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From Flashcardlet > (3) Exam 3-❤️ Lecture #2- Acute Coronary Syndrome > Flashcards

(3) Exam 3-❤️ Lecture #2- Acute Coronary Syndrome Flashcards

0
Q

Acute Coronary Syndrome

♿️ When ischemia is prolonged, Acute Coronary Syndrome develops and encompasses what disorders?

A

▪️Unstable Angina (UA)
▪️Non-ST Segment Elevation Myocardial Infarction (NSTEMI)
▪️ST Segment Elevation Myocardial Infarction (STEMI)

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1
Q

Acute Coronary Syndrome

♿️ What develops when ischemia is prolonged and not immediately reversible?

A

Acute Coronary Syndrome

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2
Q

Acute Coronary Syndrome

Partial blockage of the coronary arteries with a thrombus usually results in what?

A

Unstable Angina or NSTEMI

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3
Q

Acute Coronary Syndrome

When the patient has total occlusion of the coronary artery, they are on their to having what?

A

STEMI

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4
Q

Acute Coronary Syndrome

When plaque builds up in the coronary arteries and ruptures, what is formed?

A

thrombus

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5
Q

Acute Coronary Syndrome

🚨 What type of angina is a medical emergency and the patient is likely to be hospitalized?

A

Unstable Angina

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6
Q

Acute Coronary Syndrome

😰 In what gender may symptoms of unstable angina be more vague because they do not have typical angina?

A

Woman

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7
Q

Acute Coronary Syndrome
😰 What type of angina is described as chest pain that is a new onset, occurs at rest, or has a worsening pattern that is requiring more nitroglycerin to relieve symptoms?

A

Unstable Angina

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8
Q

Acute Coronary Syndrome
♿️ When an acute MI occurs, cardiac cells can withstand sustained ischemic conditions for approximately how long before cellular death begins?

A

Approximately 20 minutes

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9
Q

Acute Coronary Syndrome

♿️ What causes 80-90% of all acute MI’s?

A

Thrombus Formation

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10
Q

Acute Coronary Syndrome
♿️ Ischemia starts in the subendocardium and then starts to move outward towards the entire thickness of the myocardium. If ischemia persists, it takes approximately how long for the entire thickness of the heart muscle to become necrosed?

A

4-6 hours

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11
Q

Acute Coronary Syndrome

♿️ Blockage of what artery will result in an inferior wall MI?

A

Right Coronary Artery

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12
Q

Acute Coronary Syndrome

♿️ Blockage of what artery will result in anterior wall MI’s?

A

Left Anterior Descending Artery

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13
Q

Acute Coronary Syndrome

Why do younger adults have more serious first MI than an older person with the same degree of blockage?

A

Individuals with a long history of CAD will develop collateral circulation

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14
Q

Acute Coronary Syndrome
😰 MI pain in the typical person is severe immobilizing chest pain not relieved by rest, position changes, or nitrate administration and the patient usually describes what characteristics of pain?

A 
▪️Heaviness
▪️Pressure
▪️Tightness
▪️Burning
▪️Constriction
▪️Crushing
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15
Q

Acute Coronary Syndrome

🚬 At what time of day are MI’s more common?

A

In the morning

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16
Q

Acute Coronary Syndrome

😰 What patients may not have with a MI?

A

Diabetes (Cardiac Neuropathy)

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17
Q

Acute Coronary Syndrome

😰 What is the hallmark of a MI?

A

Severe, immobilizing chest pain not relieved by rest, position changes, or nitrate administration.

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18
Q

Acute Coronary Syndrome
😰 During the initial phase of a MI, the ischemic myocardial cells release catecholamines (norepinephrine & epinephrine) and results in what clinical manifestations?

A

▪️Diaphoresis
▪️Skin: Ashen, Clammy, and/or cool to touch
▪️Vasoconstriction
▪️Release of glycogen

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19
Q

Acute Coronary Syndrome

😰 What vital sign changes occur in response to the release of catecholamines due to a MI?

A

↑HR & BP, then↓BP later secondary to↓CO because adrenalin wears off

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20
Q

Acute Coronary Syndrome

😰 Crackles that persist for several hours to several days after a MI suggest what type of dysfunction?

