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Flashcards in Exam 2: CAD DAY 2 Deck (28)
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1

Other Care for Acute Coronary Syndrome

1. CABG
2. Minimally Invasive Direct CAB
3. Fibrinolytic Therapy

2

CABG

New passage between aorta and past coronary arterial obstruction

3

Commonly used grafts for CABG

Internal Mammary Artery
Saphenous Vein

4

Very important point to remember after CABG

Antiplatelet Therapy

5

When is fibrinolytic therapy used?

When facility does not have an interventional cardiac cath lab

6

What is a fibrinolytic

Dissolves thrombus (clot buster)

7

When should fibrinolytic be given?

W/in 6 hours of onset of symptoms
(Ideally within the 1st hour)

8

Advantages of minimally invasive direct coronary artery bypass

Decreased cost and length of stay
Shorter Recovery
Not true open heart surgery

9

Criteria for fibrinolytic therapy

1. Chest pain typical of MI (< 12 hrs in duration)
2. ECG finding consistent w/ acute STEMI
3. No absolute contraindications

10

Absolute Contraindications of fibrinolytic therapy

Hx: intracranial hemorrhage, intracranial tumor, ischemic stroke, severe uncontrolled HTN, active bleeding, aortic dissection, streptokinase therapy w/in 6 mo.

11

What should the patient’s blood pressure be in order to use fibrinolytics?

> 180/110 mmHg

12

Potential Nursing responsibilities w/ fibrinolytic therapy

1. Baseline labs. 2. IV lines. 3. All invasive procedures before infusion started. 4. Monitor HR, V/S, O2 sat. Watch for repercussion dysrhythmias. 5. Monitor Heparin drip. 6. Watch for bleeding. 7. Monitor Cardiac Biomarkers

13

Treatments based on Evidence based practice

Core Measures

14

Core Measures for Acute MI

1. Aspirin on arrival. 2. Aspirin prescribed @ discharge. 3. ACE or ARB @ discharge. 4. Smoking Cessation Advice. 5. B-Blocker @ discharge. 6. Fibrinolytic therapy w/in 30 min of arrival. 7. PCI w/in 90 min of arrival. 8. Inpatient mortality. 9. Statin prescribed @ discharge.

15

Potential Nursing Dx for Acute MI:

Acute Pain
Decreased Cardiac output
Ineffective tissue perfusion
Anxiety; Activity intolerance

16

Complications of MI

1. Dysrhythmias. 2. Heart Failure. 3. Cardiogenic shock. 4. Papillary muscle dysfunction. 5. Pericarditis. 6. Dressler Syndrome

17

Friction rub r/t inflammation in pericardial sac

Pericarditis
Dressler syndrome

18

Pericarditis w/ effusion and fever 4-6 weeks after MI

Dressler Syndrome

19

Nursing care after Acute MI

Provide Education: Cardiac rehab; proper NTG use; dietary teaching; maintain ideal body weight; exercise; emotional support; resumption of sexual activity

20

Team of people who work together to improve patient quality of life; collaborative

Cardiac rehabilitation

21

What should nurse teach about diet after MI

low fat; low sodium

22

Why is it important for patient to exercise after MI

Decrease mortality rate and risk of heart failure

23

Why should the nurse be concerned with emotional support for the patient after MI?

Increased risk of depression; scared and complete lifestyle change

24

When can the patient resume sexual activity after MI?

7-10 days after
Avoid ED meds w/ nitrate use.

25

What is the usual cause for sudden cardiac death

Acute ventricular dysrhythmias

26

Risk factors for sudden cardiac death (SCD)

Ejection fraction (EF) < 30%
Ventricular dysrhythmias

27

Treatment for survivors of SCD

ICD
LifeVest
Psychosocial Needs: time bomb; reluctant to resume normal activities; loneliness/withdrawal

28

How should nurse respond after SCD?

Presence/touch - be available
Allow expression of feelings from family
Allow for moments of silence
Be honest & direct; Allow family to have closure