NSG 430 EXAM 1
1. First step to produce the greatest reduction in risk for CAD.: 1. First, assess for the readiness
to change and health literacy.
2. Then, help the patient select the lifestyle changes
2. acute coronary syndrome (ACS): chest pain from ischemia is prolonged and not
immediately reversible (STEMI and NSTEMI)
3. Unstable angina (UA): chest pain that is new in onset, occurs at rest. The pain usually lasts
10 minutes or more
4. myocardial infarction (MI): occurs because of an abrupt stoppage of blood flow through a
coronary artery with a thrombus caused by platelet aggregation.
5. STEMI: occlusive thrombus, results in ST-elevation. The artery must be opened within 90
minutes of presentation to restore blood and O2 to the heart muscle (by PCI or thrombolytic
therapy)
6. PCI: Done in Cath lab. first-line treatment for MI. It confirms which artery has the
occlusive thrombus so it can be opened with a balloon and stent
- performed with local anesthesia
- patient is ambulatory shortly after the procedure
- hospital stay is about 3 to 4 days after MI
7. Thrombolytic therapy: done in hospitals that do not have a catheterizationlaboratory for
PCI for a pt with STEMI.
- limit the infarction size by dissolving the thrombus in the coronary artery
- give the thrombolytic within 30 minutes of the patient's arrival to the ED
- All thrombolytics (e.g., tenecteplase, alteplase) are given IV
8. Not candidates for PCI (CABG surgery used instead): diabetes, left ventricle dysfunction,
chronic kidney disease, failed PCI with ongoing chest pain, blockages are long or difficult to
access
9. CABG (coronary artery bypass graft): placement of arterial or venous grafts to provide
blood from the aorta to the heart muscle distal to blocked coronary arteries.Requires:
- sternotomy (opening of the chest cavity)
- cardiopulmonary bypass (blood is diverted from the patient's heart to a machine where it is
oxygenated and returned)
The Internal hammer artery (IMA) is the most common artery used for bypass graft.
10. CABG medications: Perioperative calcium channel blockers and long-actingnitrates can
control the spasms
,11. Minimally invasive direct coronary artery bypass (MIDCAB): does not in-volve a
sternotomy and CPB.
12. off-pump coronary artery bypass (OPCAB): requires sternotomy but no CPBperformed
on a beating heart
13. Totally endoscopic coronary artery bypass (TECAB): uses a robotic technol-ogy to perform
CABG surgery. No CPB.
14. PCI and thromolytic therapy pallitative or cure?: palliative. Not a cure
15. procedure of thombolytic therapy: 1. draw blood to obtain baseline laboratoryvalues
2. start 2 or 3 lines for IV therapy.
perform all invasive procedures before giving thrombolytic therapy
- therapy is given in 1 IV bolus or over time (30 to 90 minutes)
16. Signs that repercussion occurred: 1. return of the ST segment to baseline onthe ECG
2. resolution of chest pain
3. rapid rise of the serum cardiac biomarkers within 3 hours of therapy (necrotic heartcells
release proteins into the circulation after perfusion is restored to the area)
17. NSTEMI: nonocclusive thrombus, does not cause ST segment elevation. pa- tients
usually undergo catheterization within 12 to 72 hours. Thrombolytic therapyis not indicated
18. diabetics with MI: may have silent (asymptomatic) MIs because of cardiac neuropathy or
have atypical symptoms (e.g., shortness of breath). NOT candidatesfor PCI= CABG surgery
19. Initial phase of MI: sympathetic NS release (norepinephrine and epinephrine)
= diaphoresis, increased HR and BP (later drops from decreased CO) and vasocon-striction of
peripheral blood vessels, Fever (up to 100.4, 38 in first 24-48 hrs)
patient's skin may be ashen, clammy, and cool to touch.