A

Left Ventricular Dysfunction - Left Ventricle failing and starts to back up in lungs

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21
Q

Acute Coronary Syndrome

😰 Jugular Vein distention, hepatic engorgement, and peripheral edema after an MI may indicate what dysfunction?

A

Right Ventricular Dysfunction - Right side of heart cant move blood through lungs to the Left side.

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22
Q

Acute Coronary Syndrome

😰 What abnormal heart sounds after a MI may suggest ventricular dysfunction?

A

S3 or S4 & A New Murmur

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23
Q

Acute Coronary Syndrome
😰 After a MI, the systemic inflammatory process caused by myocardial cell death can cause the patients temperature may be up to what temperature for the first 24 hours?

A

100.4

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24
Q

Acute Coronary Syndrome
😰 What clinical manifestation occurs after a MI because the heart isn’t able to generate enough blood flow to the GI tract?

A

Nausea & Vomiting - Usually NPO except for ice chips

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25
Q

Acute Coronary Syndrome
😷 How long after a MI may the patients activity level be increased even though the new scar tissue is still weak and vulnerable to stress?

A

10-14 Days

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26
Q

Acute Coronary Syndrome
📚 How long after MI has scar tissue replaced necrotic tissue and the injured area is considered healed but less compliant?

A

6 weeks

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27
Q

Acute Coronary Syndrome
What is the process called when normal myocardium to hypertrophy and dilate in an attempt to compensate for the infarcted muscle after a MI occurs?

A

Ventricular Remodeling

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28
Q

Acute Coronary Syndrome

😰♿️ What is the most common complication after an MI which is life-threatening and present in 80-90% of patients?

A

Dysrhythmias

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29
Q

Acute Coronary Syndrome

😰♿️ What is the most common cause of death in the prehospital phase after a MI?

A

Dysrhythmias

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30
Q

Acute Coronary Syndrome
♿️ Electrolyte Imbalances and SNS stimulation affect the myocardial cell’s sensitivity to nerve impulses and can cause dysrhythmias, but what is the most common cause of dysrhythmias after a MI?

A

▪️Ischemia (Most Common)

▪️Electrolyte Imbalances (less likely)
▪️SNS Stimulation (Norepinephrine stressing the heart & making it more ischemic)

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31
Q

Acute Coronary Syndrome

♿️ Dysrhythmias vary with severity but what type occurs most often with anterior wall infarction, HF, or shock?

A

Life-Threatening

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32
Q

Acute Coronary Syndrome
♿️ Ventricular fibrillation, a common cause of sudden cardiac death (SCD), is a lethal dysrhythmia that often occurs within the first 4 hours after the onset of what?

A

Pain

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33
Q

Acute Coronary Syndrome

♿️ What complication of MI occurs when the pumping power of the heart has diminished and causes decreased stroke volume?

A

Heart Failure

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34
Q

Acute Coronary Syndrome
😰 Pulmonary congestion on chest X-Ray, S3 or S4 heart sounds, crackles, & jugular vein distention are signs that indicate the onset of HF but initially it occurs with what subtle signs?

A

▪️Mild Dyspnea
▪️Restlessness
▪️Agitation
▪️Slight Tachycardia

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35
Q

Acute Coronary Syndrome

😰 What happens to the patients glucose when a MI occurs?

A

Goes up because adrenal glands release glycogen

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36
Q

Acute Coronary Syndrome
📚 When the patient is discharged after a MI, what do you want to teach them to do if they’re going to increase their activity level?

A

Take their Pulse and BP

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37
Q

Acute Coronary Syndrome
♿️ What complication of a MI occurs when Heart Failure becomes so bad that the heart cant provide enough oxygen and blood flow to the body due to LV Failure?

A

Cardiogenic Shock

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38
Q

Acute Coronary Syndrome

😷 Cardiogenic Shock has a high mortality rate and requires what type of management?

A

Aggressive Management in an ICU Setting

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39
Q

Acute Coronary Syndrome
♿️ The Papillary Muscles are finger like projections at the bottom of the ventricles that have Chordae Tendineae at the ends of them which attachment to valves and keep from allowing 2 way flow. When a MI causes a Pulmonary Muscles rupture, mitral valve regurgitation occurs and usually results in what serious complication?

