Nurs 422 Exam 1: Angina and MI
Terms in this set (61)
atherosclerosis non modifiable risk factors
family hx of CAD, age, female gender, African American, hispanics
modifiable risk factors
smoking, HTN, elevated lipid levels, excessive alcohol use, substance abuse, excessive stress, limited physical activity, diabetes, obesity
precipitating events that can cause angina
anger, eating a lot, being cold, sweating, exercising
patho of angina
inadequate oxygenated blood flow to the heart muscle. it is a supply and demand issue
what is aginia
chest pain that is transient and lasts 3-5 minutes if relieved there will be no permanent damage
temporary, transient, reversible, predictable, and manageable. is predictable with activity.
aka pre-infarction. is unpredictable, may occur at night/rest. there are 3 types
when reporting angina, ask about
PQRST. precipitating events, quality of the pain, radiation of pain, severity of pain, timing when it began and with what activity
EKG of angina
ST depression. shows ischemia, can be reversed
specific to the heart.
specific to the heart
not specific to the heart
normal troponin I
less than 0.03
normal troponin T
less than 0.1
electrolytes to monitor with MIs
potassium and mag
normal potassium levels
normal magnesium levels
checks the actual blood flow of the heart
tube that goes through esophagus and takes picture of the heart
assesses blood flow through the chambers of the heart
onset of angina
first have the patient stop sit down and rest, see if goes away. if chest pain not going away, consider nitro. if unrelieved in 15 min call EMS
1 tablet or spray SL, wait 5 min. if pain unrelieved give second dose and wait 5 min. if pain unrelieved give 3rd and final dose. call 911 if unresolved after 3 times.
vitals and administering nitroglycerin
take patients vital signs every time you give nitro. can give tylenol after nitro if they have a headache
it is light sensitive
acute coronary syndromes
conditions that are characterized by an excessive demand or inadequate supply of O2 and nutrients to the heart muscle associated with: plaque disruption, thrombus formation, vasoconstriction
types of acute coronary syndromes
unstable angina, NSTEMI, STEMI
is the same as unstable angina EXCEPT actual cell death when looking at cardiac markers length of pain and symptoms are LONGER than angina
ST elevelated STEMI
acute ST elevated MI occurs when an intracoronary plaque ruptures with a thrombus formation that completely occludes the vessel. The goal is to reestablish perfusion as quickly as possible.
what is an MI
an area of tissue death that will result in decreased function (Scar tissue). location is CRITICAL.
when you get older, your vessels form an alternate blood supply way in order to get around the partial occlusions. is a good thing. *aerobic excercise
symptoms of an MI
arms/back/jaw/neck/between shoulders: pain, discomfort, numbnes
chest: pain,pressure, fullness
cold sweat, SOB, upset stomach, urge to vomit
women symptoms of an MI
some women might feel very tired days or weeks before a heart attack occurs. heartburn, a cough, heart flutters, or lose their appetite
assessment of an MI
assess if there is: chest pain, the color and temp of the skin, lung sounds for crackles, heart sounds for murmers s3/s4, peripheral pulses bilaterally, edema, LOC ,intermittent claudication, increased weight, syncope, fatigue
troponin levels for MI
the gold standard lab test for MI because they are only elevated with cardiac tissue injury or death
EKG for an MI
Q wave on EKG
means necrosis, tissue death. NOT reversible
cardiac enzymes for MI
troponin T, I, CK-MB, myoglobin
troponin T onset and return to normal?
onset: 4-6 hours
back to normal: 12-21 days
troponin I onset and return to normal?
onset: 4-14 hours
back to normal: 7 days
CK-MB onset and return to normal?
onset: 6 hours
peak: 24 hours
back to normal: 3 days
myglobin onset and return to normal?
onset: 2 hours
back to normal: 24 hours
treatment of an MI
start cardiac monitor and 12 lead EKG & MONA: morphine, oxygen, nitroglycerin, aspirin
invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage
assess for allergies to contrast dye, labs (kidney function), document pulses, informed consent
vital signs after cardiac cath
vitals q 15 min x 4, then every 30 minx2hr or until stable, q 1 hrx4, then every 4 hours
monitor urine output, peripheral pulses, assess insertion site, bed rest 2-6 hours, sandbag to keep placement of the leg, o2 sats
telemetry and post cath
has to stay on even when going to bathroom. patients can only have sponge bath, NO shower. at all times!!
if hematoma post Cath?
hold direct pressure ... not use sandbag!!
where they go in and put the balloon in to break up the athrosclerosis.
monitoring for an angioplasty
watch for hypokalemia and hypotension, dysrythmias, chest pain, and continue clopidogrel
continuing clopidogrel post angioplasty
3-12 months after drug eluting stent
1-3 months for bare metal stents
when thrombolytic therapy is indicated
chest pain after 30 minutes (and give within 6 hours of pain)
contraindications for thrombolyitic therapy
recent surgery, pregnancy,
history of cerebral bleed
, bleeding disorders
things to check before giving thrombolytic therapy
always assess neuro status
bowel therapy after any cardiac surgery/issue
give stool softeners because you don't want them straining
vasodilators effects on preload and after load
lowers both the preload and after load
morphines effects on preload and after load
decreases preload, does not effect after load
activity limits after cardiac cath
activity limited 3-12 weeks post cath
contraindications with oxygen therapy
synthetic and wool clothes, alcohol
cardiac monitoring on EKG
alarm must ALWAYS be on.
1st always check leads and document.