Download - Acute Coronary Syndrome
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Acute Coronary Syndrome
(ACS)
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Acute Coronary SyndromeIt is believed that the atherosclerotic plaque in the coronary artery ruptures, resulting in platelet aggregati0n,thrombus formation and vasoconstriction. ( Medical-Surgical Nursing by Agnatavicius and Workman.
Represents the spectrum of ischemic coronary disease ranging from unstable Angina through Myocardial Infarction.
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Risk factors:
Precipitating factors:
Predisposing factors:
Sedentary lifestyle: SmokingHypertensionAlcohol Intake ObesityCaffeine IntakeDiabetes
Advanced AgeGender: Male
Race:African-American
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Accumulation of Cholesterol that develops into hardened plaque (Atherosclerotic plaque)
Atherosclerotic plaque ruptures, fissures and ulcerated
Thrombus formation
Thrombus break-off
Occlude in smaller vessels like Coronary Arteries
Pathophysiology
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Alteration of haemostatic and coagulation of pathways
Ineffective tissue perfusion
Unstable Angina
Myocardial Infarction
Decrease ventricular compliance
Decrease blood flow and oxygen supply in systemic circulation
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Clinical manifestationRespiratory
systemSOBDyspnea
Chest painTachycardiaDysrythmias
Cardiovascular system
GI system
Nausea and VomitingEpigasric distress
Integumentary system
DiaphoresisSkin is moist, cool and pale
Neurologic system
Anxiety
Musculoskeletal system
RestlessnessFatigue and weakness
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DIAGNOSTIC TESTElectrocardiography(ECG)
Twelve-lead electrocardiogram allow the health care provider to examine the heart from varying perspectives and to note both the occurrence and the location of Angina and Infarction.
Stress TestThe health care provider often orders an Exercise tolerance test (stress test) to assess for ECG changes consistent with ischemia, evaluation medical therapy, and identifies who might benefits from referral for invasive therapy.
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Cont’.Myocardial Perfusion Imaging(MPI)
Thallium scans used radioisotope imaging to assess for ischemia or necrotic muscle tissue related to Angina or Myocardial Infarction (MI). Areas of decrease or absent perfusion, referred to as cold spots, identifies ischemia of infarction.
Magnetic Resonance Imaging (MRI)Contrast-enhanced cardiovascular Magnetic
Resonance Imaging (CMRI) may also be used as non-invasive approached to detect MI.
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’Cont’. Cardiac catheterization
This procedure may be performed to determined the extent and exact location of obstruction of the coronary arteries. It allows the cardiologist and cardiac surgeon to identifies clients who might benefit from Percutaneous Transluminal Angioplasty (PCTA) or coronary artery bypass grafting (CABG).
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Surgical Management
1. Percutaneous Transluminal Angioplasty Is an invasive procedure but non surgical
technique. It is performed to reduced the frequency and severity of discomfort for clients with Angina and to bridged clients with coronary bypass graft surgery.
2. Coronary Artery Bypass Graft Surgery Which occluded coronary arteries by passed
with client’s own artery blood vessels.
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Cont’.
3. Minimally Invasive Direct Coronary Artery Bypass May be indicate for clients with a lesion of
the left anterior descending artery.4. Transmyocardial Laser Revascularization
A left thoracotomy is performed and the heart is visualized, a laser is used to create 20-24 long and narrow channels through left ventricular muscle to left ventricle.
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Cont;.5. Robotics
Invasive open hear surgery Provides surgeon with capabilities that
simplify the surgical process, elimination of tremors that can exist with human hands, increase ability to reach inaccessible sites and improves depth perception and visual acuity
6. Off-Pump Coronary Artery Bypass It is a open heart surgery without the use of a
heart-lung bypass machine. Advantages include shorter hospital stays and decreased mortality, risk of infection and cost.
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Medical Management
1. Nitroglycerin Increased collateral blood flow,
redistributes blood flow towards the subendocardium, and causes dilatation of coronary arteries.
2. Morphine Sulfate To relieve chest discomfort that is
unresponsive to niroglycerin. And it relieves MI pain, decreased myocardial oxygen demand, relaxes smooth muscles and reduces circulating catecholamine.
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Cont’.3. Oxygen therapy
May increase the amount of oxygen available to myocardial tissue. Administered at a flow of 2-4L/min. by nasal cannula titrated to maintain an arterial oxygen saturation equal to or greater than 95%.
4. Thrombolytic therapy Used to dissolve thrombi in he coronary
arteries and restore myocardial blood flow.
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Nursing Interventions
Position the client into orthopneic position to promote comfort and sufficient oxygenation.Provide calm, quiet environment and explanations of interventions often reduce anxiety and assist in relief of chest pain.If needed, instruct client to take several deep breath to increase oxygenation.
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NURSING CARE PLAN
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Problem identified:
Nursing diagnosis:
CUES NURSING INTERVENION
RATIONALE
INDEPENDENT:
COLLABORATIVE:
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Problem identified:
Nursing diagnosis:
CUES NURSING INTERVENION
RATIONALE
INDEPENDENT:
COLLABORATIVE:
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Problem identified:
Nursing diagnosis:
CUES NURSING INTERVENION
RATIONALE
INDEPENDENT:
COLLABORATIVE:
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Problem identified:
Nursing diagnosis:
CUES NURSING INTERVENION
RATIONALE
INDEPENDENT:
COLLABORATIVE:
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Problem identified:
Nursing diagnosis:
CUES NURSING INTERVENION
RATIONALE
INDEPENDENT:
COLLABORATIVE: