Acute Coronary Syndrome Week 8 PDF

NSG2201 Week 8 Acute Coronary Syndrome Virginia Plummer OFFICIAL Revision OFFICIAL  RISK FACTORS of Coronary heart disease MODIFIABLE NON-MODIFIABLE Hypertension Age...

NSG2201 Week 8 Acute Coronary Syndrome Virginia Plummer OFFICIAL Revision OFFICIAL  RISK FACTORS of Coronary heart disease MODIFIABLE NON-MODIFIABLE Hypertension Age >45 men; >55 women Smoking Ethnicity & socioeconomic status family history Hypercholesterolemia Obesity Sedentary lifestyle Contributing Modifiable risk factors diabetes Metabolic syndrome Illicit substance use Chronic kidney disease OFFICIAL  What is Acute Coronary Syndrome (ACS)? Unstable Angina Non-ST Elevation Myocardial Infarction (NSTEMI) ST Elevation Myocardial Infarction (STEMI) OFFICIAL OFFICIAL Diagnosis Initial Clinical presentation including history and risk factors 12 lead ECG Cardiac serum markers (Troponin) Angiography, Transthoracic echocardiogram, Exercise stress tests, Chest Xray, lipid profile, Nuclear imaging. OFFICIAL  Clinical manifestations of ACS CHEST PAIN Precipitation Quality Radiation Severity Timing Associated symptoms: dyspnea, nausea, diaphoresis, decreased exercise tolerance, dizziness, palpitations, pale Be aware: SILENT ISCHEMIA OFFICIAL ECG OFFICIAL Cardiac biomarkers Troponin—myocardial muscle protein Rises within 4–6 hours of injury/infarction, peaks 10–24 hours, detected for up to 10–14 days Creatine kinase (CK) CK-MB is cardiac-specific Rises in 3–6 hours, peaks in 12–24 hours, returns to baseline within 12–48 hours Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL Stable angina, Unstable angina, NSTEMI, STEMI……… What does it all mean??? Please watch below video before proceeding https://youtu.be/C0BUPHYQ1h4 OFFICIAL Management of Acute Coronary Syndrome Lecture 2. This Photo by Unknown author is licensed under CC BY-NC. OFFICIAL  Learning objectives 1.demonstrate an in-depth understanding of the pathophysiology and clinical manifestations of Acute Coronary Syndrome 2. explain methods and techniques used to conduct a comprehensive nursing history and focused physical assessment, using a systematic primary and secondary survey approach; 3. identify and analyse diagnostic tests and investigations appropriate to diagnose Acute Coronary syndrome 4. recognise the clinical cues for patient deterioration. 5. apply a critical analysis of assessment findings and an in-depth understanding of clinical reasoning cycle to develop a therapeutic plan of care for patients experiencing Acute Coronary syndrome 6.. outline the collaborative management strategies for patients in the acute care setting and the role of the registered nurse within the team. 7.. examine a range of pharmacological agents used to treat health problems and the impact of polypharmacy on nursing care; OFFICIAL Nursing Management of ischemic chest pain MINUTES MEAN MYOCARDIUM ASSESS & position PQRST & Vital signs commence O2 if required, establish IV access 12 lead ECG Nitroglycerin (GTN) +/- Morphine, Aspirin Escalation of care, Cardiac biomarkers, Cardiac monitoring, bed rest If STE present prepare for angiogram and transfer to coronary care unit OFFICIAL Treatment ACS- REPERFUSION STEMI: Primary Percutaneous Coronary Intervention (PCI): Angioplasty, drug-eluting stent (DES) thrombectomy > may need CABGS Goal open blocked artery within 90min of onset of symptoms Advantages Complications Nursing care pre and post angiogram Thrombolytics: Considered if PCI not available Not recommended > 12hours after onset of symptoms Ideally within 3 hours symptom onset Contraindications OFFICIAL Treatment ACS- Reperfusion Unstable Angina/NSTEMI Relieve pain (nitrates and morphine), Antiplatelet Anticoagulant angiography once stabilised OFFICIAL Coronary angiogram OFFICIAL Percutaneous Coronary Intervention (PCI OFFICIAL Coronary Artery Bypass surgery (CABGS) OFFICIAL  Medications—Acute Coronary Syndrome Goal: ↓ O2 demand and/or ↑ O2 supply Nitrates (short and long acting) Morphine Antiplatelet eg Aspirin, clopidogrel Anticoagulant eg Heparin, enoxaparin Angiotensin-converting enzyme (ACE) inhibitors β-adrenergic blockers Calcium-channel blockers OFFICIAL Education and Cardiac Rehabilitation Risk factors Diet & exercise medications Management of angina resumption activity eg sex, work, driving Referral to cardiac rehab program summary to GP & follow up appointment OFFICIAL Lets take a break OFFICIAL Acute myocardial infarction: complications OFFICIAL OFFICIAL Conduction system https://youtu.be/v3b-YhZmQu8 Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Arrythmias: Atrial Fibrillation Atrial fibrillation most common disorder most prevalent in the elderly Life threatening arrhythmias include ventricular tachycardia, ventricular fibrillation, asystole and pulseless electrical activity, and cause cardiac arrest and then cessation of breathing OFFICIAL OFFICIAL Normal sinus rhythm ⬤ Sinus node fires 60–100 beats/minute ⬤ Follows normal conduction pattern Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Atrial fibrillation ⬤ Disorganisation of atrial electrical activity due to multiple ectopic foci ⬤ P waves replaced by chaotic, fibrillatory waves B Atrial fibrillation with a controlled ventricular response. Note the chaotic fibrillatory (f) waves between the RS complexes Brown, Edwards, Buckley & Aitken: Lewis’s Medical–Surgical Nursing © Elsevier Australia, 2020 OFFICIAL  Atrial fibrillation What is the clinical significance? DECREASED CARDIAC OUTPUT INCREASED RISK OF STROKE Treatment ⮚ Medications to control ventricular rate and/or convert to sinus rhythm ⮚ Electrical cardioversion ⮚ Anticoagulation ⮚ Radiofrequency catheter ablation OFFICIAL  Complications of Myocardial Infarction Pericarditis Progressive and often severe, sharp, chest pain Pain worse on lying supine, relieved by sitting up Pericardial friction rub can be heard on auscultation Pericardial effusion Buildup of fluid in pericardium (Can be rapid or slow) Cardiac tamponade Compression of the heart as the volume of pericardial effusion increases Effects on heart sounds? BP? OFFICIAL The End OFFICIAL