NR 340 Exam 2 study guide

Angina CHAPTER 12 NR 340 Exam 2 study guide Latest 2023 / 2024

Angina pectoris is a general medical term used to define types of chest pain caused by myocardial ischemia. Thrombus formation and further plaque formation eventually narrow the coronary arteries, causing ischemia and death of myocardial tissue. Angina can be classified into three different phases: stable, unstable, and variant. The angina that is of more concern to the development of ACS is the unstable angina prototype.• Classification

• Stable

▪ Occurrence is predictable, on exertion. Will resolve with nitroglycerin and rest. ECG changes seen are inverted T-waves.

• Unstable

▪ Pain that occurs more often at rest and during the night, and in unpredictable patterns. It worsens with each episode. ECG changes seen are ST depressions and T-wave abnormalities.The ST depression will return to baseline when pain is relieved. Does not respond well to nitroglycerin.

• Variant

▪ Episodes of chest pain that occur at rest. This is due to vasospasm of the coronary arteries. If the spasm is severe enough, it can lead to a myocardial infarction. ECG changes seen are ST elevation, which will resolve and go back to baseline when pain is relieved. This type of angina does not respond to nitroglycerin at all. Drug of choice for treatment of this angina is calcium channel blockers such as nifedipine (Procardia), verapamil (Calan) or cardizem (Diltiazem).• Assessment findings ▪ Diagnostic studies for angina include the following: history and physical examination, including assessment of pain and precipitating factors; laboratory data, including blood studies for anemia (hemoglobin and hematocrit values), cardiac enzymes (CK2-MB, cardiac troponin I, cardiac troponin T levels), and cholesterol and triglyceride levels; ECGs during resting periods; stress testing; and coronary angiography. Complications of untreated or unstable angina include MI, HF, dysrhythmias, psychological depression, and sudden death.▪ Symptoms of Angina • Pain is frequently retrosternal, left pectoral, or epigastric. It may radiate to the jaw, left shoulder, or left arm.• Pain may be associated with dyspnea, light-headedness, or diaphoresis.• Pain can be described as chest pressure, burning, squeezing, heavy, or smothering.• Pain usually lasts 1 to 5 minutes.• Classic placing of clenched fist against the chest (sternum) may be seen, or may be absent if the sensation is confused with indigestion.

• Diagnostics Tests • Pain usually begins with exertion and subsides with rest.

• 12 lead ECG
• Stress test
• Echocardiogram
• PCI

▪ Primary percutaneous coronary intervention (PCI) is performed in the management of AMI with improved outcomes over thrombolytic therapy. PCI should be performed within 90 minutes of arrival to the emergency department, with a target of less than 60 minutes (termed door to 1 / 2

balloon time).16 Primary PCI has been demonstrated to be more effective than thrombolysis in opening acutely occluded arteries in settings where it can be rapidly performed by experienced interventional cardiologists.16 If patients present to a facility without PCI capabilities, they should be transferred to a PCI-capable facility to receive a PCI within 90 minutes of being assessed, or triaged to receive fibrinolytic therapy at the receiving facility.▪ Post care • Interventions for each classification ▪ • Medications

• Nitroglycerin
• Dopamine or other vasopressors
• Morphine
• Heparin
• Beta blockers
• Calcium channel blockers
• ACE inhibitors or ARBs

• Patient Teaching for each classification Acute MI

CHAPTER 12

• Assessment findings

• Assessment findings specific to women
• STEMI
• NSTEMI

• Diagnostic tests

• 12 lead ECG
• Echocardiogram

• Laboratory values -

• Cardiac enzymes – CK, CKMB, Troponin
• Chemistry including electrolytes
• CBC
• Coagulation studies – PT/INR, PTT

• Interventions

• Goals of treatment
• Oxygen
• Medications

▪ Aspirin ▪ Morphine ▪ Nitroglycerin ▪ Beta blockers ▪ ACE Inhibitors or ARBs

• PCI
• Thrombolytic therapy

▪ Tenecteplase ▪ Indications ▪ Contraindications ▪ Complications • Expected

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