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What does ACS stand for
acute coronary syndrome
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Acute coronary syndrome is the umbrella term for what?
acute myocardial ischemia
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According the the AHA what are the major risk factors of ACS?
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According the the AHA what are the modifiable risk factors of ACS?
- tobacco
- cholesterol
- HTN
- physical inactivity
- obesity
- diabetes
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According the the AHA what are the contributing risk factors of ACS?
- stress
- alcohol
- diet/nutrition
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What are the three categories of ACS?
- STEMI - ST segment elevation MI
- NonSTEMI - Non-ST segment elevation MI
- Unstable angina
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What is the pathophysiology of ACS?
- plaque ruptures and travels
- platelets are activated and attach to plaque
- 40% occlusion - interruption in blood flow
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What is the priority of the nurse?
12-lead EKG within 10 min of arrival
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Which leads are elevated in ST segment elevation?
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What cardiac biomarkers identify MI?
- Troponin (specifically troponin I)
- CK - but not specific to heart muscle
- BNP
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In a NSTEMI (non-ST segment elevation MI) what will the EKG show?
ST segment depression or T wave inverted
positive biomarkers
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What do EKG and biomarkers show in a patient with unstable angina?
- Normal EKG
- Inverted T-waves
- ST segment depression
- WITHOUT Troponin elevation – no MI
- Will stay and get stress test
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What are the S/S of cardiac disease?
- Fever = inflammatory process
- Nausea
- Pain
- Poor profusion – elevated BP and HR = more O2 demand (metoprolol to decrease HR)
- Dizziness/syncope
- Cardiac arrest
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What are the S/S of the female one month before a heart attack?
- unusual fatigue
- sleep disturbance
- SOB
- indigestion
- anxiety
- heart racing
- arms weak/heavy
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What are the S/S of the female during a heart attack?
- SOB
- weakness
- unusual fatigue
- cold sweat
- dizziness
- nausea
- arms weak/heavy
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What are some unusual risk factors for CVD (cardiac vascular disease)?
- Psoriasis
- migraines
- sleep apnea
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What are the nursing priorities of care when a patient presents with MI?
- EKG
- V/S
- O2 (2L)
- Labs
- IV access (2 - large bore)
- Meds (ASA, beta blocker, NTG, Morphine)
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What does MONA stand for?
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What would be a contraindication of NTG?
- if BP is <90
- vasodilators (viagra, revatio...)
- Inferior wall MI (II, III, AVF)
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What would be a contraindication of morphine?
if BP is <100
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A change in leads II, III, AVF indicate MI to what part of the heart?
inferior
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A change in leads II, III, AVF indicate damage to which artery?
RCA (right coronary artery)
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A change in leads V1, V2, V3, V4 indicate MI to what part of the heart?
left ventricle
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A change in leads V1/V2 specifically indicate MI to what part of the heart?
Septum
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A change in leads V3/V4 specifically indicate MI to what part of the heart?
Anterior
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A change in leads V1/V2/V3/V4 indicate damage to which artery?
LAD (left anterior descending artery)
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A change in leads V5/V6/AVL/I indicate MI to what part of the heart?
lateral (posterior)
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A change in leads V5/V6/AVL/I indicate damage to which artery?
Circumflex artery
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In an inferior wall MI (II/III/AVF) what do we do?
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When inferior wall MI - what do we usually see?
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When the left ventricle is involved what happens?
- blood isn't supplied to the rest of the body
- low ejection fraction
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When the anterior of the heart is involved what happens?
- ventricles are irritable
- see more dysrhythmias (VT, heart blocks)
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What are the three I's of acute coronary event?
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This tissue alive and viable, if reprofused then viable tissue to limit the size of injury
ischemia
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This tissue if reprofusion therapy occurs, then viable tissue
injury
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This is dead tissue, even with correction the tissue will never be the same
necrosis
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What are the causes of infarction?
- thrombosis
- coronary artery spasm
- decreased coronary arterial blood flow
- increased myocardial workload
- hypoxemia
- toxic exposure (cocaine, meth)
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How long can troponin I levels be expected to detect in the blood?
7-10 days
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What does SAMPLE stand for?
- S – S/S
- A – allergies
- M – meds
- P – past med hx
- L – last oral intake
- E – events leading up to it
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When a patient presents with possible MI what is the acronym that we use to assess quickly?
- SAMPLE
- S – S/S
- A – allergies
- M – meds
- P – past med hx
- L – last oral intake
- E – events leading up to it
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Abnormal heart sounds on auscultation?
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This abnormal heart sound occurs during the rapid ventricular filling of diastole; low pitched; use bell
S3
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This abnormal heart sound is linked to resistance in ventricular filling or a vibration caused by atrial contraction; low pitched use bell
S4
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What are the core measures and guidelines for treatment of MI?
- 10 minutes for 12 lead EKG
- 30 minutes from diagnosis to thrombolytics if no contraindication- if PCI not available
- 90 minutes from diagnosis to cath lab
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Pt with chest pain, negative cardiac markers or slightly elevated troponin, ST segment depression or T wave inversion?
unstable angina
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Pt with chest pain, positive cardiac markers, ST segment elevation?
STEMI
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pt with or without chest pain, positive cardiac markers, ST segment depression or T wave inversion?
Non-STEMI - still an MI
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What do inverted T waves represent?
Ischemia - long term (older than 24 H)
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When do we give O2 in STEMI, unstable angina, NSTEMI?
O2 sat <90%
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What type of MI?
anteriolateral MI
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What type of MI?
Lateral MI
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What type of MI?
Anteriolateral MI
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What is the role of the RN Post PCI?
- Monitor for bleeding Q15 x2H, Q30 x1H, Q1H x4H
- Site check palpate for softness
- Pulses
- Keep the pt lying flat – per policy protocol
- Retroperitoneal bleed: initially when lose volume BP down, HR up, RR up (RR increases first, HR second, BP then goes down)
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How much drainage from a chest tube is too much post CABG
- 100H for 2H
- there should be no bubbling
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What is MIDCABG?
- smaller incision over breast
- uses mammary artery
- heart remains beating
- no perfusion pump
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Why are pacer wires in place after CABG?
Increased chance of heart block - may need pacing
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When JVD is present what do we do to the HOB?
45 degrees or >
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What is the rationale for administering diuretics in a patient with low BP but high HR - when crackles are present?
it will ultimately increase cardiac output and then increase BP
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if a patient has 3 PVC's in a row, what does that mean?
VT
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