JoAnn Smith, 68 years old/Acute Coronary
Syndrome (ACS) Myocardial Infarction (MI) CASE
STUDY LATEST 2024 GRADED A+ (SOLVED)
Cause of ACS - ANSWER: Prolonged ischemia resulting in unstable angina (UA), non-
ST-segment-elevation myocardial infarction (NSTEMI), and STEM.
Nursing Management for ACS - ANSWER: Pain assessment and relief, careful
observation of signs and symptoms, promotion of rest and comfort, and teaching
stress reduction strategies.
ACS is caused by the decline of a once stable---- - ANSWER: Atherosclerotic plaque -
the previously stable plaque ruptures, releasing substances into the vessel. This
causes plaque aggregation and thrombus formation.
NSTEMI - ANSWER: Partially blocked by a thrombus
STEMI - ANSWER: Totally blocked by a thrombus and blood flow is restricted
Pain - ANSWER: Occurs with increasing frequency and is easily provoked by minimal
or no exertion, during sleep, or even at rest.
Unstable Angina: Pain Symptoms - ANSWER: At rest or has worsening patterns
Pt. with previously diagnosed angina describes pain that has prolonged rapidly in the
past few hours, days, or weeks, often pain at rest
Unstable Angina: Gender Differences - ANSWER: 75 YOA+: MI incidence in men and
women equalize
Men present more with acute MI
Men develop greater collateral circulation than women
Men have larger coronary arteries
Women seek medical attn for symptoms more than men
Myocardial Infarction: Pain Symptoms - ANSWER: Severe/ persistent chest pain not
relieved by rest or nitrates is the hallmark of an MI
Pain: heaviness, pressure, burning, crushing, tightness, or constriction
Pain usually lasts 20 min. or more and is more severe than usual angina
,Epigastric pain pt. may take antacids without relief
Myocardial Infarction: Gender Differences - ANSWER: Women seen to have first MI
at older age, often have more comorbidities
Women seek medical attn later in CV disease process and often more ill on
presentation
UA is first heart event for women most often
Women: more "silent" MIs
Women: more disability after CV event
Common Pain Locations for MI and UA - ANSWER: Epigastric
Substernal
Retrosternal
Pain may - ANSWER: Radiate to the neck, jaws, and arms or to the back
Active or at rest, asleep or awake
Commonly occurs in early mornings
Pain Patterns/ Locations UA and MI - ANSWER: Mid sternum, left shoulder and down
both arms, neck and arms
Substernal radiating to neck and jaw, substernal radiating down left arm
Epigastric radiating to neck, jaw, and arms
Intrascapular
Which statement best describes acute coronary syndrome (ACS)?
ACS is the progression of untreated ischemia.
ACS is the equalization of oxygen demand and supply.
ACS is the development of a stable atherosclerotic plaque.
ACS is the first clinical sign of systemic atherosclerotic disease - ANSWER: ACS is the
progression of untreated ischemia.---
When ischemia is prolonged and not immediately reversible, ACS develops and
encompasses the spectrum of unstable angina, non-ST-segment-elevation
myocardial infarction, and ST-segment-elevation myocardial infarction.
, How does acute coronary syndrome cause injury to the heart?
Collateral circulation develops from a thrombus that obstructs blood flow.
Platelets adhere to the plaque, occluding blood flow to the myocardium.
A plaque narrows the blood vessel causing increased blood flow to the myocardium.
Blood flow to the myocardium is partially blocked, resulting in myocardial
inflammation. - ANSWER: Platelets adhere to the plaque, occluding blood flow to the
myocardium. ---
A thrombus develops from platelets that adhere to the plaque, resulting in lack of
blood flow to the myocardium distal to the blockage, which causes necrosis.
What is a primary difference in the clinical manifestations of acute coronary
syndrome between men and women?
Men experience more disability after myocardial infarction than women.
The initial cardiac event for men is more often unstable angina than myocardial
infarction.
More women than men present with acute myocardial infarction as the first sign of
coronary artery disease.
Fewer women than men manifest the "classic" signs and symptoms of unstable
angina or myocardial infarction. - ANSWER: Fewer women than men manifest the
"classic" signs and symptoms of unstable angina or myocardial infarction. ---
Fewer women than men manifest the "classic" signs and symptoms of a cardiac
event. Women are more likely to have nontypical symptoms (e.g., fatigue, shortness
of breath, indigestion, anxiety).
Collaborative care for ACS - ANSWER: Focuses on stabilizing the patient in crisis,
treating pain, and eliminating the coronary arterial blockage.
Medications - ANSWER: Sublingual nitroglycerin (SL NTG) and asprin (chewable) if
not administered before arrival into ER
Morphine sulfate is given for pain UNRELIEVED by nitroglycerin
Coronary angiography with possible percutaneous coronary intervention (PCI) is ... -
ANSWER: considered once patient is stable and angina is controlled, or if angina
returns or increases in severity
Syndrome (ACS) Myocardial Infarction (MI) CASE
STUDY LATEST 2024 GRADED A+ (SOLVED)
Cause of ACS - ANSWER: Prolonged ischemia resulting in unstable angina (UA), non-
ST-segment-elevation myocardial infarction (NSTEMI), and STEM.
