Chapter 28 Management of Patients With Coronary Vascular Disorders

Treatment (MONA) Treatment seeks to decrease myocardial oxygen demand and increase oxygen supply Medications (Morphine, Oxygen, Nitro., Aspirin) Reduce and control risk factors Reperfusion therapy may also be done

Medications*** Nitroglycerin Beta-adrenergic blocking agents Calcium channel blocking agents Antiplatelet and anticoagulant medications Aspirin Clopidogrel and ticlopidine Heparin Glycoprotein IIB/IIIa agents

Collaborative Problems Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Myocardial infarction

Treatment of Angina Pain Treatment of angina pain is a priority nursing concern. Patient is to stop all activity and sit or rest in bed. Assess the patient while performing other necessary interventions. Assessment includes VS, and observation for respiratory distress, and assessment of pain. In the hospital setting, the ECG is assessed or obtained. Administer oxygen. Administer medications as ordered or by protocol, usually NTG.

Anxiety Use a calm manner Stress-reduction techniques Patient teaching Addressing patient spiritual needs may assist in allaying anxieties Address both patient and family needs

Chapter 28 Management of Patients With Coronary Vascular Disorders Self-Review

Myocardial Infarction An area of the myocardium is permanently destroyed. Usually caused by reduced blood flow in a coronary artery due to rupture of an atherosclerotic plaque and subsequent occlusion of the artery by a thrombus. In unstable angina, the plaque ruptures but the artery is not completely occluded. Unstable angina and acute myocardial infarction are considered the same process but at different point on the continuum. The term acute coronary syndrome includes unstable angina and myocardial infarction.

Effects of Ischemia, Injury, and Infarction on ECG

Clinical Manifestations and Diagnosis Chest pain, other symptoms ECG Laboratory tests—biomarkers CK-MB Myoglobin Troponin T or I

Treatment of Acute MI Obtain diagnostic tests including ECG within 10 minutes of admission to the ED Oxygen Aspirin, nitroglycerin, morphine, beta-blockers Angiotensin-converting enzyme inhibitor within 24 hours Evaluate for percutaneous coronary intervention or thrombolytic therapy As indicated; IV heparin or LMWH, clopidogrel or ticlopidine, glycoprotein IIb/IIIa inhibitor Bed rest

Nursing Process: The Care of the Patient with ACS—Assessment A vital component of nursing care! Assess all symptoms carefully and compare to previous and baseline data to detect any changes or complications. Monitor ECG.

Collaborative Problems Acute pulmonary edema Heart failure Cardiogenic shock Dysrhythmias and cardiac arrest Pericardial effusion and cardiac tamponade

Percutaneous Coronary Intervention

Coronary Artery Bypass Grafts

Greater and lesser saphenous veins are commonly used for bypass graft procedures.

Cardiopulmonary Bypass System

Postoperative Care of the Cardiac Surgical Patient