20. After MI: - increased BG (glycogenolysis occurs)
- by 6 wks heart muscle is considered healed (scar tissue has replaced necrotictissue)
- Dysrhythmias are the most common complication after an MI
- acute pericarditis (2 or 3 days after) = friction rub (diaphragm of stethoscope, midto lower
left sternal border)
- Nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids are avoided inthe first 4
weeks after MI because they can interfere with myocardial scar formation
- NPO (except water) until stable
, 21. necrotic zone after MI: within a day or two proteolytic enzymes of the neu- trophils and
macrophages begin to remove necrotic tissue and necrotic muscle wallis thin. = identified by
ECG: lowering ST segements, T wave inversion, pathologic Qwave
22. biomarker highly specific indicators of MI: Troponin (increase 4 to 6 hours after the onset
of MI, peak at 10 to 24 hours, and return to baseline over 10 to 14days)
23. patient with a STEMI must: undergo cardiac catheterization within 90 minutes of
presentation or receive thrombolytic therapy within 30 minutes in agencies without PCI
capability
24. When developing a teaching plan for risk factors associated with MI focus on: modifiable
risk factors (lowering LDLs)
25. Characteristic of acute MI: chest pain greater than 20 min
26. the first line of treatment for patients with confirmed STEMI: Emergent PCI: open the
blocked artery within 90 minutes of arrival
27. when a patient should stop exercise after MI: - chest pain
- change in heart rate of more than 20 beats over the resting heart rate
28. thrombolytic therapy cautions: change in level of consciousness (intracranialbleeding)
minor bleeding is expected: surface bleeding from IV sites or gingival bleeding (apply manual
pressure or ice packs)
Major bleeding: drop in BP, increase in HR, sudden change in the patient's mental status, blood
in the urine or stool. stop the drug and notify the HCP.
29. after thrombolytic therapy concern: 1. bleeding
2. reocculusion of the artery: IV heparin is started
30. Contraindications for Thrombolytic Therapy: - Intracranial or intraspinalsurgery within 2
mo
- Recent (within past 3 mo) ischemic stroke
- closed-head or facial trauma within past 3 mo
- Active internal bleeding
- Major surgery (<3 wks)
- Severe uncontrolled hypertension
31. pericarditis: complication after MI
chest pain increases when taking a deep breath and is relieved by leaning forwardassess:
pericardial friction rub
32. Emergency Management Chest Pain: 1. Assess ABCs
1. First step to produce the greatest reduction in risk for CAD.: 1. First, assess for the readiness
to change and health literacy.
2. Then, help the patient select the lifestyle changes
2. acute coronary syndrome (ACS): chest pain from ischemia is prolonged and not
immediately reversible (STEMI and NSTEMI)
3. Unstable angina (UA): chest pain that is new in onset, occurs at rest. The pain usually lasts
10 minutes or more
4. myocardial infarction (MI): occurs because of an abrupt stoppage of blood flow through a
coronary artery with a thrombus caused by platelet aggregation.
5. STEMI: occlusive thrombus, results in ST-elevation. The artery must be opened within 90
minutes of presentation to restore blood and O2 to the heart muscle (by PCI or thrombolytic
therapy)
6. PCI: Done in Cath lab. first-line treatment for MI. It confirms which artery has the
occlusive thrombus so it can be opened with a balloon and stent
- performed with local anesthesia
- patient is ambulatory shortly after the procedure
- hospital stay is about 3 to 4 days after MI
7. Thrombolytic therapy: done in hospitals that do not have a catheterizationlaboratory for
PCI for a pt with STEMI.
- limit the infarction size by dissolving the thrombus in the coronary artery
- give the thrombolytic within 30 minutes of the patient's arrival to the ED
- All thrombolytics (e.g., tenecteplase, alteplase) are given IV
8. Not candidates for PCI (CABG surgery used instead): diabetes, left ventricle dysfunction,
chronic kidney disease, failed PCI with ongoing chest pain, blockages are long or difficult to
access
9. CABG (coronary artery bypass graft): placement of arterial or venous grafts to provide
blood from the aorta to the heart muscle distal to blocked coronary arteries.Requires:
- sternotomy (opening of the chest cavity)
- cardiopulmonary bypass (blood is diverted from the patient's heart to a machine where it is
oxygenated and returned)
The Internal hammer artery (IMA) is the most common artery used for bypass graft.
10. CABG medications: Perioperative calcium channel blockers and long-actingnitrates can
control the spasms
,11. Minimally invasive direct coronary artery bypass (MIDCAB): does not in-volve a
sternotomy and CPB.