A

Cardiogenic Shock

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40
Q

Acute Coronary Syndrome
♿️ What fatal complication of a MI can lead to HF & Dysrhythmias if a rupture occurs due to the myocardial wall becoming thinned and bulging out in the opposite direction during contractions?

A

Ventricular Aneurysm

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41
Q

Acute Coronary Syndrome

♿️ What complication of a MI occurs when inflammation radiates to the outside of the heart and the pericardium?

A

Acute Pericarditis

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42
Q

Acute Coronary Syndrome

😰 What characteristic clinical manifestation of Pericarditis is relieved by sitting in a forward position?

A

Chest Pain

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43
Q

Acute Coronary Syndrome
♿️ Pericarditis may result in what what complication that causes decreased SV and compromises the cardiac output due to fluid build up under the pericardium that compresses the heart muscle?

A

Cardiac Tamponade

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44
Q

Acute Coronary Syndrome

💥📈 What ST Segment changes occur if the patient is having a heart attack / injury to the cells?

A

ST Segment Elevation

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45
Q

Acute Coronary Syndrome

📈 How often is progression monitored if there are ECG changes?

A

Daily

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46
Q

Acute Coronary Syndrome
💉 What is the Gold Standard serum cardiac marker that is most specific to heart cells and is sensitive to myocardial injury?

A

Troponin T & Troponin I

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47
Q

Acute Coronary Syndrome

💉 How long after the onset of MI symptoms does CK-MB levels rise?

A

After about 3 hours

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48
Q

Acute Coronary Syndrome

💉 How long after the onset of MI symptoms will Troponin start rising?

A

About 4 hours

49
Q

Acute Coronary Syndrome

💉 How often are serum cardiac markers repeated to see if they are going down?

A

Q6-8 hours

50
Q

Acute Coronary Syndrome

😷 What are the initial interventions for a patient having a MI?

A 
▪️12-Lead ECG
▪️Semi Fowlers Position
▪️Keep O2 @ 93%
▪️IV Access
▪️Nitroglycerin (SL) or spray
▪️Chewable Aspirin (ASA)
▪️Morphine IV if no relief with NTG
51
Q

Acute Coronary Syndrome
💊 When a patient is having a MI, what medication is given to stop the enlargement of the clot and prevent new ones from starting?

A

Chewable Aspirin (ASA)

52
Q

Acute Coronary Syndrome

😷 What intervention would you expect to prepare a patient to undergo within 90 minutes of arriving at the ED with a MI?

A

Angioplasty with stent placement

53
Q

Acute Coronary Syndrome

😷 What ongoing monitoring is done for patients that have had a MI?

A

▪️Treat Dysrhythmias
▪️Frequent VS Monitoring
▪️Bed Rest / Limit Activity for 12-24 hours

54
Q

Acute Coronary Syndrome

😷 If a coronary revascularization with emergent PCI is not available, what would be done instead for patients with a MI?

A

Thrombolytic Agents

55
Q

Acute Coronary Syndrome

😷 Why should a patient recovering from a MI be on bed rest / limited activity for 12-24 hours?

A

Don’t want the heart to work harder than it has to. If oxygen demand is increased, less oxygen will get to the areas that need it and cells will die.

56
Q

Acute Coronary Syndrome
💊 Until the patient is stable and can undergo a Coronary Angiography with PCI, what drug combination is recommended to prevent clots in patients with Unstable Angina or NSTEMI?

A

▪️Aspirin
▪️Heparin Drip
▪️Glycoprotein Inhibitor (Integrilin)

57
Q

Acute Coronary Syndrome

😷 Whether it is a STEMI or NSTEMI, Angioplasty with stent placement will be done if what cardiac markers are positive?

A

Troponin

58
Q

Acute Coronary Syndrome
😷 The goal in the treatment of a MI is to have the patient in the catheter laboratory within how long after coming to the ER?

A

90 minutes

59
Q

Acute Coronary Syndrome

💊 What is the treatment of choice for a confirmed MI whether ST elevation is present or not?

A

Balloon Angioplasty + Stent(s)

60
Q

Acute Coronary Syndrome

😷💥 When is IV Thrombolytic therapy used in patients with a MI?

