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Definitions
Causes
Diagnosis
Medical Treatment
Nursing Care
100
A broad term that includes chronic stable angina and acute coronary syndromes and affects the arteries that provide blood, oxygen & nutrients to the myocardium.
What is coronary artery disease?
100
Coronary artery plaque rupture, coronary artery spasm, platelet aggregation and emboli from mural thrombi.
What are causes of acute myocardial infarction?
100
Classification of actute coronary syndromes based upon the presence or absence of ST segment elevation on the ECG and positive troponin levels.
What ST-elevation MI (STEMI) the traditional manifestation Non-ST-elevation MI (NSTEMI) common in women and unstable angina (USA).
100
The steps in treatment for a client with chest pain.
What are stopping any client activity and have them lie down with HOB elevated, apply O2 as you assess the pain, obtain vital signs, obtain IV access and order stat ECG, give up to 3 nitroglycerin sublingual, if no relief, give morphine and aspirin.
100
During this phase of treatment, the nurse promotes bedrest, ensures limited mobility. Later in this stage the client will abulate independently to the bathroom, and progress to 50, 100, then 200 feet three times a day. THe client can shower for 5-10 minutes with a chair available to rest if needed.
What is Phase One of cardiac rehabilitation? Phase 2 starts at discharge through convalescence at home. Phase 3 is long term conditioning.
200
This occurs when blood flow through the coronary arteries is partially or completely block to the point that insufficient oxygen is supplied to meet the requirements of the myocardium.
What is ischemia? Infarction (death of myocardial cells) occurs when severe ischemia and decreased perfusion are prolonged leading to irreversible tissue death.
200
MI's often start in this layer of the heart where there is greater oxygen demand and the poorest oxygen supply and is usually associated with cardiac arrhythmias.
What is the subendocardial layer of the heart? Transmural MI's involve all 3 muscle layers (endo, epi & myo), has pathological Q waves on ECG, and has more effect on cardiac contraction (wall motion, cardiac output d/t pump failure)
200
These are signs and sypmtoms of metabolic syndrome.
What are BP of 130/85 or higher (or taking BP meds), HDL < 40 for men and <50 for women (or taking anticholesterol drug), triglycerides >150 (or taking anticholesterol drugs), FBS > 100 (or taking antidiabetic drugs) and wast > 40" for men & > 35 for women
200
We administer acetaminophen (Tylenol) to prevent headaches before administering this medication
What is Nitroglycerin? Patients who are not used to nitrates often get cerebral vasodilation = headache.
200
A drop of > 20 mmHg in SBP, change of 20 beats or more in HR, and reports of dyspnea or chest pain when monitoring a client during activity.
What are signs of Activity Intolerance? Stop activity and notify the health care provider. Do not advance to the next level.
300
The chest discomfort that occurs with moderate to prolonged exertion, is consistent in frequency, duration and intensity over several months, is associated with a fixed atherosclerotic plaque and is usually relieved by rest, nitroglycerin and drug therapy.
What is chronic stable angina (CSA)?
300
Factors such as family history, age, gender, and ethnic background
What are nonmodifiable risk factors that cannot be altered or controlled?
300
These symptoms include indigestion, pain between the shoulders, aching jaw, or choking sensation that occurs with exertion or stressful circumstances. May also include fatigue, sleep distrubances and dyspnea
What is atypical angina signs often seen in women.
300
This drug relieves MI pain, decreases myocardial oxygen demand, relaxes smooth muscle and reduces circulating catecholamines and is given in 2-10 mg doses IV every 5-15" until client's pain is relieved, they receive the maximum dose or signs of toxicity are seen.
What is morphine sulfate?
300
The nurse needs to identify, assess hemodynamic status and discomfort when these occur following an acute MI.
What is the arrhythmias, Sinus Bradycardia, Sinus Tachycardia, Heart Blocks & Premature Ventricluar contractions? Check pulse, check BP to see effects on cardiac output and may require treatment with medications or pacing.
400
A term used to describe clients who have unstable angina (USA) or acute MI in which the atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregation, thrombus formation & vasoconstriction.
What is Acute Coronary Syndrome (ACS)?
400
These factors can be controlled by the patient such as smoking, diet, obesity, exercise, cholesterol levels, diabetes, blood pressure.
What are modifiable risk factors?
400
chest pain that may radiate to jaw or arm which may be described as tightness, burning, pressure or indigestion. If severe, it may have associated nausea, vomiting, diaphoresis, weakness, palpitations ventricular arrhythmias, S3 or S4 heart sounds, fever & shortness of breath.
What are typical myocardial ischemia signs and symptoms?
400
These medications are used in acute MI to prevent fibrinogen from attaching to activated platelets at the site of a thrombus. They are given before and during coronary angioplasty to maintain patency of the artery and with fibrinolytic agents in AMI.
What are Glycoprotein (GP) IIb/IIIa inhibitors such as Abciximab, ReoPro, Integrilin or Aggrastat? Note: These clients must be on bleeding precautions and take an anti-ulcer medication. Check all stool fo occult blood
400
These are signs and symptoms of cardiogenic shock the nurse must monitor for in Acute MI.
What are tachycardia, hypotension, UOP < 30 mL/hr, Cold, clammy skin with poor peripheral pulses, agitation, restless or confusion, pulmonary congestion, tachypnea and continue chest discomfort?
500
This term describes chest pain or discomfort that occurs at rest or with exertion and causes severe activity limitations. The pain lasts longer than 15 minutes or may be poorly relieved by rest or nitroglycerin. The client will present with ST segment changes but will not have elevated troponin or creatine kinase MB (CPK-MB).
What is unstable angina pectoris (USA)?
500
The most important risk factor for women
What is age?
500
The tests ordered when an Acute Myocardial Infarction (AMI) is suspected.
What are CXR, 12 lead ECG, Troponin I or T, creatine kinases-MB (CPK-MB), myoglobin, cardiac catheterization, echocardiogram.
500
How (1) beta blockers, (2) ace inhibitors, (3) calcium channel blockers and (4)thrombolytics such as t-PA, reteplase, tenecteplase help in acute MI (AMI).
What is 1) decrease O2 demand & increase O2 supply, 2) decrease afterload and work of the heart, 3) vasodilation of coronary arteries (increase O2 supply) & vascular arteries (decrease afterload) and 4) dissolving clots and restore myocardial blood flow.
500
To prevent this from occuring, the client is given stool softeners and is not allowed to pull themselves up in bed.
What is a vagal maneuver which can lower the heart rate and cause arrhythmias? You can also stimulate the vagus nerve by coughing & vomiting