and vagal stim (which causes bradycardia and dysrhytmia)
91
Q

what is a type of stool softener given after MI

A
  • docusate sodium (colace)
92
Q

describe nutritional therapy for a pt with MI (5)

A
  • initally: NPO except sips of water until stable
  • advance as tolerated
  • low salt
  • low cholestrol
  • low sat fats
93
Q

when is CABG recommended? (4)

A
  • no satisfactory improvement w medical management
  • left main coronary artery or 3 vessel disease
  • not candidates for PCI (lesions long & difficult to access)
  • if PCI has failed & chest pain is ongoing
94
Q

what is coronary artery bypass graft surgery

A
  • construction (grafting) of new vessels between the aorta, other major arteries, and the myocardium distal to the obstructure coronary artery
95
Q

what does CABG surgery require

A
  • sternotomy = opening of chest cavity

- cardiopulmonary bypass CPB

96
Q

what is CPB

A
  • involves diverting the pt’s blood from the heart to the CPB machine
  • blood is oxygenated in the blood and then returned via a pump to the pt
    = vital organs perfsued while the surgeon operates on a nonbeating, blood-less heart
97
Q

what is minimally invasive direct coronary artery bypass

A
  • technique that offers the pt with single-vessel disease, an approach to surgical tx that does not involve a sternotomy and CPB
  • involves several small incisions between the ribs & thorascope is used to dissect the IMA
98
Q

how is the heart slowed during a MICABG

A
  • by a beta blocker or stopped with adenosine
99
Q

what type of dysarhythmia most often occurs within the 1st four hours of chest pain during an MI

A
  • ventricular fibrillation
100
Q

what factors can precipitate angina (8)

A
  • physcial exertion
  • temp extremes
  • strong emotions
  • consumption of a heavy meal
  • tobacco use
  • sexual activity
  • stimulants
  • circadian rhythm patterns
101
Q

what are priority nursing interventions during the initial phase of ACS

A
  • pain assessment and relief
  • physiological monitoring
  • prompt rest & comfort
  • alleviate stress & anxiety
  • understand pt’s emotional and behavioral rxns
102
Q

what can be given for pain associated w ACS (3)

A
  • nitro
  • morphine
  • O2

= all decrease chest pain

103
Q

what physiological monitoring should be done with ACS (6)

A
  • continuous ECG monitoring
  • VS
  • intake & output
  • physical assessment for variations from baseline
  • lung & heart assessment
  • o2 status
104
Q

what comfort measures can promote rest in a pt (6)

A
  • frequent oral care
  • adequate warmth
  • quiet atmosphere
  • use of relaxation therapy
  • assurance that personnel are nearby and responsive to their needs
  • bed rest
105
Q

what are the major nursing responsibilities for a pt after a PCI

A
  • signs of recurrent angina
  • assess VS (including HR and rhythm)
  • signs of bleeding
  • maintenance of bed rest
106
Q

most of the complications after CABG are related to??

A
  • use of CPB
107
Q

what are major consequences of CPB (3)

A
  • bleeding and anemia (d/t damage to RBC)
  • fluid and electrolyte imbalances
  • hypothermia (bc blood is cooled as passes thru)
108
Q

nursing care post-CABG focuses on (9)

A
  • monitor hemodynamic status
  • monitor fluid status
  • assess for bleeding
  • electrolyte replacement
  • restore temp
  • post-op dysrhythmias (first 3 days after esp.)
  • surgical site care
  • prevent infection
  • pain mngmt
109
Q

why is exercise an important aspect of the rehab program for ACS (8)

A
  • increases CO
  • decreases blood lipids
  • decreases BP
  • increases blood flow thru coronary arteries
  • increase msucle mass
  • improve psychological state
  • assist in weight loss
  • maximal o2 uptake
110
Q

what should be taught regarding physical activity for a pt with ACS (4)

A
  • regular schedule of physical activity
  • “listen to what ur body is saying” –> dont overexert
  • check the pulse rate while exercising –> give pt max HR
    & if they exceed this or does not return to resting pulse in a few min, they should stop and rest
  • stop exercising if angina occurs
111
Q

what are the most common arteries involved in an MI

A
  • left circumflex
  • left marginal
  • left anterior descending
112
Q

what is the most dangerous blockage in an MI

A
  • left coronary artery bc it impacts many branches
113
Q

what is the downside to PCI

A
  • high risk within 30 days of causing vascular spasm or failing to hold back plaque = risk of repeating MI

NURS 3512 - Class 1-6 (47 decks)

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