NUR 508 Test 1
-another name for an MI or heart attack
-Pts with clinical symptoms compatible
What is acute coronary syndrome?
with acute myocardial ischemia
-also includes angina
-smoking, HTN, DM, obesity (modifiable)
Risk factors for acute coronary syn-
-age, gender, race, genetics (non-modifi-
drome
able)
-stable: intensity/freq are predicted, re-
lieved with rest/nitrates, develops after
What is stable vs unstable angina? precipitating factor
-unstable: not predictable, new onset, oc-
curs with rest, often progresses to MI
What is the most common cause of
atherosclerosis
acute coronary syndrome?
-occurs after sustained ischemia for >20
What is the timeline of damage with an min
MI? -necrosis happens after 4-6 hours (irre-
versible)
-NSTEMI is a partial occlusion; ST de-
What is the difference between a STEMI pression!
and NSTEMI? -STEMI is a total occlusion; ST eleva-
tion!!; can lead to lethal rhythm
1. chest pain (crushing/elephant on
chest)
What are the 4 main s/s of acute coro-
2. diaphoresis
nary syndrome?
3. pallor
4. cool extremities
1. detailed Hx and physical: is the pain
What are the two main diagnostic tools better with meds or rest?
for acute coronary syndrome? 2. 12 lead EKG: definitive diagnostic
tool**
-troponin, CK-MB, and myoglobin
What are the main cardiac enzymes that -should be the same or lower levels with
are tested and what can they tell us? each passing day; if not, they may have
re-occluded
What are the main initial interventions for
acute coronary syndrome? 1/8
, NUR 508 Test 1
1. 12 lead EKG
2. semi-fowlers
3. MONA: morphine, oxygen, nitrates,
aspirin
4. NPO initially, in case they need
surgery
-dysrhythmias
-cardiogenic shock
-HF
What are some complications of myocar- -papillary muscle rupture (valves of the
dial cell death? heart)
-septal rupture (blood mixes in heart)
-if heart is permanently damaged, may
have permanent T wave elevation**
-telemetry, ICU, or cardiac cath lab
-treat dysrhythmias
What are the ongoing interventions for -frequent VS monitoring: q1h but maybe
an MI patient? even q15min
-bed rest for 12-24h after (reserves oxy-
gen)
-used when PCI is not available
When is thrombolytic therapy used? -administer within 6 hours of symptom
onset
-complete all invasive procedures prior to
admin (including any needle sticks)
What are some interventions related to -monitor for manifestations of bleeding
thrombolytic therapy for MI? -assess for signs of reperfusion: back to
baseline VS, EKG, resp and neuro are
baseline
-conduit placed to transport blood be-
tween aorta and myocardium distal to
What is a CABG procedure? blocked artery
-high-risk procedure: heart stopped and
hypothermia used
-systemic inflammation
What are some complications of CABG?
-hypotension d/t massive dilation
2/8
-another name for an MI or heart attack
-Pts with clinical symptoms compatible
What is acute coronary syndrome?
with acute myocardial ischemia
-also includes angina
-smoking, HTN, DM, obesity (modifiable)
Risk factors for acute coronary syn-
-age, gender, race, genetics (non-modifi-
drome
able)
-stable: intensity/freq are predicted, re-
lieved with rest/nitrates, develops after
What is stable vs unstable angina? precipitating factor
-unstable: not predictable, new onset, oc-
curs with rest, often progresses to MI
What is the most common cause of
atherosclerosis
acute coronary syndrome?
-occurs after sustained ischemia for >20
What is the timeline of damage with an min
MI? -necrosis happens after 4-6 hours (irre-
versible)
-NSTEMI is a partial occlusion; ST de-
What is the difference between a STEMI pression!
and NSTEMI? -STEMI is a total occlusion; ST eleva-
tion!!; can lead to lethal rhythm
1. chest pain (crushing/elephant on
chest)
What are the 4 main s/s of acute coro-
2. diaphoresis
nary syndrome?
3. pallor
4. cool extremities
1. detailed Hx and physical: is the pain
What are the two main diagnostic tools better with meds or rest?
for acute coronary syndrome? 2. 12 lead EKG: definitive diagnostic
tool**
-troponin, CK-MB, and myoglobin
What are the main cardiac enzymes that -should be the same or lower levels with
are tested and what can they tell us? each passing day; if not, they may have
re-occluded
What are the main initial interventions for
acute coronary syndrome? 1/8
, NUR 508 Test 1
1. 12 lead EKG
2. semi-fowlers
3. MONA: morphine, oxygen, nitrates,
aspirin
4. NPO initially, in case they need
surgery
-dysrhythmias
-cardiogenic shock
-HF
What are some complications of myocar- -papillary muscle rupture (valves of the
dial cell death? heart)
-septal rupture (blood mixes in heart)
-if heart is permanently damaged, may
have permanent T wave elevation**
-telemetry, ICU, or cardiac cath lab
-treat dysrhythmias
What are the ongoing interventions for -frequent VS monitoring: q1h but maybe
an MI patient? even q15min
-bed rest for 12-24h after (reserves oxy-
gen)
-used when PCI is not available
When is thrombolytic therapy used? -administer within 6 hours of symptom
onset
-complete all invasive procedures prior to
admin (including any needle sticks)
What are some interventions related to -monitor for manifestations of bleeding
thrombolytic therapy for MI? -assess for signs of reperfusion: back to
baseline VS, EKG, resp and neuro are
baseline
-conduit placed to transport blood be-
tween aorta and myocardium distal to
What is a CABG procedure? blocked artery
-high-risk procedure: heart stopped and
hypothermia used
-systemic inflammation
What are some complications of CABG?
-hypotension d/t massive dilation
2/8
