Coronary Artery Disease
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Coronary Artery Disease - Nursing - Lecture Slides |, Study notes of Nursing
Material Type: Notes; Class: Nursing; Subject: Nursing; University: Morehead State University; Term: Forever 1989;
Typology: Study notes
Pre 2010
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Coronary Artery Disease
Coronary Artery Disease
Advanced before symptoms occur Clinical Manifestation Chest, epigastric, jaw, back, or arm discomfort participated by exertion or stress Lasting less than 15 min Relieved by rest or nitroglycerin (^) Angina pectoris (^) Stable (^) Unstable (^) Ischemia (^) T wave inversion (^) ST depression
Myocardial Infarction
Etiology
narrowing occlusion due to embolus or thrombus decreased blood flow (shock/hemorrhage/ vasospasm/ rapid ventricular rates)
Types of MI
Inferior: II,III, AVF=supplied by RCA
Anterior: V3-V4=LAD
Lateral Posterior=I, aVL,
V5,V6=Circumflex
Septal=V1,V2=ventricular septum
supplied by LAD
ACUTE Anteriorseptal
Damage
Zone of ischemia
>20 minutes infarction
Zone of injury
Zone of infarction
Begin treatment ASAP to decrease
area of infarction
Resolution of pain is primary indicator
of effectiveness of treatment
Degree of Impairment
Area
most in LV (LAD & Circumflex)
size
amount of
collateral
circulation
Increases withage
Condition of
uninvolved
myocardium
effectiveness of
compensatory
mechanisms
Clinical Manifestations
Chest Pain
substernal, lower sternum, upper abdomen crushing, heavy, constriciting radiation (neck, jaw, L arm) confusion with GI delays treatment Other SOB, pallor, cold clammy, diaphoresis, dizziness, NV, fever, dysrythmias, decreased UOP, crackles, hepatic engorgement, peripheral edema, anxiety, denial
Diagnosis of MI
Chest Pain
occurs with rest or activity CP lasts > 5 min and not relieved with 3 NTG accompanying symptoms N/V, diaphoresis
EKG
ischemia (inverted T wave, ST depression) injury (elevated ST segment) necrosis (pathological Q wave >.04 seconds,
1/3 height of R wave)
Diagnosis of MI/CAD
ECG findings: lead changes
Enzymes: CK-MB elevated in 4 hours
GXT: used with stable angina
Thallium: imaging under-perfused
areas
Echocardiogram
Heart Cath
Treatments
Intraaortic Balloon
Pump
Coronary
Angioplasty
(Percutaneous
Transluminal
Coronary
Angioplasty/
PTCA)
Stents Other directional coronary angioplasty laser therapy transluminal extraction catheters rotablators
Surgical Intervention
Coronary Artery Bypass Graft (CABG)
attachment of artery or vein graft to coronary artery beyond area of blockage to reestablish blood flow Minimally invasive direct coronary artery bypass (LAD): treatment for lesions in LAD
Other Treatments
Activity
Bedrest with AMI until enzymes peak and diagnosis can be made gradually increase if free of CP and hemodynamically stable home walking program
Referrals
Nursing Interventions
Control Chest Pain nitrates thrombolytic therapy Monitor Tissue Perfusion Monitor for bleeding Prevent Injury
Decrease Anxiety
Improve Activity
Tolerance
sexual activity guidelines