NUR 242 Med Surg Exam 2 Question and Answer |
Latest Update Verified Questions with Clear
Explanations | A+ Verified
• angina pectoris -✓✓chest pain that results when the heart does not get enough
oxygen
• unstable angina -✓✓chest pain that occurs while a person is at rest and not exerting
themself, not relieved by nitro
• Stable angina -✓✓chest pain that occurs when a person is active or under severe
stress, *IS* relieved by nitro
• labs associated with acute MI -✓✓EKG: ST elevation (sometimes)
CXR: decreased heart function
Echocardiography: shows wall motion and ejection fraction
Elevated troponin -> 1st will be negative, 2nd is usually elevated. Peaks around 24 hrs
post MI
Elevated CK-MB: NOT cardiac specific, shows muscle cell death. Increases with other
disease processes like rhabdomyolysis
Increased Myoglobin
CBC: increased WBC
• manifestations of acute MI -✓✓-differs in everyone (pain is subjective) men different vs
women
-depends on the wall involved
*Anterior wall*: most fatal (has ST elevation)
*Inferior wall*: lesion on right coronary artery, persistent hiccups is a telltale sign
*Posterior wall*: uncommon
Diaphoresis
Crushing, aching, burning chest pain/pressure
Dyspnea (low O2)
Dizziness (low BP)
Nausea/vomiting or malaise
Palpitations
Cool, dusky, pale skin
Feeling of impending doom
EKG: ST elevation WITH cardiac markers = STEMI
No ST elevation WITH cardiac markers= NSTEMI
• STEMI -✓✓ST elevated myocardial infarction
Flipped T waves (retrograde)- zone of ischemia also seen post MI
ST elevation- zone of injury
Q Waves- zone of infarction
, • NSTEMI/NONSTEMI -✓✓non ST elevated myocardial infarction
NO ST elevation
Sometimes ST depression
Elevated troponins
T wave irregularities
Q wave irregularities
• What is door to balloon time? -✓✓Time of hospital presentation to time occluded artery
is opened should be ≤ 30 min.
• Treatment of MI and ACS -✓✓Morphine- decreases respirations but also PRELOAD
O2
Aspirin and other antiplatelets/ Heparin: goal is to prevent blood clots and restore blood
flow
Cath lab- possibly put in stents or other procedures to open vessel
Nitroglycerin/ nitrates: vasodilators (arteries and veins)- decreases preload and
afterload to decrease workload of the heart while opening coronary vessels to decrease
O2 demand on the myocardium
*Can be given IV, sublingual, transdermal, paste, oral*
Beta Blockers: used early, and continued for at least a year. Patient needs to be
WEANED off these medications
ACE inhibitors: prevent the conversion of angiotensin 1 to angiotensin 2 which is a
potent vasoconstrictor.
Antiarrythmics
Thrombolytics: altepase
CCB
Stool softeners: prevents bearing down
Statins
• biggest risk for antiplatelet medications -✓✓Risk for GI bleeding-> watch for S/S:
fatigue, malaise, dark black tarry stools.
Pts usually take this for only ONE year following PCI
• Side effects of nitroglycerin -✓✓*HEADACHE*
Syncope
Hypotension
• patient teaching for nitro -✓✓take one tablet every 5 mins x3, do not take anymore
after 3rd tab. If chest pain is unrelieved then go to ER immediately. Store nitro in a dark
area away from light.
• precautions for beta blockers -✓✓-Asthma
-COPD
-respiratory issues
Latest Update Verified Questions with Clear
Explanations | A+ Verified
• angina pectoris -✓✓chest pain that results when the heart does not get enough
oxygen
• unstable angina -✓✓chest pain that occurs while a person is at rest and not exerting
themself, not relieved by nitro
• Stable angina -✓✓chest pain that occurs when a person is active or under severe
stress, *IS* relieved by nitro
• labs associated with acute MI -✓✓EKG: ST elevation (sometimes)
CXR: decreased heart function
Echocardiography: shows wall motion and ejection fraction
Elevated troponin -> 1st will be negative, 2nd is usually elevated. Peaks around 24 hrs
post MI
Elevated CK-MB: NOT cardiac specific, shows muscle cell death. Increases with other
disease processes like rhabdomyolysis
Increased Myoglobin
CBC: increased WBC
• manifestations of acute MI -✓✓-differs in everyone (pain is subjective) men different vs
women
-depends on the wall involved
*Anterior wall*: most fatal (has ST elevation)
*Inferior wall*: lesion on right coronary artery, persistent hiccups is a telltale sign
*Posterior wall*: uncommon
Diaphoresis
Crushing, aching, burning chest pain/pressure
Dyspnea (low O2)
Dizziness (low BP)
Nausea/vomiting or malaise
Palpitations
Cool, dusky, pale skin
Feeling of impending doom
EKG: ST elevation WITH cardiac markers = STEMI
No ST elevation WITH cardiac markers= NSTEMI
• STEMI -✓✓ST elevated myocardial infarction
Flipped T waves (retrograde)- zone of ischemia also seen post MI
ST elevation- zone of injury
Q Waves- zone of infarction
, • NSTEMI/NONSTEMI -✓✓non ST elevated myocardial infarction
NO ST elevation
Sometimes ST depression
Elevated troponins
T wave irregularities
Q wave irregularities
• What is door to balloon time? -✓✓Time of hospital presentation to time occluded artery
is opened should be ≤ 30 min.
• Treatment of MI and ACS -✓✓Morphine- decreases respirations but also PRELOAD
O2
Aspirin and other antiplatelets/ Heparin: goal is to prevent blood clots and restore blood
flow
Cath lab- possibly put in stents or other procedures to open vessel
Nitroglycerin/ nitrates: vasodilators (arteries and veins)- decreases preload and
afterload to decrease workload of the heart while opening coronary vessels to decrease
O2 demand on the myocardium
*Can be given IV, sublingual, transdermal, paste, oral*
Beta Blockers: used early, and continued for at least a year. Patient needs to be
WEANED off these medications
ACE inhibitors: prevent the conversion of angiotensin 1 to angiotensin 2 which is a
potent vasoconstrictor.
Antiarrythmics
Thrombolytics: altepase
CCB
Stool softeners: prevents bearing down
Statins
• biggest risk for antiplatelet medications -✓✓Risk for GI bleeding-> watch for S/S:
fatigue, malaise, dark black tarry stools.
Pts usually take this for only ONE year following PCI
• Side effects of nitroglycerin -✓✓*HEADACHE*
Syncope
Hypotension
• patient teaching for nitro -✓✓take one tablet every 5 mins x3, do not take anymore
after 3rd tab. If chest pain is unrelieved then go to ER immediately. Store nitro in a dark
area away from light.
• precautions for beta blockers -✓✓-Asthma
-COPD
-respiratory issues
