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bacco products Inactivity Obesity Diabetes Metabolic syndrome Homocysteine level Type A
Usual medical treatment Control Blood pressure Blood glucose Lipid levels
Life style changes Exercise Weight loss Stress reduction Smoking cessation
Silent
Diabetics
Diagnostic tests 12 lead ECG Cardiac enzymes CXR Stress test Coronary angiogram
Usual medical treatment Nitrates Nitroglycerin Sublingual onset 3 min; duration 30-60 min Spray same Ointment duration 3-6h Patch onset 2h; duration 24h Isosorbide Beta blockers CCB Decrease: contractility, HR, SVR, BP Decrease morbidity & mortality esp after MI Oral Long acting Wear 12-14h to decrease tolerance Rest Medications
ACEI
Prevent vasoconstriction
Clinical manifestations Chest pain Women Fatique, SOB, indigestion, anxiety Feeling not quite right New onset, at rest, worsening pattern
Diabetics
Myocardial infarction Necrosis Irreversible myocardial cell death Cellular death in 20min in subendocardium 4-6h for transmural
Clinical manifestations Severe, immobilizing chest pain Not relieved by rest, nitrates, or position change Often early in the morning
Other tests
Usual medical treatment UA & NSTEMI Aspirin Heparin Glycoprotein IIb/IIa inhibitor STEMI PCI Fibrinolytics 1-6h from onset 60 min ideal 30 min from ED arrival Heparin to prevent reocculusion Success
Other medications PTCA 90 min door to balloon time if STEMI IV nitro Morphine Beta blockers ACEI Antidysrhythmics Lipid lowering agents Stool softeners
Explain flush & flutter Explain post procedure course NPO 6-8h if not emergent 2 IV sites
Procedural nursing care Monitor - ECG rhythm, vs, conscious sedation, pt tolerance Emotional support
Post procedure nursing care Bed rest 4-6h Leg straight 1-2h, then 30 degrees Pressure dressing Distal pulse, color, temp, bleeding & vs CABG Reasons Types Sternotomy Cardiopulmonary bypass Off pump Minimally invasive Transmyocardial laser revascularization >50% occlusion left main Severe blockage in several Failed medical management Not a candidate for PCI Failed PCI .q15min x4, q30min x2, q1h x4
Pre op nursing care Obtain consent Demonstrate/ return demonstrate Teaching ICU 24-36h 3-5 day hospitalization Devices Post op care Monitor and tend to devices Monitor ECG I&O Lung & hear sounds Pain CO Resp status ET tube, vent, restraints extubated in 12h Pulmonary artery catheter Art line IV central or peripheral Pacer wires NG tube Urinary catheter Pleural, mediastinal chest tubes Incentive spirometry Leg exercises Deep breath Do not cough
Emotional response
Cardiac rehab Phase I In hospital, self care, ROM, walk, 3-4 stairs
Return to sexual activity 7-10d after uncomplicated MI Able to climb 2 flights of stairs Inability common returns after several attempts Prophylactic nitro Orogenital no stress No rectal No ED Rx with nitrates