Acute Coronary Syndrome Education for Nurses, Schemes and Mind Maps of Pathophysiology

Download Acute Coronary Syndrome Education for Nurses and more Schemes and Mind Maps Pathophysiology in PDF only on Docsity! AU r Pe, ly" Navicent Everything about us, is all about you. Gala we eS ees Acute Coronary Syndrome Education for RNs  Understand the goals and purpose of our Chest Pain Center (CPC)  Develop understanding of:  Risk factors for MI (heart attack)  Pathophysiology of Acute Coronary Syndrome (ACS)  Signs & Symptoms, Early recognition & interventions  Atypical presentations, including differences in age & gender  Typical dysrhythmias in MI  Cardiac biomarkers (lab work)  Guidelines for stress testing  Process for initiating code STEMI  Treatment of ACS  ACS is a term used to describe the spectrum of acute coronary artery disease such as: • Unstable Angina • Non ST-elevation MI (NSTEMI) • ST segment elevation MI (STEMI) • Coronary Artery Disease (CAD): • atherosclerotic plaques, called atheromas or “lesions” • block coronary artery blood flow. •  Heart’s Supply of – Oxygen – Nutrients Concepts of Myocardial O2 Supply and Demand –  demands (WORK)exceed supply (Blood Flow or O²) – Imbalance leads to myocardial ischemia. Effects of Ischemia – Heart failure – Arrhythmias common in common in p ht  Age is the number 1 risk factor for heart disease.  Heart disease is a leading cause of death in people over the age of 65.  Aging causes:  Heart walls, particularly the left ventricle, get thicker.  Heart rate changes  Heart muscle cells deteriorate.  Abnormal heart rhythms (atrial fib)  Heart valves may thicken or leak .  In elderly symptoms are:  less frequent and may be non-existent.  ECG - shows fewer clues  To detect ischemia or acute coronary injury.  Why do we need one?  To rule out Right Ventricular infarct  MD may order  Used infrequently SVT: Supraventricular Tachycardia (rate too fast) Heart Blocks (rate too slow)  Cardiac Biomarkers (Lab results indicating a patient is having a MI)  Cardiac Proteins  Troponin is specific to myocardial injury and rise quickly after injury  Cardiac Enzymes  Enzymes specific to cardiac muscle that are released into the blood stream when tissue dies.  CPK - MB Rises in 2-4 hours, peaks in 12-20 hours and returns to normal 48 - 72 hours later.  LDH Rises in 24 hours, Peaks in 48-72 hours and returns to normal in 7-10 days..  Exercise Stress test  Easiest  Must be able to exercise  Must be able to evaluate ST baseline on EKG  Pharmacologic imaging study  Pts unable to exercise  Exercise imaging for:  baseline ST abnormalities  BBB  LV hypertrophy  intra-ventricular conduction defect  paced rhythm  digoxin  IF you suspect your patient is having a MI….  Think H.E.A.R.T.  H –Help (call Quick team, MD, House Coordinator)  E – EKG STAT  A – Activate Inpatient STEMI order set  R – Reperfusion  T – Transport to the Cath Lab  The Quick Team will help assess the situation and initiate the Code STEMI process.  Order and obtain a STAT 12 lead EKG  If it is felt the patient may be having a STEMI, call 3-6511 to activate the STEMI team.  If a cardiologist is on the case, call them.  If no cardiologist, call the attending:  I am calling about ____ in room ___.  He/she is having the following symptoms: (describe)  We are obtaining a 12 lead EKG.  Would you like me to fax it to you to read or would you like for me to get the in house physician to read? (10 minutes to read the EKG)  If there is no Cardiologist on the case ask:  If the patient is having a STEMI, do you want me to call the Cardiologist on call for STEMI or do you have a preference in which Cardiologist is called?  Notify the House Coordinator  assess & facilitate implementation of Code STEMI  Activate Inpatient STEMI Order Set as ordered  Implement orders (labs, meds, prep etc)  Assist with transport to Cath Lab  Remember to transport on EKG monitor!  GOAL: Get patient to Cath Lab in under 90 minutes!!  CABG – Coronary Artery Bypass Graft  Surgical Procedure: grafts are sewn onto the coronary arteries to bypass the narrowed area.  The sooner you act, the more cardiac muscle you save!  The more cardiac muscle lost results in increased disability and possibly death for the patient!  Remember, ACT FAST!  TRUST YOUR INSTINCTS !!  It is always best to ask for help and not need it than to need it and never ask for it!! Chest Pain Center Annual Education Test When the test is successfully completed (score 100%), you’ll be prompted to supply your name, API# and the last four digits of your social security number.