12. off-pump coronary artery bypass (OPCAB): requires sternotomy but no CPBperformed
on a beating heart
13. Totally endoscopic coronary artery bypass (TECAB): uses a robotic technol-ogy to perform
CABG surgery. No CPB.
14. PCI and thromolytic therapy pallitative or cure?: palliative. Not a cure
15. procedure of thombolytic therapy: 1. draw blood to obtain baseline laboratoryvalues
2. start 2 or 3 lines for IV therapy.
perform all invasive procedures before giving thrombolytic therapy
- therapy is given in 1 IV bolus or over time (30 to 90 minutes)
16. Signs that repercussion occurred: 1. return of the ST segment to baseline onthe ECG
2. resolution of chest pain
3. rapid rise of the serum cardiac biomarkers within 3 hours of therapy (necrotic heartcells
release proteins into the circulation after perfusion is restored to the area)
17. NSTEMI: nonocclusive thrombus, does not cause ST segment elevation. pa- tients
usually undergo catheterization within 12 to 72 hours. Thrombolytic therapyis not indicated
18. diabetics with MI: may have silent (asymptomatic) MIs because of cardiac neuropathy or
have atypical symptoms (e.g., shortness of breath). NOT candidatesfor PCI= CABG surgery
19. Initial phase of MI: sympathetic NS release (norepinephrine and epinephrine)
= diaphoresis, increased HR and BP (later drops from decreased CO) and vasocon-striction of
peripheral blood vessels, Fever (up to 100.4, 38 in first 24-48 hrs)
patient's skin may be ashen, clammy, and cool to touch.
20. After MI: - increased BG (glycogenolysis occurs)
- by 6 wks heart muscle is considered healed (scar tissue has replaced necrotictissue)
- Dysrhythmias are the most common complication after an MI
- acute pericarditis (2 or 3 days after) = friction rub (diaphragm of stethoscope, midto lower
left sternal border)
- Nonsteroidal antiinflammatory drugs (NSAIDs) and corticosteroids are avoided inthe first 4
weeks after MI because they can interfere with myocardial scar formation
- NPO (except water) until stable
, 21. necrotic zone after MI: within a day or two proteolytic enzymes of the neu- trophils and
macrophages begin to remove necrotic tissue and necrotic muscle wallis thin. = identified by
ECG: lowering ST segements, T wave inversion, pathologic Qwave
22. biomarker highly specific indicators of MI: Troponin (increase 4 to 6 hours after the onset
of MI, peak at 10 to 24 hours, and return to baseline over 10 to 14days)
23. patient with a STEMI must: undergo cardiac catheterization within 90 minutes of
presentation or receive thrombolytic therapy within 30 minutes in agencies without PCI
capability
24. When developing a teaching plan for risk factors associated with MI focus on: modifiable
risk factors (lowering LDLs)
25. Characteristic of acute MI: chest pain greater than 20 min
26. the first line of treatment for patients with confirmed STEMI: Emergent PCI: open the
blocked artery within 90 minutes of arrival
27. when a patient should stop exercise after MI: - chest pain
- change in heart rate of more than 20 beats over the resting heart rate
28. thrombolytic therapy cautions: change in level of consciousness (intracranialbleeding)
minor bleeding is expected: surface bleeding from IV sites or gingival bleeding (apply manual
pressure or ice packs)
Major bleeding: drop in BP, increase in HR, sudden change in the patient's mental status, blood
in the urine or stool. stop the drug and notify the HCP.
29. after thrombolytic therapy concern: 1. bleeding
2. reocculusion of the artery: IV heparin is started
30. Contraindications for Thrombolytic Therapy: - Intracranial or intraspinalsurgery within 2
mo
- Recent (within past 3 mo) ischemic stroke
- closed-head or facial trauma within past 3 mo
- Active internal bleeding
- Major surgery (<3 wks)
- Severe uncontrolled hypertension
31. pericarditis: complication after MI
chest pain increases when taking a deep breath and is relieved by leaning forwardassess:
pericardial friction rub
32. Emergency Management Chest Pain: 1. Assess ABCs
