ACS, MI, CATH week 2

Question 1

What is the cause of CAD

Answer 1

atherosclerosis

Question 2

What are the types of CAD

Answer 2

1. Stable CAD (stable angina)

2. Acute coronary syndrome (ACS) - plaque ruptures, thrombus formation

Question 3

Acute clinical presentation of CAD

Answer 3

Unstable angina
Non-ST Elevation MI (NSTEMI)
ST Elevation MI (STEMI)

Question 4

Severity of blood obstruction with Unstable Angina (UA), Non-ST elevation MI (NSTEMI), and ST elevation MI (STEMI)

Answer 4

Unstable angina = minor
NSTEMI = partial
STEMI = complete

Question 5

knowing the stages of many heart issues (flip)

Answer 5

Angina –> arrhythmias –> MI –> HF or cariogenic shock

Question 6

How do we ID someone having an MI

Answer 6

look at ST elevation on ECG; however, they may be having an NSTEMI where the ST segment is not elevated. If this is the case, you need to look at patient’s s/s and cardiac markers

Question 7

Chest pain assessment scale: PQRST

Answer 7

Provoke: what provokes or precipitates the discomfort?

Quality: What is the quality of your pain?

Radiation: Does your discomfort/pain go to any other location?

Severity: Can you rank your discomfort on scale 1-10

Timing: When did the discomfort start and what were you doing at the time?

Question 8

Describe stable angina

Answer 8

“effort” angina: triggered by physical or mental exertion

resolves with rest or nitrates

Question 9

Describe unstable angina

Answer 9

new onset or worsening angina that is unpredictable
rest/med do not resolve

– also called acute coronary syndrome, may lead to MI

Question 10

What is you client likely to experience if they have an inferior wall MI?

Answer 10

Drop in blood pressure - it involves the right coronary artery

Question 11

What are reasons someone may have chest pain?

Answer 11

Angina
ACS MI
Unstable angina 
Pericarditis 
Pulmonary pneumonia 
PE

Question 12

What are non-cardiac reasons that someone may experience chest pain?

Answer 12

Esophageal disorders
Hiatal hernia 
Reflux
Spasm
Esophagitis
Anxiety/panic disoder
Costochondriasis 
Dissecting aorta

Question 13

How to relieve pericarditis pain

Answer 13

lean forward

Question 14

ACS patho

Answer 14

Includes unstabe angina - NSTEMI, STEMI

Question 15

Unstable angina patho

Answer 15

medical emergecy when changes from previous - fatigue, significant pain with little exertion

Question 16

MI patho

Answer 16

Ischemia and necrosis - usually thrombus blockage of vessel - severity affected by collateral circulation

Question 17

What are assessments for someone experiencing ACS, Unstable angina or MI

Answer 17

HR and RR (check for elevation)
BP (increased or decreased)
saturation (decreased)
Chest pain (not relieved with rest)
Perfusion in extremities
LOC
UOP
N/V
Fever
Diaphoresis, ashen, pale skin
Anxious appearance

Question 18

Why might diabetics experience pain differently

Answer 18

d/t neuropathy

Question 19

When does angina become a medical emergency

Answer 19

when stable angina turns to unstable angina

Question 20

MI diagnostic tools: ECG - what will you see?

Answer 20

ST elevation, Q wave, T wave inversion

Question 21

Cardiac marker: Troponin

Answer 21

Troponin I: < 0.35 mcg/L
Troponin T: <0.2 mcg/L
3-4 hours normal in 10-14 days)

Question 22

Cardiac markers: Ck with MB

Answer 22

38-174 u/L MB

< 5% increase 4 hours peak 24 normal 48

Question 23

Cardiac marker: Myoglobin

Answer 23

5-70 mcg/mL, increase 1-3 hour peak 12 hour

Question 24

Goal for coronary angio with MI

Answer 24

Need to get to cath lab, goal is to get them in there in 60 minutes of MI

Question 25

Interventions when MI

Answer 25

Bestrest, HOB up, need IV access, will progress to more activity slowly

Question 26

Intervention unstable angina

Answer 26

if MI is ruled out, patient will be put on anti-platlet medication and heparin

Question 27

MONA for MI

Answer 27

Morphine - give to alter preload (vasodilation), decreases anxiety, only medication that is analgesic, bronchodilation Oxygen - increase O2 supply Nitroglycerine SL - vasodilator for coronary arteries which will relieve pain, decrease the myocardial o2 demand because its increasing the size of the coronary arteries, it increases the artery size (patient might get HA) Chewable aspirin - anti- platelet properties to limit extent of clot

Question 28

MI - reperfusion therapy

Answer 28

a. Cath / PTCA stent | b. Surgical revascularization CABG

Question 29

Thrombolytics MI

Answer 29

30 minutes from presentation to max 6 hours after symptoms start - tPA (retaplase)

Question 30

Meds that can be used for cardiac problems

Answer 30

BB Ace inhibitors Antiplatlet and anticoagulant

Question 31

Beta blocker

Answer 31

reduce myocardial o2 consumption | reduce myocardial contractility

Question 32

antiplatlet and anti-coagulant

Answer 32

Prevent platlet aggregation and subsequent thrombus

Question 33

What does HIT stand for

Answer 33

Heparin induced thrombocytopenia

Question 34

education for MI

Answer 34

Cardiac rehab - for progressive activity Diet - low in cholesterol and sodium and high in fiber decrease stress benefits of lifestyle change

Question 35

Cardiac catheterization

Answer 35

Angiography into the right or left coronary artery. Contrast dye inserted into the artery. NCLEX considers the access in the femoral artery

Question 36

Cardiac catheterization: assessments

Answer 36

BP, HR, RR, sat., assess for hemostasis, assess extremities, movement, sensation

Question 37

What do we need to consider if someone is require to have contrast dye?

Answer 37

making sure they are not on metformin (kidney damage), assess kidney function before resuming metformin, need to know creatinine

Question 38

What can occur with femoral access for cardiac catheterization?

Answer 38

Retroperitoneal bleed

Question 39

Complications of coronary cath

Answer 39

``` Restenosis Dissection perforation abrupt closure vasospasm acute MI acute arrhythmia cardiac arrest Risk for thrombosis ```

Question 40

Why will a patient be on anti-platelet medication for up to a year after coronary catheterization

Answer 40

Risk of thrombosis and restenosis

Question 41

6 P's to assess for cardio

Answer 41

``` pulse paralysis pain perishingly cold pallor paraesthesia ```