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Chapter 40 Care of Patients with Acute Coronary Syndromes

Terms in this set (188)

*aspirin-325 mg- antiplatelet drug may also be taken daily to prevent clots that further block coronary arteries.

-Nitroglycerin (NTG): increases collateral blood flow, redistributes blood flow toward the subendocardium & dilates the coronary arteries. ANGINA usually response to NTG Instruct patient to lie down with the HOB- hypotension can occurMonitor for Headache

Treatment for morphine toxicity****naloxone (Narcan)

Oxygen, Nitro, and if no relief Morphine I.V.
Other meds:
Thrombolytic Therapy:
t-PA, activase, retavase, Tenecteplase (TNK) can be bolised as quickly as 5 miniutes

Beta adrenergic blockers- metoprolol (Toprol XL), carvedilol CR (Coreg CR), or beta blockers- slow the HR & decrease the force of cardiac contraction- prolong the period of diastole & increase myocardial perfusion while reducing the force of myocardial contraction Monitor bradycardia, hypotension, decreased LOC, chest discomfort*Assess the lungs for crackles & wheezes.
**DON"T give bb's if pulse is below 60 or the systolic BP is below 100 without first checking with the HCP. METOPROLOL- Assess patient for cough, SOB, edema & weight gain (indications of HF)

Angiotension-converting inhibitors
give within 48 hours of MI- monitor patient for decreased urine output, hypotension, & cough. Check for changes in serum potassium, creatinine, & BUN.

CCB:
Verapamil, Procardia, Norvasc/Carizem
not indicated after an MI Monitor for hypotension, & peripheral edema, & review frequency of angina episodes. Also used for chronic stable angina

Antiarrhythmics:
amiodarone, lidocaine, magnesium for VF/VT
Heparin I.V.
Stool softeners

Patients with diabetes mellitus & CAD- may not experience chest pain or pressure- give morphine as the priority in managing pain .
-Failed medical management
-Presence of left main coronary artery or three-vessel disease (critera for surgery)
-Not a candidate for PCI (e.g., lesions are long or difficult to access),Cant do angioplasty, then you need surgery, or if you did one and didn't work.
-Failed PCI with ongoing chest pain

Coronary artery bypass graft (CABG) surgery
-Requires cardiopulmonary bypass- used to provide oxygenation, circulation, & hypothermia during induced cardiac arrest. Blood is delievered from the heart to the bypass machine, where it's heparinized, oxygenated, & returned to the circulation through a cannula placed in the ascending aortic arch or femoral artery. Keeping the heart "warm" decreases postop complications that were more common when cold cardioplegia was used.
-Uses arteries and veins for grafts
(Closely assess the patient for dysrhythmias, such as brady-dysrhythmias, a-fib, or heart block. Hypoxemia & hypokalemia are frequent causes of ventricular dysrhy. Monitor for, report, & document other complications of CABG including: fluid & electrolyte imbalance, hypotension, cardiac tamponade, hypothermia, hypertension, bleeding,
Managing Fluid & Electrolyte imbalance:edema is common. serum electrolytes may be decreased (calcium, magnesium & potassium) Desired potassium- 4.0 mEq/L; magnesium- 2.2 mEq/L
*Hypotension-major problem- Decreased preload (can result from hypovolemia & vasodilation) Hypothermia-after surgery because it promotes vasoconstriction & hypertension

Minimally invasive direct coronary artery bypass (MIDCAB)
-Alternative to traditional CABG
-no bypasss
-less risk, more successful for elderly