A

When PCI is not available in STEMI

61
Q

Acute Coronary Syndrome
💊 When PCI is not available, What “clot buster” IV medication is given to patients with a MI to stop the infarction process by dissolving thrombus?

A

Alteplase, t-PA

62
Q

Acute Coronary Syndrome
💊 Alteplase / t-PA is ideally given within the first hour, but must be given within how long after the onset of MI symptoms?

A

6 hours

63
Q

Acute Coronary Syndrome
💊 Alteplase / t-PA is used to dissolve clots when using IV Thrombolytic Therapy on a patient with a MI, but what medication is used with it to keep new clots from forming?

A

IV Heparin

64
Q

Acute Coronary Syndrome

💊 How are all Thrombolytics administered?

A

IV

65
Q

Acute Coronary Syndrome

💊 Alteplase / t-PA is hard to reverse and should not be given to what patients?

A 
Patients that have had:
▪️Recent Trauma
▪️Recent Surgery
▪️Recent Head Injury
▪️Prolonged CPR
▪️A Stroke
66
Q

Acute Coronary Syndrome

😷 Why should blood be draw and 2-3 IV’s be started to draw blood from first before starting Thrombolytic Therapy?

A

If blood is drawn or an IV is started after administering Alteplase, there will be prolonged bleeding.

67
Q

Acute Coronary Syndrome

😷 Patients on Thrombolytics should be monitored closely for what?

A

Bleeding - Neuro Checks & VS for internal bleeding

68
Q

Acute Coronary Syndrome

😷 What classic signs of reperfusion do you want to assess for in patients on Thrombolytic Therapy?

A

▪️ST segment return to baseline
▪️Chest pain is resolved
▪️Rapid rise and fall of Troponin because damage to heart has been stopped.

69
Q

Acute Coronary Syndrome

💊 What surgery is recommended for patients with a failed PCI or that isn’t a candidate for PCI?

A

Coronary Artery Bypass Graft (CABG)

70
Q

Acute Coronary Syndrome

Coronary Artery Bypass Graft is also know as what?

A

Open heart surgery

71
Q

Acute Coronary Syndrome

😷💥 What patients are not candidates for PCI and would need to have a CABG?

A

▪️Presence of Left Main Coronary Artery
▪️Presence of Three-Vessel Disease
▪️Lesions are long and difficult to assess
▪️History of Diabetes

72
Q

Acute Coronary Syndrome

😰💥 The presence of what symptom after a PCI indicates that it was a failed attempt and CABG is needed?

A

Failed PCA with ongoing Chest Pain

73
Q

Acute Coronary Syndrome

♿️ What is a post-op concern for CABG that requires sternotomy?

A

Infection

74
Q

Acute Coronary Syndrome

💊 What is used so that the patients heart can be stopped with an open sternotomy?

A

Cardiopulmonary Bypass (CPB) Machine

75
Q

Acute Coronary Syndrome
💊 With CABG surgery the patients own veins and arteries are commonly used for grafting. What vein in the leg is the most common used for bypass graft because of length?

A

Saphenous Vein

76
Q

Acute Coronary Syndrome
💊 How does the Saphenous Vein differ from the Internal Mammary Artery and what characteristic of the Saphenous Vein usually causes it to occlude sooner than the Internal Mammary Artery?

A

Saphenous Vein has valves so it has to be turned around and the valves cause it to occlude sooner.

77
Q

Acute Coronary Syndrome
💊 During a bypass graft, what most commonly used artery is left attached to its original (Subclavian Artery) and sutured just past the blockage at the opposite end to provide blood flow to the distal tissue?

then dissected f

A

Internal Mammary Artery (IMA)

78
Q

Acute Coronary Syndrome

💊 What surgical procedure is an alternative to the traditional CABG that does not involve a full sternotomy?

A

Minimally Invasive Direct Coronary Artery Bypass (MIDCAB)

79
Q

Acute Coronary Syndrome
💊 What procedure uses full or partial sternotomy to access all of the coronary vessels but is performed on a beating heart using mechanical stabilizers instead of CPB?

A

Off-Pump Coronary Artery Bypass (OPCAB)

80
Q

Acute Coronary Syndrome

💊 What can be used to assist the surgeon when performing CABG or Mitral Valve Replacement?

