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NURSING 2 > ACS, MI, CATH week 2 > Flashcards

ACS, MI, CATH week 2 Flashcards

1
Q

What is the cause of CAD

A

atherosclerosis

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2
Q

What are the types of CAD

A
  1. Stable CAD (stable angina)

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

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3
Q

Acute clinical presentation of CAD

A

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

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4
Q

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

A

Unstable angina = minor
NSTEMI = partial
STEMI = complete

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5
Q

knowing the stages of many heart issues (flip)

A

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

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6
Q

How do we ID someone having an MI

A

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

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7
Q

Chest pain assessment scale: PQRST

A

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?

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8
Q

Describe stable angina

A

“effort” angina: triggered by physical or mental exertion

resolves with rest or nitrates

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9
Q

Describe unstable angina

A

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

– also called acute coronary syndrome, may lead to MI

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10
Q

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

A

Drop in blood pressure - it involves the right coronary artery

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11
Q

What are reasons someone may have chest pain?

A 
Angina
ACS MI
Unstable angina 
Pericarditis 
Pulmonary pneumonia 
PE
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12
Q

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

A 
Esophageal disorders
Hiatal hernia 
Reflux
Spasm
Esophagitis
Anxiety/panic disoder
Costochondriasis 
Dissecting aorta
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13
Q

How to relieve pericarditis pain

A

lean forward

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14
Q

ACS patho

A

Includes unstabe angina - NSTEMI, STEMI

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15
Q

Unstable angina patho

A

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

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16
Q

MI patho

A

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

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17
Q

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

A 
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
18
Q

Why might diabetics experience pain differently

A

d/t neuropathy

19
Q

When does angina become a medical emergency

A

when stable angina turns to unstable angina

20
Q

MI diagnostic tools: ECG - what will you see?

A

ST elevation, Q wave, T wave inversion

21
Q

Cardiac marker: Troponin

A

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

22
Q

Cardiac markers: Ck with MB

A

38-174 u/L MB

< 5% increase 4 hours peak 24 normal 48

23
Q

Cardiac marker: Myoglobin

A

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

24
Q

Goal for coronary angio with MI

A

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

25
Q

Interventions when MI

A

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

26
Q

Intervention unstable angina

A

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

27
Q

MONA for MI

A

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

28
Q

MI - reperfusion therapy

A

a. Cath / PTCA stent

b. Surgical revascularization CABG

29
Q

Thrombolytics MI

A

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

30
Q

Meds that can be used for cardiac problems

A

BB
Ace inhibitors
Antiplatlet and anticoagulant

31
Q

Beta blocker

A

reduce myocardial o2 consumption

reduce myocardial contractility

32
Q

antiplatlet and anti-coagulant

A

Prevent platlet aggregation and subsequent thrombus

33
Q

What does HIT stand for

A

Heparin induced thrombocytopenia

34
Q

education for MI

A

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

35
Q

Cardiac catheterization

A

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

36
Q

Cardiac catheterization: assessments

A

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

37
Q

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

A

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

38
Q

What can occur with femoral access for cardiac catheterization?

A

Retroperitoneal bleed

39
Q

Complications of coronary cath

A 
Restenosis
Dissection
perforation
abrupt closure
vasospasm
acute MI
acute arrhythmia 
cardiac arrest 
Risk for thrombosis
40
Q

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

A

Risk of thrombosis and restenosis

41
Q

6 P’s to assess for cardio

A 
pulse
paralysis
pain
perishingly cold
pallor
paraesthesia

NURSING 2 (12 decks)

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