NURS480 Week 3.pdf

NURS480 Week 3: Cardiac and Perfusion Exemplars: o ACS: Definition, TYPES, NSETMI v. STEMI, s/s, labs, Nursing care, Meds, Treatment, PCI, complications. o CABG: Definition, priority nursing, complications o Pacemaker: definition, types, indications...

NURS480 Week 3: Cardiac and Perfusion Exemplars: o ACS: Definition, TYPES, NSETMI v. STEMI, s/s, labs, Nursing care, Meds, Treatment, PCI, complications. o CABG: Definition, priority nursing, complications o Pacemaker: definition, types, indications, priority nursing o Aneurysms: Definition, types, risk factors, priority nursing, complications o Lethal dysrhythmia, asystole, PEA, ventricular Tachycardia, VFib, 3rd degree heart block 01. Acute Coronary Syndrome (ACS) Blood supply to the heart muscle is suddenly blocked (by a thrombus made of plaque) - Coronary arteries are demanding more oxygen than the vesicles of the body can provide. - The demand for oxygen exceeds the supply. ACS is a continuum from angina to Myocardial infarction (MI) - Imbalance of myocardial oxygen supply and demand - When blood flow to the heart is compromised, ischemia causes chest pain o Anginal pain – tight squeezing, heavy pressure or constricting feeling in the chest. o Pain can radiate to the jaw, neck or arm. o MI – pain unrelieved by rest or nitroglycerin and lasting for more than 15 minutes.  o Females and older adults do not always experience manifestations typically associated with angina or MI. o Unstable Angina, STEMI, NSTEMI o Angina – gets worse and lasts longer. - ischemia can lead to necrosis. ▪ An abrupt interruption of oxygen to the heart muscle produces myocardial ischemia -> tissue necrosis (infarction). Stable (exertional) angina Unstable (pre - infarction) Variant (Prinzmetal’s) Angina Angina It occurs with exercise or It occurs with exercise or It is due to a coronary emotional stress and is at rest, but increases in artery spasm, often relieved by rest or occurrence, severity, and occurring during periods of nitroglycerin. duration over time. rest. o Stemi – complete blockage – No blood flow – True infarction / tissue death – NOT REVERSIBLE ▪ When cardiac muscle suffers ischemic injury, cardiac enzymes are released into the bloodstream, providing specific markers of MI. o NSTEMI – N= narrowing. Some blood can be perfused – impaired O2 – Ischemia. - REVERSIBLE Stable Angina Myocardial Infarction Precipitated by exertion or stress Can occur without cause, often in the Relieved by rest or nitroglycerin morning after rest Manifestation < 15 min. Relieved only by opioids Not associated with nausea, epigastric Manifestations last more than 30 minutes. distress, dyspnea, anxiety, diaphoresis Associated with nausea, epigastric distress, dyspnea, anxiety and diaphoresis. Risk Factors: o Male sex or post-menopausal clients o Ethnic background o Sedentary lifestyle and hypertension o Tobacco use  o Hyperlipidemia and obesity o Excessive alcohol consumption o Metabolic disorder – DM, Hypothyroidism o Stress o Atherosclerotic changes related to aging predispose the heart to poor blood perfusion and oxygen delivery. Incidence of cardiac disease increases with age. S/sx + Assessment o Recognize cues: ▪ Palpitations  Tachycardia and tachypnea / SOB ▪ Diaphoresis – pallor, cool, clammy skin ▪ Anxiety and Nausea / vomiting – feeling of impending doom ▪ Angina = Chest pain – substernal or precordial: Can radiate down the shoulder or arm, may present jaw pain. ▪ Decreased LOC ▪ How can women feel an MI differently from men? - vague pain / GI symptoms Females experience atypical Angina: o GI symptoms o Pain between shoulders o Jaw ache o Sensation of choking with exertion. o Analyze Cues: ▪ Hypotension: Ventricular dysfunction Low CO Dizzy ▪ Hypertension: r/t anxiety or SNA (Sympathetic Nerve Activity) ▪ Pulmonary Edema: JVD 3rd heart sound Breath sounds – rales (crackles heard on inspiration due to fluid in the lungs / alveoli popping open) o ACS – DX Procedures / Labs o Priority Intervention = 12 lead ECG ▪ ST depression and/ or T wave inversion = Ischemic issues ▪ STEMI = Rush to the hospital ▪ NSTEMI = education  ▪ After EKG = retrieve blood to look at cardiac enzymes o This helps us determine our next course of action. ▪ Recap: ST elevation = injury Abnormal Q – wave = necrosis ST Depression = Ischemia o Myoglobin: ▪ Earliest marker of injury to cardiac or skeletal muscle ▪ No longer evident after 24 hours Not Cardiac specific.