A

Robot-Assisted Surgery (Da Vinci robot arms)

81
Q

Acute Coronary Syndrome

💊Drug therapy for Acute Coronary Syndrome tend to be the same drugs used for what other cardiovascular disorders?

A

CAD & Angina

82
Q

Acute Coronary Syndrome

💊 What drug therapy is used for patients with ACS?

A 
▪️IV Nitroglycerin Drip (Tridil)
▪️Morphine
▪️β-Adrenergic Blockers
▪️ACE Inhibitors
▪️Anti-Dysrhythmias
▪️Cholesterol-Lowering Drugs
▪️Stool Softener
83
Q

Acute Coronary Syndrome
💊 What medication is used in the initial treatment of the patient with ACS that is having chest pain and ST Segment Elevation

A

IV Nitroglycerin (Tridil) Drip

84
Q

Acute Coronary Syndrome
💊 What medication that calms the patient which reduces the work of the heart and also dilates the blood vessels is given if Nitroglycerin doesn’t relieve pain?

A

Morphine

85
Q

Acute Coronary Syndrome

🍓 What diet will patients with an MI initially be on?

A

NPO with ice chips

86
Q

Acute Coronary Syndrome

🍓 When can the diet be advanced from NPO in patients with an MI?

A

When stable - Pain free & Nausea is resolved

87
Q

Acute Coronary Syndrome

🍓 What diet will the patient with an MI progress to once they are pain free and nausea is resolved?

A

↓Salt
↓Saturated Fats
↓Cholesterol

88
Q

Acute Coronary Syndrome

💊 What is used to treat pain in patients with ACS?

A

▪️Nitroglycerin
▪️Morphine
▪️Oxygen

89
Q

Acute Coronary Syndrome

😷 Why are patients with ACS on continuous heart monitoring?

A

They are at risk for life threatening dysrhythmias

90
Q

Acute Coronary Syndrome
😷 When monitoring heart rhythms of a patient recovering from a MI, what would indicate that damage is still occurring or is reoccurring?

A

ST Segment Elevation

91
Q

Acute Coronary Syndrome
😷 Dyspnea, Tachycardia, Pulmonary Congestion, and Distended Neck Veins are evidence of what complication that is monitored for in patients recovering from ACS by assessing heart & breath sounds and VS?

A

HF

92
Q

Acute Coronary Syndrome

📚 What is important to teach patients with ACS?

A

Explain why rest is important (Scar tissue hasn’t formed that well yet)

93
Q

Acute Coronary Syndrome

😷 What is the nurses role in reducing the patients anxiety?

A

Identify the source and alleviate it

94
Q

Acute Coronary Syndrome

😷 What complication of PCI does the nurse monitoring for and is a medical emergency?

A

Recurrent Angina

95
Q

Acute Coronary Syndrome

😰 What symptom should not occur after a PCI and is considered a medical emergency if it does?

A

Chest Pain

96
Q

Acute Coronary Syndrome

😷 Why is the catheter insertion site monitored after a PCI?

A

Monitored for bleeding because they received anticoagulants during the procedure and if bleeding occurs, it is arterial bleeding and the patient could die quickly.

97
Q

Acute Coronary Syndrome

😷 What action does the nurse take if there is any type of bleeding at the catheter insertion site after a PCI?

A

Apply firm pressure nonstop for 20 minutes

98
Q

Acute Coronary Syndrome
😷 After a PCI, VS are checked frequently because there is a risk for hemorrhage and cardiac rhythms are monitored because the procedure could have altered the heart rhythm or triggered what complication?

A

Dysrhythmia

99
Q

Acute Coronary Syndrome

😷 After a PCI, a neurovascular assessment should be done on what area of the body?

A

Check 6 P’s distal from where they did the procedure.

100
Q

Acute Coronary Syndrome
😷 The HCP should be notified if there are any neurovascular problems identified because there could be a clot forming at what part of the artery and preventing blood flow down to the foot.

A

Could mean there is a clot forming INSIDE the artery

101
Q

Acute Coronary Syndrome

😷 After a PCI, what is the patient instructed not to do for 4-6 hours because it could pop the clot that was formed?

A

No Bending

102
Q

Acute Coronary Syndrome

😷 After a PCI, why is it important to flush the kidneys to protect them from the contrast?