Nursing Management for ACS - ANSWER: Pain assessment and relief, careful
observation of signs and symptoms, promotion of rest and comfort, and teaching
stress reduction strategies.
ACS is caused by the decline of a once stable---- - ANSWER: Atherosclerotic plaque -
the previously stable plaque ruptures, releasing substances into the vessel. This
causes plaque aggregation and thrombus formation.
NSTEMI - ANSWER: Partially blocked by a thrombus
STEMI - ANSWER: Totally blocked by a thrombus and blood flow is restricted
Pain - ANSWER: Occurs with increasing frequency and is easily provoked by minimal
or no exertion, during sleep, or even at rest.
Unstable Angina: Pain Symptoms - ANSWER: At rest or has worsening patterns
Pt. with previously diagnosed angina describes pain that has prolonged rapidly in the
past few hours, days, or weeks, often pain at rest
Unstable Angina: Gender Differences - ANSWER: 75 YOA+: MI incidence in men and
women equalize
Men present more with acute MI
Men develop greater collateral circulation than women
Men have larger coronary arteries
Women seek medical attn for symptoms more than men
Myocardial Infarction: Pain Symptoms - ANSWER: Severe/ persistent chest pain not
relieved by rest or nitrates is the hallmark of an MI
Pain: heaviness, pressure, burning, crushing, tightness, or constriction
Pain usually lasts 20 min. or more and is more severe than usual angina
,Epigastric pain pt. may take antacids without relief
Myocardial Infarction: Gender Differences - ANSWER: Women seen to have first MI
at older age, often have more comorbidities
Women seek medical attn later in CV disease process and often more ill on
presentation
UA is first heart event for women most often
Women: more "silent" MIs
Women: more disability after CV event
Common Pain Locations for MI and UA - ANSWER: Epigastric
Substernal
Retrosternal
Pain may - ANSWER: Radiate to the neck, jaws, and arms or to the back
Active or at rest, asleep or awake
Commonly occurs in early mornings
Pain Patterns/ Locations UA and MI - ANSWER: Mid sternum, left shoulder and down
both arms, neck and arms
Substernal radiating to neck and jaw, substernal radiating down left arm
Epigastric radiating to neck, jaw, and arms
Intrascapular
Which statement best describes acute coronary syndrome (ACS)?
ACS is the progression of untreated ischemia.
ACS is the equalization of oxygen demand and supply.
ACS is the development of a stable atherosclerotic plaque.
ACS is the first clinical sign of systemic atherosclerotic disease - ANSWER: ACS is the
progression of untreated ischemia.---
When ischemia is prolonged and not immediately reversible, ACS develops and
encompasses the spectrum of unstable angina, non-ST-segment-elevation
myocardial infarction, and ST-segment-elevation myocardial infarction.
, How does acute coronary syndrome cause injury to the heart?
Collateral circulation develops from a thrombus that obstructs blood flow.
Platelets adhere to the plaque, occluding blood flow to the myocardium.
A plaque narrows the blood vessel causing increased blood flow to the myocardium.
Blood flow to the myocardium is partially blocked, resulting in myocardial
inflammation. - ANSWER: Platelets adhere to the plaque, occluding blood flow to the
myocardium. ---
A thrombus develops from platelets that adhere to the plaque, resulting in lack of
blood flow to the myocardium distal to the blockage, which causes necrosis.
What is a primary difference in the clinical manifestations of acute coronary
syndrome between men and women?
Men experience more disability after myocardial infarction than women.
The initial cardiac event for men is more often unstable angina than myocardial
infarction.
More women than men present with acute myocardial infarction as the first sign of
coronary artery disease.
Fewer women than men manifest the "classic" signs and symptoms of unstable
angina or myocardial infarction. - ANSWER: Fewer women than men manifest the
"classic" signs and symptoms of unstable angina or myocardial infarction. ---
Fewer women than men manifest the "classic" signs and symptoms of a cardiac
event. Women are more likely to have nontypical symptoms (e.g., fatigue, shortness
of breath, indigestion, anxiety).
Collaborative care for ACS - ANSWER: Focuses on stabilizing the patient in crisis,
treating pain, and eliminating the coronary arterial blockage.
Medications - ANSWER: Sublingual nitroglycerin (SL NTG) and asprin (chewable) if
not administered before arrival into ER
Morphine sulfate is given for pain UNRELIEVED by nitroglycerin
Coronary angiography with possible percutaneous coronary intervention (PCI) is ... -
ANSWER: considered once patient is stable and angina is controlled, or if angina
returns or increases in severity
