Acute Coronary Heart Disease - Copy
Transcript of Acute Coronary Heart Disease - Copy
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Cardiovascular
system
ACUTE CORONARY
SYNDROME
Reported by:
Nashraifar A. Jahiron
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system
ACS
Is an emergent situation characterized
by an acute onset of myocardial
ischemia that result in myocardial
death if definitive intervention do not
occur promptly.
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Causes: hypertension
smoking
DMOBESITY
high cholesterol level 240 mg/dl
Risk factor: age >55
males
family history
hereditary
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Heart with ischemia that leads to ACS
NORMAL HEART
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Pathophysiology RF
Atherosclerotic plaque partially obstruct coronary blood flow
Stable plaqueUnstable plaque with ulceration or rupture and thrombosis
Transient ischemia Sustained ischemia
Unstable angina
Myocardial infarction
Myocardial inflammation
And necrosis
Injury of the vascular endothelium
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CLINICAL MANIFESTATION
Chest pain
Shortness of breath
Indigestion
Nausea Anxiety
Cool, pale and moist skin
Fast heart rate and respiratory
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DIAGNOSTIC TEST
Physical exam
Patient history
Electrocardiogram
Echocardiogram To determine cardiac activity
Laboratory test
Cardiac enzymes and biomarkers
Creatine kinase and its isoenzymes Myoglobin
troponin
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Patients with ACS are, for the most part, dichotomized
by whether significant ST elevation is present or not.
On the basis of serial enzymatic measurements,
patients without ST elevation can subsequently be categorized
to have unstable angina or non-ST elevation myocardial
infarction (NSTEMI.
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MEDICAL MANAGEMENT
Pharmacologic therapy
Aspirin
Nitroglycerin
IV beta blockers
Unfractionated heparin
• Analgesics
• Angiotensin converting enzyme inhibitor
• Thrombolytics
Alteplase
Reteplase
tPA(tissue plasminogen activator)
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Nitrates -
• indications: to prevent anginal attacks, reduce myocardial ischemia
• contraindications: marked hypotension, increased ICP, severeanemia
Beta-Blockers- these are drugs that is more useful in treating stable angina
• indications: antiarrhythmic, anti anginal, antihypertensive
• contraindications: clients who has decreased HR and BP, Clients
who have 2nd or 3rd degree AV block, pregnancy, bronchial asthma,
COPD.
Calcium channel blockers-
• indications: treatment of stable and variant angina, certain
dysrhythmias, hypertension
• contraindications: pregnant, hypotension
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Nursing responsibilities
Anti anginals:
• Before giving the drug- obtain VS ,health hx, & drug hx
• upon giving: offer sips of water before giving SL Nitrates,
• monitor VS & effects of IV Nitroglycerin. Report angina that persists.
• client teaching: a SL Nitroglycerin tablet is used if chest pain occurs. Repeat in 5mins
if pain has not subsided & again in another 5mins if pain persists. If pain still has not
subsided immediate medical help is necessary• -show client how SL nitro glycerin are taken. Inform that a stingin & biting sensation
indicates the tablet is fresh
• - meds bottle should be kept dry & away from sunlight.
• - instruct client taking Transdermal patch to apply it OD, usually in the morning,
Beta Blockers & Ca channel blockers- do not discontinue these drugswithout the health care client’s approval. Withdrawal symptoms
(reflex tachycardia& pain) may be severe
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SURGICAL MANAGEMENT
Emergent percutaneous Coronary Intervention(PCI)
Used to open the occluded coronary artery and promote
reperfusion to the area that has been deprived of
oxygen.
Cardiac catheterization laboratory and staff nurseshould be available if an emergent PCI is to be
performed.
Coronary artery bypass surgery
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NSG. DIAGNOSIS
Ineffective cardiac tissue perfusion related to
reduced coronary blood flow
Risk for imbalanced fluid volume
Risk for ineffective peripheral tissue perfusionrelated to decreased cardiac output.
Death anxiety related to cardiac event
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COMPLICATIONS
Acute Pulmonary Edema
Heart failure
Cardiogenic shock
Dysrhytmias and cardiac arrest Pericardial effusion and cardiac tamponade
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NURSING MANAGEMENT
Relieving pain and other signs and symptoms.
Administer medication as prescribed
Administer oxygen with medication by nasal cannula 2-4 Lpm.
Monitor vital signs frequently
Bedrest with the backrest elevated or in a supported chair
helps to decrease chest discomfort.
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1. Promoting adequate tissue perfusion
• Bed or Chair rest high 30 degrees during the initial
phase of treatment helps myocardial oxygen
consumption.• Limitation on mobility
• Check skin temperature and peripheral pulses frequently
to monitor tissue perfusion.
2.Reducing anxiety
• Provide information to the patient ad family in an honest
and supportive manner.
• Ensuring a quiet environment.
• Preventing interventions that disturb sleep.
• Teaching relaxation techniques• Music therapy
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MONITORING AND MANAGING POTENTIAL
COMPLICATIONS
Monitor the patient closely and report promptly for changes of:
Cardiac rate and rhythm
Heart sounds
Blood pressure Chest pain
Respiratory status
Urinary output
Skin color
Temperature
ECG changes
Sensorium
Laboratory values
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1. Which risk factor for coronary artery
disease is non-modifiable?
a. Cigarette smoking
b. Diabetes mellitus
c. hereditary
d. Hypertension
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2. Exceeding which SERUM
CHOLESTEROL level significantly increase
the risk of coronary artery syndrome?
a. 100 mg/dl
b.150 mg/dl
c. 175 mg/dld. 240 mg/dl
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3. Which condition most commonly causeof acute coronary artery syndrome?
a. Atherosclerosis
b. Diabetes mellitusc. Myocardial infarction
d. Renal failure
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4. A nurse describes atherosclerosis for client education.
which of the following statements if made by the client ,
requires additional teaching?a. Plaques obstruct the coronary artery
b. Plaques obstruct the coronary vein
c. Hardened vessels can’t dilate to allow
d. Atherosclerosis can cause angina
5. Which action is the first priority of care for a client
exhibiting signs and symptoms of coronary artery syndrome?
a. Decrease anxiety
b. Enhance myocardial oxygenation
c. Administer sublingual nitroglycerin
d. Educate the client about his symptoms
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6. Medical treatment of coronary artery disease includes the ff invasive
procedure except?
a. Cardiac catheterization
b. Coronary artery bypass surgeryc. Oral medication administration
d. Percutaneous coronary intervention(PCI
7. In caring the client with cardiac problem , the nurse must know that the
condition most likely responsible for myocardial infarction is which of thefollowing?
a. Aneurysm
b. heart failure
c. coronary artery thrombosis
d. renal failure
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8. What is the most common complication of acute coronary artery
syndrome?
a. Cardiogenic shock
b. Heart failure
c. Arrhythmiasd. Pericarditis
9. In what position should the nurse place the head of the bed to obtain
the most accurate?
a. High fowlersb. Raised 10 degrees
c. Raised 30 degrees
d. Supine
10. What is the drug of choice in treating acute coronary artery
disease in preventing angina attacks?
a. nitroglycerin
b. methotrexate
c. antipyretics
d. opioids