A

Contrast is toxic to kidneys

103
Q

Acute Coronary Syndrome

😷 How long are patient usually in ICU after CABG?

A

24-36 hours

104
Q

Acute Coronary Syndrome
😷 What interventions are needed for the ongoing and intensive monitoring of the hemodynamic status for patients after a CABG?

A 
▪️ICU for first 24-36 hours
▪️Pulmonary Artery Catheter 
▪️Intra-arterial Line 
▪️Pleural/Mediastinal Chest Tubes 
▪️Continuous ECG Monitoring 
▪️ET Tube w/ Mechanical Ventilation 
▪️Epicardial Pacing Wire 
▪️Urinary Catheter 
▪️NG Tube
105
Q

Acute Coronary Syndrome
😷 After a CABG the patient has an Intra-Arterial Line that can be used to draw ABG’s but is primarily used for continuous monitoring of what?

A

BP

106
Q

Acute Coronary Syndrome

😷 What common complication of a CABG is the reason that a chest tube is inserted postoperatively?

A

Atelectasis (Collapse of the lung)

107
Q

Acute Coronary Syndrome
😷 So the heart doesn’t get compressed, patients often have tubes coming out of the mediastinum during a CABG to remove what?

A

Blood because there may be bleeding around the heart during surgery

108
Q

Acute Coronary Syndrome

😷 After a CABG, the patient will have continuous ECG monitoring to detect for what complication?

A

Dysrhythmias

109
Q

Acute Coronary Syndrome

😷 After a CABG, the patient will have an ET Tube with Mechanical Ventilation that usually stays in for how long?

A

Most patients will be extubated within 6 hours which is usually the next morning.

110
Q

Acute Coronary Syndrome
😷 If a Sternotomy was done, what is often sutured to the surface of the heart that comes out of the chest cavity and can be connected to a pulse generator for emergency pacing of the heart?

A

Epicardial Pacing Wires

111
Q

Acute Coronary Syndrome
😷 A Pulmonary Artery Catheter is usually put in during a CABG procedure and is used to monitor what throughout the recovery phase?

A

Heart Pressures

112
Q

Acute Coronary Syndrome
😷 When a Pulmonary Catheter is inserted, a balloon is wedged into a branch of the pulmonary artery so that pressures in what area of the heart can be measured indirectly?

A

Left Ventricle

113
Q

Acute Coronary Syndrome
😷 When monitoring heart pressures using a Pulmonary Artery Catheter, what happens to the Left Ventricle pressures if the heart starts to fail?

A

L. Ventricle pressures will rise

114
Q

Acute Coronary Syndrome
📚 Teach the patient to gradually increase activity after a MI because if the scar tissue has not had time to harden it could cause what complications?

A

▪️Ventricular Aneurism
▪️Hole in the Heart
▪️Extend their Heart Attack

115
Q

Acute Coronary Syndrome

📈 What test is done on patients with a MI before they are discharged that will gauge their activity level?

A

Low-Level Stress Test

116
Q

Acute Coronary Syndrome

📚 What steps do you want to teach the patient to take if they experience chest pain or SOA during exercise?

A

▪️Stop
▪️Sit Down
▪️Take Nitroglycerin
▪️Call HCP because its a new event

117
Q

Acute Coronary Syndrome
📚 If a patient is taking Nitroglycerin, what medication do you want to instruct them not to take because it is contraindicated with Nitrates and will drop the BP significantly?

A

Erectile Dysfunction Drugs

118
Q

Acute Coronary Syndrome

📚 What medication can the nurse teach the patient with a MI to take prophylactically before sexual activity?

A

Nitrates

119
Q

Acute Coronary Syndrome

📚 When should patients with a MI be taught to avoid sex?

A

▪️After a heavy meal
▪️Tired or haven’t had a good nights rest
▪️If they’ve been drinking heavily
▪️With unfamiliar partners

120
Q

Acute Coronary Syndrome

What is the overall expected outcomes for patients with ACS?

A 
▪️Stable VS
▪️Relief of Pain
▪️Decreased Anxiety
▪️Realistic Program of Activities
▪️Effective Management of Therapeutic Regimen

From Flashcardlet (47 decks)

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