ATI MED-SURG CH 31 Angina and MI Questions & Answers

What are the symptoms of acute coronary syndrome (angina-->MI) due to? - ANSWERSSymptoms of acute coronary syndrome are due to an imbalance between myocardial oxygen supply and demand What does research show regarding treatment of MI? - ANSWERSimproved outcomes following an MI in clients treated with aspirin, beta blockers, and angiotensin converting enzyme inhibitors or angiotensin receptor blockers. When blood flow is cut from the heart what causes the chest pain? What is the quality of the pain and how can you differentiate angina from an MI? - ANSWERSischemia causes chest pain. Anginal pain: tight squeezing, heavy pressure, or constricting feeling in the chest. The pain can radiate to the jaw, neck, or arm. Pain unrelieved by rest or nitroglycerin and lasting for more than 15 min differentiates MI from angina Health promotion and disease prevention from MI - ANSWERS● Maintain an exercise routine to remain physically active. Consult with a provider before starting any exercise regimen. ● Have cholesterol level and blood pressure checked regularly. ● Consume a diet low in saturated fats and sodium. Consult with a provider regarding diet restrictions. ● Promote smoking cessation. Assessment: what are the different types of angina? - ANSWERSStable (exertional) angina: occurs with exercise or emotional stress and is relieved by rest or nitroglycerin. Unstable (preinfarction) angina: occurs with exercise or at rest, but increases in occurrence, severity, and duration over time. Variant (Prinzmetal's) angina: is due to a coronary artery spasm, often occurring during periods of rest. Risk factors for MI - ANSWERS● Male gender or postmenopausal women ● Ethnic background ● Sedentary lifestyle ● Hypertension ● Tobacco use ● Hyperlipidemia ● Obesity ● Excessive alcohol consumption ● Metabolic disorders (diabetes mellitus, hyperthyroidism) ● Methamphetamine or cocaine use ● Stress (with ineffective coping skills) ● older adult clients-> physically inactive, one or more chronic diseases (hypertension, heart failure, and diabetes mellitus), or lifestyle habits (smoking and diet) that contribute to atherosclerosis. *Atherosclerotic changes related to aging predispose the heart to poor blood perfusion and oxygen delivery.* ● Incidence of cardiac disease increases with age, especially in the presence of *hypertension, diabetes mellitus, hypercholesterolemia*, elevated homocysteine, and highly sensitive C-reactive protein (HS-CRP Expected findings for MI - ANSWERS● Anxiety, feeling of impending doom ● Chest pain: substernal or precordial ◯ Can radiate down the shoulder or arm, or present as jaw pain ◯ Can be described as a crushing or aching pressure ● Nausea ● Dizziness Physical assessment findings for MI - ANSWERSPHYSICAL ASSESSMENT FINDINGS ● Pallor, and cool, clammy skin ● Tachycardia and heart palpitations ● Tachypnea and shortness of breath ● Diaphoresis ● Vomiting ● Decreased level of consciousness Lab tests for MI - ANSWERS*cardiac enzymes released w/ myocardial injury* ● Myoglobin: Earliest marker of injury to cardiac or skeletal muscle. Levels no longer evident after 24 hr. ● Creatine kinase-MB: Peaks around 24 hr after onset of chest pain. Levels no longer evident after 3 days. ● Troponin I or T: Any positive value indicates damage to cardiac tissue and should be reported. ◯ Troponin I: Levels no longer evident after 7 to 10 days. ◯ Troponin T: Levels no longer evident after 10 to 14 days. How would you assess an EKG in the case of angina or MI? - ANSWERS● Angina: ST depression and/or *T-wave inversion indicates presence of ischemia* ● MI: T-wave inversion indicates ischemia; *ST-segment elevation indicates injury*; *abnormal Q-wave indicates necrosis.* What is cardiac catheterization? - ANSWERS● Aka coronary angiogram: invasive diagnostic procedure used to evaluate the presence and degree of coronary artery blockage. ● Angiography involves the insertion of a catheter into a femoral (sometimes a brachial) vessel and threading it into the right or left side of the heart. Coronary artery narrowing and occlusions are identified by the injection of contrast media under fluoroscopy. Nursing actions for cardiac catheterization - ANSWERS● Ensure the client understands the procedure prior to signing informed consent. ● Ensure that the client remains NPO 8 hr prior to procedure. ● Ensure that the client and family understand the procedure. ● Assess for iodine/shellfish allergy (contrast media). What do you montior (nursing care) for a patient with angina/MI? - ANSWERS◯ Vital signs every 5 min until stable, then every hour ◯ Serial ECG, continuous cardiac monitoring ◯ Location, precipitating factors, severity, quality, and duration of pain ◯ Hourly urine output: greater than 30 mL/hr indicates renal perfusion ◯ Laboratory data: cardiac enzymes, electrolytes, ABGs What nursing care do you provide for a patient w/ angina/MI in addition to monitoring? - ANSWERS● Administer oxygen: 2 to 4 L/min. ● Obtain and maintain IV access. ● Promote energy conservation. *Cluster nursing interventions.* Angina/MI Meds: Vasodilators Medication used and method of action - ANSWERSNitroglycerin prevents coronary artery vasospasm and reduces preload and afterload, decreasing myocardial oxygen demand. Angina/MI Meds: Vasodilators Nursing considerations - ANSWERSNURSING CONSIDERATIONS ● Used to treat angina and help control blood pressure. ● Used cautiously with other antihypertensive medications. ( beta-blockers, calcium channel blockers, and diuretics) ● *Can cause orthostatic hypotension.* Pregnancy Risk Category C. ● contraindicated if hypersensitivity to nitrates. ● contraindicated in severe anemia, closed angle glaucoma, and traumatic head injury because the medication can increase intracranial pressure. ● Use cautiously in clients who have hyperthyroidism or kidney or liver dysfunction Angina/MI Meds: Vasodilators Nitroglycerin complications - ANSWERSHeadache ● Instruct clients to use aspirin or acetaminophen to relieve pain. ● Clients should notify the provider if headache does not resolve in a few weeks. Dosage can be reduced. Orthostatic hypotension ● Advise clients to sit or lie down if experiencing dizziness or faintness. ● Clients should avoid sudden changes of position and rise slowly. Reflex tachycardia ● Monitor vital signs. ● Administer a beta blocker such as metoprolol if needed. Tolerance ● Use lowest dose needed to achieve effect. ● Take all long acting forms of nitroglycerin with a medication free period each day. This action reduces the risk of tolerance. Angina/MI Meds: Vasodilators Administration - ANSWERS● Rapid onset ● Short duration ● Treat acute attack ● Prophylaxis of acute attack ● Use at the first indication of chest pain. Do not wait until pain is severe. ● Use prior to activity that is known to cause chest pain, such as climbing a flight of stairs. For sublingual tablet ● Place the tablet under the tongue and allow it to dissolve. ● Store tablets in original bottles, and in a cool, dark place. ● Spray translingual spray against oral mucosa and do not inhale. Angina/MI Meds: Vasodilators Client education for chest pain - ANSWERSCLIENT EDUCATION FOR CHEST PAIN ● Instruct the client to stop activity and rest. ● Instruct the client to place a nitroglycerin tablet under the tongue to dissolve (quick absorption). ● If pain is unrelieved in 5 min, the client should call 911 or be driven to an emergency department. ● The client can take up to two more doses of nitroglycerin at 5-min intervals. ● Remind the client that a *headache* is a common side effect of this medication. ● Encourage the client to sit and lie down slowly.